ESTRUTURAS Rotadores Transversos Rotadores Oblquos Flexores Laterais Eretores da Espinha

PAPIS DAS ESTRUTURAS PAPIS DA FORA MUSCULAR - Contraposio a foras: -- Verticais -- Laterais -- Rotacionais -- Antero-posteriores - Funo sobre o Espao Interveteb. -- Aumento (+) / Reduo (-) PAPIS DO COMPRIMENTO MUSCULAR - Regul. espao intervert. mx. repous - Regul. Incl. e Simetr. Interv. repouso REGIES

CONSEQNCIAS DA NO FUNCIONALIDADE DAS ESTRUTURAS

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+ + Rotadores Transversos + Rotadores Oblquos

+ + Flexores Laterais

Eretores da Espinha

Problema a ser resolvido com todo aluno: 1. Alcanar objetivo do aluno. 2. Evitar que as estratgias utilizadas para alcanar seu objetivo prejudiquem a sade do aluno. Para garantir o sucesso do professor, no segundo item, ele pode melhorar a condio da(s) rea(s) especfica(s) que correm risco de doena com a aplicao das estratgias para alcanar o objetivo do aluno. 3. Atuar na rea preventiva.

Idia Central: Sade = Bem Estar (Fsico) - Sade = Bem Estar Muscular: Fora; Conforto Dores/tenses - Sade = Bem Estar Cardiovascular - Sade = Bem Estar Respiratrio - Sade = Bem Estar Nervoso - Sade = Bem Estar Bioenergtico - Sade = Bem Estar Digestivo - Sade = Bem Estar sseo Leses; Leso Discal (sobrecarga excessiva); Leso de LCA (sobrecarga); Leso de menisco (sobrecarga); Degenerao ssea da regio articular (atrito por degenerao da estrutura articular de proteo); fraturas (sobrecarga til ou suprflua); leso de manguito (sobrecarga); pinamento citico (sobrecarga excessiva); Espondilolistese (sobrecarga excessiva) Inflamaes; Tendinites (uso excessivo); Artrite (leso por degenerao da estrutura articular de proteo por atrofia ou sobrecarga excessiva) Dores: Ciatalgia; Lombalgia; Cervicalgia; Dor no Joelho; Dor no ombro Limitao dos movimentos-funes; Baixa tolerncia ao impacto; Impossibilidade de abaixar-se Lordose (e dores lombares); Cifose (e dores cervicais); Escoliose (e dores e hrnias) Dores (compresso discal ou nervosa); Tenses Bursite Artrose

http://www.airback.com.br/images/coluna_air2.jpg Cuidados com a Coluna Estamos aqui neste momento para falar um pouco sobre a nossa coluna vertebral, sua anatomia, a biomecnica, as lombalgias e relao com as condies ergonmicas de trabalho ou do dia-a-dia que acabam por agravar os problemas com a coluna. Dentre vrios motivos para digitarmos este texto selecionamos alguns: as dores nas costas acontecem com alta incidncia, alguns autores relatam que entre 70 a 80% da populao mundial (tm, teve ou ter) algum tipo de dor nas costas; as condies de trabalho so um dos maiores agravantes; o manuseio, levantamento e carregamento de cargas excessivamente pesadas so grandes coadjuvantes; a manuteno de posturas incorretas por muito tempo; alguns fatores que ainda necessitam de maiores estudos tambm contribuem para as dores nas costas uma deles a converso psicossomtica e por fim destacamos a fadiga da musculatura. Antes de continuarmos as descries e as recomendaes de cuidados com a coluna vertebral vamos mostrar um pouco da sua anatomia para que possamos ter alguns parmetros: A coluna vertebral possui algumas curvaturas que so fisiolgicas, o aumento, acentuao ou diminuio destas curvaturas representam patologia e precisam ser tratadas. As curvaturas fisiolgicas so quatro: lordose cervical, cifose torcica, lordose lombar e cifose coccgea (sacro e cccix) estas curvaturas podem ser encontradas em vista lateral, j numa vista posterior no existem curvaturas fisiolgicas, caso as encontrarmos temos uma patologia chamada de escoliose. Vale dizer tambm que a coluna vertebral formada por um nmero varivel de vrtebras entre 33 e 34 ossos (vrtebras), que so separadas uma das outras por um disco intervertebral, este disco responsvel pela mobilidade da coluna. Esta parte da anatomia bastante interessante e poderemos ver no desenhos seguir:

Acima podemos ver a vrtebra que a parte ssea da coluna, o orifcio de conjugao que o espao por onde passam os nervos (existem dois tipos de nervos um responsvel pelas sensaes e outro responsvel pelos movimentos). Entre as vrtebras vemos o disco intervertebral e mais ao centro do disco encontramos o ncleo pulposo. Quando nos movimentamos para frente, para traz ou para os lados o ncleo pulposo se movimenta tambm porm em sentido contrrio ou seja quando fletimos o tronco para frente o ncleo vai para traz em direo ao nervo. O ncleo pulposo muito mais rgido do que o disco e tm a tendncia de "tentar fugir", quem impede esta "fuga" so os anis fibrosos, quando estes anis so danificados o ncleo fica instvel e pode conseguir a "fuga" , a sada do ncleo chamada de hrnia de disco. A hrnia de disco pode acontecer entre qualquer uma das vrtebras, porm a maior incidncia se d na regio lombar. Os nervos so divididos em troncos, o tronco cervical inerva principalmente os membros superiores (braos) e o tronco lombar inerva principalmente os membros inferiores (pernas). Quando dizemos inervar queremos dizer que estes nervos so responsveis pelas sensaes e movimentos destas regies. Portanto quando acontece uma hrnia na regio lombar pode ser sentido reflexo (dor ou formigamento) nas pernas ou perna, como na ilustrao abaixo.

Dependendo da regio, localizao ou gravidade da compresso no nervo que ser definido o tipo de irradiao, ela pode atingir uma rea contnua ou parcialmente. Alm da dor irradiada podemos encontrar tambm casos onde a dor ocorre apenas localizada, ou seja, a dor se d no mesmo local da leso. Algumas situaes do dia-a-dia no trabalho ou em casa que contribuem para as leses na coluna ou nos discos: o trabalhador escorrega enquanto caminha; um objeto vai cair ao cho e abruptamente tenta-se peg-lo; a trabalhador vai pegar uma carga e o local est inacessvel; o trabalhador vai pegar uma carga de conformao assimtrica; o trabalhador portador de desvios posturais; o trabalhador que suporta peso com o corpo; pegar ou manusear, cargas mais pesadas com o tronco em flexo, flexo lateral ou toro; pegar ou manusear cargas longe do corpo, pegar ou manusear cargas muito altas ou muito baixas. Todos os dias cometemos alguns ou vrios erros com a nossa postura, estes erros um dia podem ser fatais, pois com j comentamos em outros textos as doenas de um modo geral no acontecem da noite para o dia, elas so cumulativas e progressivas isto se aplica em gnero, nmero e grau no caso da coluna. Veremos a seguir algumas situaes que contribuem e muito para as leses, dos anis fibrosos e consequentemente dos discos:

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"Acabamos de assistir as vdeo cassetadas" da postura, infelizmente no poderemos rir pois teremos que socorrer o indivduo que passou por todas estas cenas... Em resumo todas as vezes que aumentamos ou eliminamos as curvaturas fisiolgicas da nossa coluna estamos nos pr dispondo aos riscos de dor nas costas, a dor pode ou no ser associada a uma leso no disco, pois quando no ocorre uma leso no disco pode estar havendo apenas uma contratura muscular que explicaremos em outro texto. Vamos descrever algumas situaes boas para a movimentao de cargas e outras ruins e voc pode escolher qual deve seguir ou proporcionar ao seu corpo durante o seu dia: Ruins!!! Carga longe do corpo; carga muito baixa, carga elevada; movimentao frequente de carga; carga assimtrica; carga com pega ruim (mala sem ala); Boas!!! Perto do corpo; elevadas 75 cm do piso; pequenas distncias a percorrer; "pesos leves"; ocasionalmente; simetricamente e sem rotao do tronco; com uma pega adequada. Consideraes finais: - No h problema em manipularmos cargas (desde que sejam observados os cuidados com a coluna) - No caso de cargas volumosas (utilizar a posio semi fletida joelho/coluna)

- Peas que possam ser pegas com apenas uma das mos no interior de caixas ou caambas (deve-se apoiar um dos braos na borda da caamba e levantar com o outro). Manter a boa forma fsica e saber aproveitar os eventuais intervalos para um exerccio de respirao e de relaxamento inegavelmente uma boa maneira de se minimizar riscos e evitar problemas.

Agora voc tem um material eficiente na manuteno da sade de sua coluna no esquea, utilize estas informaes todos os dias. Um grande abrao e at o prximo. Wilson A. Silva Entre em contato com a Keen System - A Ergonomia que Funciona p/ fone (11) 3814-2260 ou email
http://images.google.com.br/imgres? imgurl=http://www.oftega.com/ergo7.jpg&imgrefurl=http://www.oftega.com/ergo3.htm&h=284&w=244&sz=16&tbnid=7OFwTOM3KXAJ:&tbnh=109&tbnw=94&start=10&prev=/ images%3Fq%3Dergonomia%26hl%3Dpt-BR%26lr%3D%26ie%3DUTF-8

Ergonomia : Capacidade para cuportar cargas mecnicas

A figura 7 mostra um exemplo de uma m postura sentada: nesta posio, os corpos vertebrais da espinha lombar formam ngulos agudos com os demais. O segundo fator importante a capacidade para suportar cargas mecnicas do anel fibroso. Embora este anel fibroso seja muito resistente aplicao de presso, carece de uma grande resistncia trao, o que significa que pode se rompe se submetido a tenses durante longos perodos de tempo. Algumas partes do anel fibroso esto submetidas contudo a esta classe de cargas de trao quando as superfcies dos dois corpos vertebrais no so paralelos entre si. Isto ocorre quando uma pessoa senta-se com as costas curvadas. En este caso las estructuras del anillo fibroso estn expuestas a una carga de presin elevada en la parte anterior y a una carga de traccin elevada en la posterior (fig. 8). Es exactamente esta carga de traccion la que puede producir daos permanentes en la banda fibrosa del disco invertebral a largo plazo, con la consecuencia de que ya no podr soportar la presin ejercida por el nucleo pulposo. El interior del disco penetrar entonces en el conducto vertebral, lo que predispone a desarrollar una hrnia discal. Esta serie de factores de esfuerzo o incluso dainos, debidos a una postura sentada incorrecta, no se limita a las estructuras del disco intervertebral, sino que afecta tambin a los demas elementos del segmento del movimiento.

J sabemos que a coluna vertebral est estabilizada pelos los ligamentos longitudinales anteriores y posteriores, os diversos ligamentos unidos s apfises espinhais e transversas e o ligamento flavo. A diferena do ligamento longitudinal anterior, o posterior est dotado de abundantes terminais nervosos- outro fator que pode ajudar a explicar muitos casos de dores nas costas ocasionados por uma m postura sentada. Por ltimo, as dores deste tipo poden ser atribudas tambm a deformaes das articulaes da faceta. Como pode ser visto na figura 5, as superfcies destas articulaes esto localizadas em ngulos muito pronunciados .Isto impede que as vrtebras deslizarem para a frente, o que significa que as articulaes no poden realizar movimentos rotatrios como aqueles realizados pelas articulaes dos dedos da mo. Ao invs deles, so produzidos "movimentos guiados" quando as duas superfcies da articulao deslizam juntas e separadas. Segundo esta configurao anatmica, fcil imaginar que as superfcies da articulao j perdera o contato entre si quando as duas vrtebras deixam sua posio normal e as cpsulas articulares esto submetidas a uma carga de trao. Resumindo: em sua posio erguida normal nossa coluna vertebral pode suportar perfeitamente a presso. Contudo, se for submetida a uma tenso por estar flexionada (devido a uma m postura geral ou fraqueza dos msculos sustentadores), as estruturas do segmento de movimento como, por exemplo, o anillo fibroso do disco intervertebral, os ligamentos e as facetas articulares estaro submetidas a uma tenso excessiva. As conseqncias variam entre uma dor aguda e uma doena degenerativa crnica. FISIOPATOLOGIA DA DEGENERAO VERTEBRAL A partir da ruptura do disco intervertebral, a coluna passa a ter uma instabilidade segmentar progressiva. Com o rompimento da estrutura discal, o disco tende a extruir do espao intervertebral (hrnia de disco) ou pode perder o seu poder higroscpico, gerando um processo de desidratao progressiva. Este processo reduz a estrutura discal, ocasionando uma maior aproximao entre os corpos vertebrais adjacentes. Este mecanismo de pinamento discal determina a formao do disco doloroso, que ocasiona crises lgicas lombares peridicas. Com o pinamento discal estabelece-se uma desestruturao completa da unidade funcional vertebral. Assim, temos uma degenerao progressiva de todos os elementos que dela participam. A reao de defesa a este fenmeno de desmoronamento da coluna vertebral realizada atravs da formao de osteofito (vulgarmente chamados de bico de papagaio). Estes tem a finalidade de aumentar a base de sustentao vertebral, visando a melhor estabilidade do segmento lesado. As dores, que manifestam periodicamente, so ocasionadas por processos inflamatrios cclicos concernentes evoluo do dano vertebral. Cada crise lgica apresenta contratura da musculatura para-vertebral, cujo objetivo imobilizar o segmento lesado. Dessa forma, as contraes musculares dividem-se em: contratura de ofensa e contratura de defesa. A contratura de ofensa desenvolve-se a partir da leso discal instalada e a sua repetio danosa unidade funcional. A contratura de defesa se realiza durante os movimentos vertebrais e visa a proteo da coluna. Aps se estabelecer uma leso numa das curvas da coluna vertebral, as outras, conseqentemente, mudam a sua posio do eixo. Isto ocorre porque h uma relao ntima entre esses segmentos da coluna. Se acontecer um desenvolvimento de hiperlordose lombar, acarretar num aumento da cifose dorsal e a retificao da coluna cervical. Este desarranjo evolui com a reduo da altura corporal do indivduo e leva o nome de raquiadaptao. Suas conseqncias se fazem atravs de dores incapacitantes nas regies vertebrais, dores irradiadas como as citicas e braquialgias, incapacidades motoras que vo desde as paresias at as paralisias e

mecanismos de espasticidade muscular. Isto acontece com a obstruo parcial ou total do canal vertebral, denominando-se canal estreito espondiltico ou degenerativo HRNIA DE DISCO: causada por uma ruptura das fibras concntricas do disco intervertebral. O disco suporta cargas corporais e une vrtebra a vrtebra. Com a ruptura, processa-se o deslocamento de seu ncleo at a extruso do mesmo. Quando se instala a leso do disco, desencadeia um processo inflamatrio, ocasionando a dor. As causas das rupturas discais relacionam-se a traumatismos e tem como agravante causas diversas, como deformidades da coluna, rigidez corporal nos sedentrios, obesidade, hipotonia e flacidez muscular. Os fatores psicolgicos tambm contribuem para a instalao desses quadros, tais como depresso, estresse, etc. O tratamento pode ser conservador, como por exemplo repouso, bloqueio anestsico, uso de analgsicos e antiinflamatrios ,calor, massoterapia e reeducao atravs de exerccios corporais. A cirurgia aconselhada nos casos mais graves, garantindo o restabelecimento da resistncia e estabilidade da coluna vertebral. Sendo esta uma estrutura que suporta grandes cargas, apenas a retirada da hrnia no alcana esse objetivo principal, sendo necessrio a fixao dos elementos operados. As hrnias discais cervicais incidem mais freqentemente nas pessoas estressadas e tensas. J a dorsal mais rara, pois nesta rea a coluna tem o suporte dos arcos costais (costelas). A hrnia lombar ocorre devido ao excesso de carga que a coluna suporta. 570. Musculao para aluno com hrnia de disco- 19/06/03 Que tipo de exercicio de musculao posso passar para um aluno que possui hrnia discal L3, L4 e foraminal direita em L5-S1. Obrigada e espero resposta ansiosa. Marilia Rezende Soares Oi Marlia, recebemos um retorno pra voc do Consultor Prof. Divanei Zaniqueli, que nos informa o seguinte: Cara Marlia, uma leso discal entre L3 e L4, geralmente afeta a raiz nervosa L4, que sai do canal espinhal entre as vrtebras L4 e L5. Os principais msculos afetados por esta leso so o tibial anterior e o quadrceps. Tendo sido realizados todos os testes de disfuno reflexa, motora e sensitiva, os exerccios mais indicados para reduzir possveis dficits de fora so as extenses de joelho e a dorsiflexo do tornozelo. Leso no disco entre L5 e S1 afeta a raz nervosa S1, que direciona seus ramos ao glteo mdio e isquiotibiais principalmente. A abduo do quadril e a flexo do joelho seriam os exerccios indicados. Na ausncia de dores e espasmos na regio lombar so indicadas as extenses de coluna para fortalecer a musculatura paravertebral, possivelmente enfraquecida. Lembre-se, o espao aqui curto e a discusso complexa, procure o mdico do seu aluno, para discutir uma interveno multidisciplinar. Leia ainda: Tenho Hrnia de Disco... Ser que posso voltar a praticar musculao?

Sentar um dos movimentos mais bsicos do ser humano. Atualmente, sentar no mais uma mera questo de descanso enquanto comemos, conversamos, relaxamos, a posio que assumimos para trabalhar. Fisiologia do Sentar Antigamente a hierarquia dentro de qualquer ambiente de trabalho era ditada pela diferenciao do grau de conforto dos funcionrios diante de seus imediatos superiores, alm do prprio tamanho da cadeira ou poltrona. Permanecer sentado durante horas a fio, mesmo em atividades pouco exaustivas, pode causar fadiga, distrbios circulatrios e dores fsicas mesmo em cadeiras que so um verdadeiro primor em termos de esttica. Imagine-se, pois, o que sentem os operadores de mquinas de escrever, telex, telefones, monitores, computadores e processadores de texto. Com sua ateno voltada ao trabalho e concentrados na tarefa, o que exige ateno e cria tenses, fcil que assumam, com o passar do tempo, posturas que sero prejudiciais sua sade. No Brasil, estima-se que o aumento das lombalgias durante o trabalho em escritrios - fenmeno muito difcil de explicar quando de um afastamento temporrio para o tratamento de sade, por no ser reconhecido pelos rgos da Previdncia como se tratando de "acidentes de trabalho" - deve-se postura incorreta quando se fica sentado, vcio provavelmente criado por cadeiras muito bonitas porm completamente inadequadas ergonomicamente s finalidades a que se destinam.

As Dores do Sentado

Observem a ilustrao. Nela, anatomicamente, esto assinaladas as percentagens de incidncia das dores que afligem muitos dos funcionrios de escritrios, fruto de pesquisas profundas realizadas pela Giroflex. Nenhuma parte do corpo escapa de uma incidncia menor ou maior de dor quando a cadeira no proporciona o devido suporte estrutura ssea, exercendo presso indevida sobre os tecidos moles do corpo e interferindo na circulao sangunea. As causas do Desconforto Uma causa frequente do cansao o fato do assento ser geralmente demasiado alto, provocando dores devido presso na dobra do quadril. Alm do mecanismo de regulagem, para precisar a altura, o assento deve ser moldado com depresses para o apoio s tuberosidades isquiticas. Outra dor comum a sentida nos joelhos e coxas: os msculos das pernas permanecem contrados por tempo prolongado, os vasos sanguneos so prensados pelo tecido muscular e, assim, o sangue no corre livremente pelos msculos, provocando entorpecimento e dor. Da mesma forma, a corrente sangunea pode ser estrangulada na altura em que se apoia na borda do assento, provocando o afloramento dos capilares sanguneos epiderme, alm de entorpecimento dos membros inferiores e at o aparecimento de varizes. As dores nas costas so a maior fonte de queixas, da queda de rendimento, fadiga no trabalho e at afastamentos para a plena recuperao. Nos EUA, segundo uma pesquisa, esta a segunda maior causa de afastamento do trabalho (Gunnar Andersson). Acontece que a maioria dos encostos no proporciona apoio suficiente s costas. A parte mais sensvel, quando em posio sentada, a regio renal, pois o peso do corpo fica completamente assentado sobre a mesma, razo pela qual deve estar apoiada no encosto para que a espinha dorsal no se curve demasiadamente para trs. A regulagem da altura e o ngulo do encosto tm especial importncia nestes casos. A Giroflex desenvolveu uma conformao de assentos e encostos exclusivos para suas cadeiras de escritrios. E desenvolveu uma tese que serve para seu trabalho:

os ps devem estar completamente apoiados; a altura do assento deve permitir a formao de um ngulo reto das coxas com as pernas; a regio renal deve estar completamente apoiada no encosto; o assento deve apresentar depresses para evitar que o peso da perna pressione os vasos sanguneos, estrangulando-os.

A Giroflex e o Design Graas a um programa exaustivo de ensaios e pesquisas realizadas por ergonomistas, a Giroflex possui hoje uma base cientfica muito slida para dar continuidade ao design de sua linha de cadeiras. Todavia, uma postura correta na posio sentada no depende somente da qualidade da cadeira, mas tambm das dimenses do ambiente de trabalho e do layout dos mveis e equipamentos. E, naturalmente, dos tipos de trabalhos que ali sero executados. O que se necessita um ambiente de trabalho onde exista uma integrao total de todas as exigncias da ergonomia. Funo, fisiologia industrial, construo, materiais, forma, cores - so estes os critrios do projeto utilizados no desenvolvimento de qualquer mvel Giroflex. Atravs de uma sntese bem-sucedida procura-se sempre criar o assento para cada finalidade especfica que oferece: O maior conforto para o funcionrio de escritrio, eliminando ao mximo a fadiga de trabalho; Um produto de alta qualidade, maximizando a relao de custo-benefcio, durante um longo perodo de vida til; O poder de opo dos peritos em organizao do trabalho, arquitetos e especificadores, para que possam escolher os mveis entre uma larga faixa de design e cores e, naturalmente, a maior adequao a cada posto de trabalho. A grande faixa de produtos fabricados pela Giroflex permite otimizar o mobilirio , tanto de escritrios, como salas de reunio e de recepo dentro de estilos que podem variar entre o simples e austero ao extremo luxo, sem abrir mo das exigncias funcionais e fisiolgicas de seus ocupantes. A mola propulsora ] destes novos desenvolvimentos da Giroflex no tem nenhuma relao com determinadas tendncias da moda na poca, situando-se mais nos domnios da ergonomia, funes, materiais, etc. Atravs destas incurses, da liberdade em criar sem compromissos - oferecendo sempre novos benefcios ao consumidor - a Giroflex hoje, sem favor algum, uma "criadora de tendncias" dentro dos escritrios. Esta abordagem cientfica no nasceu ontem. Quando a ateno central do ambiente de trabalho passou a ser o prprio homem - segundo os ditames da ergonomia - foi possvel estabelecer diretrizes para o desenvolvimento de uma nova e revolucionria gerao de cadeiras. Para isso, a Giroflex recorreu ao Dr. Etienne Grandjean, Chefe do Departamento de Tecnologia de Zurique, um dos mais renomados pesquisadores e estudiosos da Ergonomia na Europa. O Dr. Grandjean criou, para suas pesquisas, uma verdadeira "mquina de sentar" e, utilizando mais de 1000 pessoas dos mais variados biotipos, desenvolveu o que chamou de cadeira ideal. Foram milhares de medidas mdias de quadris, ombros, costas e membros inferiores, enfim, ujm perfil tpico da populao humana que passa mas da metade de sua vida de trabalho sentada diante de uma escrivaninha, mesa telefnica, monitor, computador, etc. O professor e designer Arno Voteller, juntamente com sua equipe, desenvolveu ento a primeira gerao de cadeiras e poltronas anatmicas Giroflex. O resto faz parte da histria de sucesso da prpria empresa.

A Cadeira Ideal Pontos Benefcios anatmicos Mola Evita impactos bruscos na base da coluna. Tais amortecedora movimentos podem ocasionar dores de cabea, problemas de coluna e de viso. A mola amortecedora utilizada em todos os modelos projetados funo de trabalho. Regulagem de Tem por funo possibilitar a formao de altura do ngulo reto (90) entre coxas e pernas, dando assento liberdade a circulao sangunea. Os ps devem permitir um apoio ao solo ou em outra formao semelhante. Bordas Evitam o estrangulamento dos vasos arredondadas do sanguneos, impedindo a ocorrncia de assento formigamentos causados pela dormncia nas pernas, consequentes dores e o possvel surgimento de varizes. Escavao do De formao anatmica visando o apoio s assento tuberosidades isquiticas, proporcionando melhor ventilao e melhor distribuio de

ngulos de curvatura do encosto

peso, obtendo perfeita circulao sangunea na regio. Tambm moldado anatomicamente, possibilitando apoio regio renal, favorecendo a distribuio de peso do tronco, evitando o surgimento de dores nos rins e na coluna vertebral.

O Papel da Anatomia

O perfil do assento deve ter o formato que possa acompanhar a anatomia humana. Num design tecnicamente perfeito, o corpo como um todo, as vrtebras lombares e as costas so as diretrizes bsicas para a concepo de um projeto obedecendo aos princpios da ergonomia. O corpo deve contar com suporte pleno em qualquer posio sentada; As vrtebras lombares devem ser suportadas em seus pontos estratgicos; as costas devem ser apoiadas at o topo, para evitar a tenso dos msculos. A cadeira deve permitir perodos de relaxamento atravs do efeito dinmico (a mudana da posio sentada quando desejado), alterando desta forma os perodos de tenso e relaxamento de vrios grupos de msculos. Alm destes quesitos bsicos, a rotao da cadeira ter um papel cada vez mais importante no escritrio futuro. preciso lembrar que diversos funcionrios se alternaro dividindo os mesmos postos de trabalho, como por exemplo o processamento de textos e a telecomunicao. A cadeira de escritrio do amanh deve, pois, ser ajustvel com grande rapidez.

Nervo Citico ou Isquitico (ERHART, E. A. Neuroanatomia. Atheneu: 5a ed. So Paulo, 1974. pgs. 133; 135; 136):

Dores nas costas

Escoliose

Coluna com escoliose

Efeito da trao na coluna

Coluna normalizada pelo efeito da trao

O esforo de flexo ( Mf ), provocado pela fora de trao ( Ft ), tende a endireitar o trecho curvo da coluna vertebral.

Anatomia Normal do Disco Intervertebral, da Medula Espinhal e das Razes Nervosas

Compresso Discal Normal

Degenerao Discal por Ruptura de Fibras Concntricas (Essa ruptura pode ter sido causada por: compresso discal gerada pela compresso excessiva do disco devido a encurtamento do espao intervertebral decorrente de encurtamento muscular e/ou fraqueza muscular; espondilolistese)

Hrnia Discal

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Pinamento de Raiz Nervosa por Hrnia Discal devido Degenerao

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Pinamento de Medula Espinhal por Hrnia Discal

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Pinamento de Cauda Equina e Raiz Nervosa por Ligamento Flavo e Esporas sseas

Sndrome do Msculo Piriforme

Estenose Espinhal

Nervo Citico Normal

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Nervo Citico Pinado

Doenas da Coluna http://www.cirurgiadacoluna.com.br/doencas_da_coluna.htm#Discopatia_Dolorosa 1. Osteoporose 2. Hrnia de Disco 3. Espondilolistese 4. Escoliose 5. Estenose Espinhal 6. Discopatia Dolorosa 7. Hiperidrose 8. Trauma 9. Tumores 1. Osteoporose A osteoporose um transtorno metablico caracterizado pela diminuio da densidade ssea, o que aumenta a fragilidade do osso, deixando-o incapaz de resistir aos impactos que sofre no dia a dia. Isso pode fazer com que ocorram fraturas aos mnimos traumas, com conseqncias como as leses de nervos, deformidades, e dor muito acentuada. Com o aumento na expectativa de vida, a osteoporose vem sendo cada vez mais comum, pois uma patologia da terceira idade, especialmente das mulheres aps a menopausa. As fraturas de coluna esto entre as leses mais comumente provocadas pela osteoporose. Geralmente estas fraturas podem ser tratadas com remdios para a dor, imobilizao, fisioterapia e uso de coletes. A necessidade de tratamento cirrgico est restrita s situaes muito graves, em que h leso neurolgica, ou dor intratvel pelos meios comuns, o que acontece em apenas 0,2% dos casos. Nos ltimos anos tem sido utilizada a vertebroplastia percutnea, tcnica que recompe rapidamente a estabilidade mecnica da coluna vertebral e alivia rapidamente a dor, evitando a imobilizao prolongada.

Dicas: A falta de exerccio piora a osteoporose, as caminhadas fazem parte do tratamento! No basta tomar clcio, para que o clcio fique no osso so necessrios hormnios e vitamina D. A exposio ao sol muito importante, pois aumenta os nveis de vitamina D. Clcio em excesso pode trazer problemas - fale com seu mdico antes de tomar! O exame para detectar osteoporose a densitometria - fale com seu mdico! 2. Hrnia de Disco A palavra hrnia significa deslocamento de algo para fora de seu lugar, na hrnia de disco o que ocorre um deslocamento do ncleo, a parte interna do disco intervertebral, atravs de uma ruptura anel, a parte externa, que funciona como capa do disco. Isso pode ser comparado ao que acontece quando a capa de uma almofada se rasga e parte da espuma do recheio sai. Geralmente o fragmento de ncleo que escapa de dentro do disco comprime uma das razes do nervo citico, provocando dor forte em uma das pernas, o sintoma conhecido como dor citica. Na maioria dos casos a hrnia de disco pode ser tratada com medicaes para reduzir a dor e a inflamao do nervo, repouso relativo e fisioterapia. A cirurgia esta indicada nos casos em que no h melhora com o tratamento, ou quando o sofrimento da raiz nervosa muito intenso. Existem vrios tipos de tcnicas cirrgicas para o tratamento das hrnias de disco, devendo-se procurar a mais adequada a cada caso. 3. Espondilolistese uma deformidade em que uma vrtebra desliza sobre outra e provoca um desalinhamento da coluna. Isso pode ocorrer por desgaste das articulaes responsveis pela sustentao, ou por um defeito na parte posterior da vrtebra, chamado espondillise. Este deslizamento ocorre de forma muito lenta, e muitas vezes est estacionado, no progressivo. As deformidades fsicas visveis acontecem apenas nos casos em que o deslizamento muito grande, os maiores sintomas costumam ser dor lombar crnica e citica. O tratamento inicial visa o controle da dor, e consiste de medicao, exerccios e fisioterapia. Como em todas as deformidades, a nica maneira do problema ser corrigido a cirurgia, que se reserva para os casos mais graves e para aqueles que os outros tratamentos no funcionaram. Na cirurgia a vrtebra que desliza deve ser fixada, e os nervos que esto apertados devem ser liberados. A fixao costuma ser feita com a colocao de implantes metlicos de titneo (parafusos). Na maioria dos casos no necessrio trazer a vrtebra de volta para o lugar, apenas fix-la de modo a impedir que siga se movendo. 4. Escoliose Escoliose uma deformidade em que existe uma curvatura lateral da coluna, fazendo com que o corpo fique assimtrico. A escoliose pode ter vrias causas, mas o mais comum so as escolioses ditas 'idiopticas', sem causa definida, que se manifestam ainda na infncia ou puberdade.O tratamento depende de cada caso: quando o desvio pequeno, costuma-se indicar exerccios posturais, nos desvios maiores pode ser necessrio o uso de coletes, ou mesmo cirurgia corretiva. A escoliose uma deformidade anatmica, a nica maneira de corrigi-la por cirurgia, os exerccios visam o controle da dor e a manuteno do quadro nos casos em que a deformidade pequena. Existem vrios tipos de cirurgias, com abordagens diferentes, mas, basicamente, a cirurgia consiste em colocar uma ou mais hastes

metlicas que restituem o alinhamento e fixam a coluna, reduzindo a deformidade. Como em todas as cirurgias, o resultado varia a cada caso, e quanto mais grave o caso mais difcil o resultado ideal. Em alguns casos h normalizao do alinhamento da coluna, na maioria dos casos h melhora, que via de regra grande, mas sem correo completa. 5. Estenose Espinhal A coluna uma estrutura mvel, bastante sujeita a traumatismos e a degenerao, que o processo de desgaste gradual que acompanha o envelhecimento, e pode ser acelerado por fatores individuais. As estruturas da coluna mais vulnerveis degenerao so os discos e as cartilagens das articulaes posteriores, mesmo no processo de envelhecimento normal, os discos tendem a reduzir-se at o colapso, as articulaes ficam aumentadas pelo processo de artrose, e os ligamentos engrossam e perdem sua elasticidade e seu poder de estabilizar a coluna. Passa a existir uma hipertrofia (aumento) das estruturas articulares e, ocasionalmente, algum desalinhamento entre as vrtebras. Todas essas alteraes levam a uma reduo gradual do espao disponvel para os elementos nervosos, o que se chama estenose espinhal. Embora seja parte do processo de envelhecimento normal, muitas vezes essa estenose provoca sintomas de compresso dos nervos, como dores nas pernas, diminuio da sensibilidade, e dificuldade para caminhar. A maioria dos casos podem ser tratados clinicamente, mas algumas vezes necessria uma cirurgia de descompresso ou artrodese da coluna. 6. Discopatia Dolorosa Embora seja a mais conhecida, a hrnia no a nica patologia do disco intervertebral. Devido a sua funo amortecedora, o disco uma estrutura naturalmente sujeita a desgaste, chamado de degenerao discal. A degenerao do disco no necessariamente uma doena, de fato, um acontecimento normal, que faz parte do processo de envelhecimento. Todas as pessoas de 50 anos ou mais, mesmo as que nunca tiveram nenhum problema nas costas, apresentam sinais de degenerao discal. Porm, em um nmero grande de casos ocorre uma degenerao sintomtica, ou seja, a degenerao discal provoca dor e outros sintomas. Diferente da hrnia, na discopatia dolorosa no precisa haver ruptura do disco, sendo mais comum a perda da capacidade de amortecimento pela reduo na altura e pelo endurecimento das estruturas discais. Por isso, a dor citica, irradiando-se para a perna, no to freqente, sendo mais comum a dor na regio lombar, de carter incomodativo, mas podendo evoluir com crises de dor bastante intensa, e geralmente durando bastante tempo. O diagnstico e tratamento das discopatias dolorosas motivo de controvrsia, mas, atualmente, vem-se indicando cada vez mais o tratamento cirrgico nos casos em que as medicaes e fisioterapia no tem bom resultado. Diferente da hrnia, na cirurgia da discopatia dolorosa o objetivo maior no descomprimir o nervo, e sim reconstituir o espao discal, com tnicas de artrodese ou artroplastia. 7. Hiperidrose A hiperidrose uma condio clnica caracterizada pelo excesso de suor, principalmente nas palmas das mos e na planta dos ps, sendo comum a pessoa ter as mos sempre midas, chegando, s vezes, a pingar. A hiperidrose afeta at 1% da populao, podendo ocorrer em pessoas de ambos os sexos, e provocada por uma hiperestimulao do sistema nervoso autnomo, que controla as glndulas sudorparas. Embora no seja propriamente uma doena espinhal, a hiperidrose pode ser tratada pelos cirurgies de coluna com experincia em vdeo-toracoscopia. 8. Trauma As leses da coluna por traumatismo so relativamente comuns, principalmente nos casos de acidentes de trnsito e quedas de altura. Podem ocorrer vrios tipos de fraturas e deslocamentos, ocasionalmente com conseqncias graves, como a leso do tecido nervoso, provocando paralisias. Muitas leses podem ser tratadas com repouso ou uso de coletes, sem necessidade de cirurgia, ficando esta reservada para os casos em que h uma instabilidade da coluna. Geralmente as leses da parte ssea e dos ligamentos da coluna podem ser resolvidas com graus de seqela razoveis, sendo o maior problema a leso das estruturas nervosas, que pode produzir incapacidade grave e irreversvel. 9. Tumores A coluna pode ser afetada por tumores benignos ou malignos, prprios ou disseminados de outros rgos comprometidos. Os sintomas mais comuns so dor nas costas, geralmente muito forte, localizada, e de surgimento recente, fraqueza ou adormecimento nos membros, dificuldades para urinar, e emagrecimento. O tratamento dos tumores varia muito conforme o tipo, localizao, e grau de disseminao da doena, havendo vrios que so passveis de cura. Dr. Craig M. Morse, Chiropractor/Acupuncturist http://images.google.com.br/imgres?imgurl=http://www.park-ridge.il.us/cmorse/normal-disc-top-reduc %27d.gif&imgrefurl=http://www.park-ridge.il.us/cmorse/doctormorselumbar.html&h=222&w=283&sz=17&tbnid=sqsjMmHdfgMJ:&tbnh=86&tbnw=109&start=3&prev=/image s%3Fq%3Ddisc%2Bpain%26hl%3Dpt-BR%26lr%3D%26ie%3DUTF-8 Lumbar Disc Pain Symptoms Include Some Or All Of The Following: Low Back Pain; Leg Pain; Tingling; Numbness Chiropractic is the safest, most effective treatment for disc bulges. Studies have shown chiropractic to be safer and more effective than bed rest, drugs, or surgery. Chiropractic treatment for disc problems include, adjustments, cox flexion and distraction (which is a

combination of traction and mobilization), specific exercises, physiotherapy (ie. Ultrasound or interferential cuuent), and education on how to bend, lift, and alter the situation that caused the disc problem to begin with. If you have been diagnosed with or suspect that you have a disc problem you should see your chiropractor immediately. A disc is the cartilage between the vertebral bodies that absorbs shock and allows for movement in your spine. It has a liquid center and is surrounded by many layers of tough fibrous tissue that hold the liquid in and the two vertebral bodies together. Directly behind the disc is the spinal cord and to the sides are the spinal nerves. These are the nerves that get pinched when the disc bulges. Disc bulges are most commonly attributed to gradual abuse or wear and tear causing some of the inner rings to break. This allows the liquid center to eventually push the outer rings into the nerve. It is this pressure and the inflammation in the surrounding area that causes the pain, tingling, and or numbness that commonly accompany disc bulges. These symptoms can be permanent if left untreated, that is why it is imperative to see your chiropractor immediately if you suspect that you may have a disc bulge. Understanding How The Back Works http://images.google.com.br/imgres? imgurl=http://yourmedicalsource.com/yms_images/exh5542a.jpg&imgrefurl=http://yourmedicalsource.co m/library/backpain/BAK_works.html&h=281&w=400&sz=42&tbnid=lnmbT5owxeQJ:&tbnh=84&tbnw=119 &start=23&prev=/images%3Fq%3Ddisc%2Bdegeneration%26start%3D20%26hl%3Dpt-BR%26lr%3D %26ie%3DUTF-8%26sa%3DN The spine, which connects the skull to the pelvis, is also called the vertebral column. It consists of 24 segments of block-shaped bone called vertebrae and an additional 9 fused vertebrae that make up the lowest part of the spine, the sacrum and tailbone. Each vertebrae of the vertebral column has protruding bony areas for the attachment of muscles that are important for the spine to move. The spinal column protects the spinal cord and its emerging nerves that run down most of the length of the spine. The vertebrae have two major functions: To bear the weight of the body To house the spinal cord or spinal nerve roots (cauda equina) within the spinal column The spine is arranged in three natural curves: The neck region or cervical spine, made up of 7 vertebrae - where the vertebrae curve forward. The trunk region or thoracic spine, made up of 12 vertebrae - where the vertebral column curves backward, and to which the ribs attach The low back region or lumbar spine, made up of 5 vertebrae - which curves forward in the same direction as the cervical spine. When these curves are in their normal alignment, the body is in a balanced position. This distributes weight evenly throughout the vertebrae so one is in a less vulnerable position for strain and injury. There are two major parts to each vertebra: Vertebral body - The vertebral body is the front portion of the vertebrae. It is shaped like a cylinder and is greater in height than the back portion. Vertebral arch - The vertebral arch is the back portion of the vertebrae. It is an irregularly shaped structure. At the center of each vertebra is a hole, protected by the surrounding strong bone. Placed together, the central opening of each vertebra makes up the spinal canal through which the spinal cord, cauda equina, or spinal nerve roots pass. The spinal cord is the mass of nerve that connect the brain to the rest of the body. Each vertebra has important bony projections called processes that provide sites for the attachment of ligaments and muscles that are important for the stability and movement of the spine. The projections on either side of each vertebra are called transverse processes, and the ones at the back are called the spinous processes. The transverse processes are long and slender; the spinous processes are broad and thick. The back portion of the vertebrae, behind the transverse processes, consists of an area of bone called the laminae. On the back part of the vertebrae are two upper and two lower processes that form the joints connecting the back part of each vertebra. These are the facet joints. They are important for movement between each vertebra and for movements of the entire vertebral column as a unit. The Discs Of The Back Between each vertebra are spongy pads, like soft cushions, called discs - or more correctly, intervertebral discs. Each disc has a soft jelly-like center called the nucleus pulposus, which is surrounded by a fibrous outer envelope called the annulus fibrosis. Eighty percent of the disc is water, which is why it is so elastic. Together, a disc with the attached part of the vertebra above and below is considered an intervertebral joint. These joints allow the movement of the back. Healthy discs are elastic and springy. They make up 20% to 25% of the total length of the vertebral column. Initially, the disc contains about 85% to 90% water, but this amount decreases to 65% with age, resulting in disc degeneration. The Spinal Cord And The Lower Back

The nerves that come off the spinal cord are called nerve roots. These nerve roots pass through small openings on either side of the connecting vertebrae. Various nerve roots combine to form spinal nerves. There are five pairs of lumbar (lower back) spinal nerves. The nerve roots that arise from the end of the spinal cord and continue down the spinal canal through the lower part of the spine looks like a "horse's tail" and are collectively named the cauda equina. The Ligaments Of The Back There are a series of ligaments that are important to the stability of the vertebral column. Important to the lumbar spine (lower back) are seven types of ligaments: Anterior longitudinal ligaments and posterior longitudinal ligaments are associated with each joint between the vertebrae. The anterior longitudinal ligament runs along the front and outer surfaces of the vertebral bodies. The posterior longitudinal ligaments run within the vertebral canal along the back surface of the vertebral bodies. The ligamentum flavum is located on the back surface of the canal where the spinal cord or caude equina runs. The interspinous ligament runs from the base of one spinous process (the projections at the back of each vertebra) to another. Intertransverse ligaments and supraspinous ligaments run along the tips of the spinous processes. Joint-related structures called capsular ligaments also play an important role in stabilization and movement. The Muscles Of The Lower Back The muscles and tendons of the spine have been described as being a supporting system for the spine, much like a tent supported by guide ropes. A group of back muscles called the erector spinae are an example of these muscles, which form on each side of the spine and consist of three columns. These muscles move the lower back, help straighten the back, provide resistance when a person is bending forward at the waist, and help a person return to the erect position. The multifidus is another important muscle of the lumbar region. This muscle is thick and prominent in the lumbar spine and becomes smaller at its attachments high up the spine. It is an effective lever arm that allows the lumbar spine to bend backward. The interspinales muscles, located on either side of the interspinous ligament, also are active in the backward bending of the lumbar spine. The intertransversarii muscles attach to the transverse processes. These muscles are not only active in backward bending, but also in bending from side to side. The intersegmental muscles are a series of muscles near the bottom of the spine that connect one intervertebral segment to another. The abdominal muscles, located at the front and side of the abdomen, are very important in supporting and protecting the abdominal internal organs. They also play an important role in protecting movement of the vertebral column in backward bending, forward bending, and side bending. How Serious Is Back Pain? The seriousness of back pain depends on the cause. Tumor, infection, and fractures are serious problems but are rare. Cauda equina syndrome, in which the nerves in the lower part of the spinal canal are compressed for any reason (such as by a herniated disc) or because of spinal stenosis may result in permanent incontinence (inability to control urination) if the compression is not immediately relieved by surgery. In general, when first seeing a patient with back pain, physicians consider that the cause of the pain may be serious if: It wakes a person from sleep. It occurs in children (although many cases of back pain in children prove not to be serious). It occurs along with an inability to control urine or stools. It is accompanied by unexplained fever or weight loss It occurs in someone with a history of cancer But back pain may have long-term, adverse effects on the quality of one's life. While most causes of back pain are certainly not life threatening, chronic back pain can be life-altering. For many individuals who suffer from chronic back pain, the condition can certainly affect their lifestyle. 130. Dor Citica, como tratar? - 06/02/01 Gostaria de saber como tratar de problemas no nervo citico atravs de atividade fsica e quais os melhores alongamentos para aliviar esse problemas? Gustavo - Prof.E.F http://www.cdof.com.br/consult15.htm Uma Dor Citica, pode ser ocasionada por diversas maneiras diferentes. Ela tem esse nome por ser uma dor proveniente de afetao no Nervo Citico. Esse nervo tem seu incio na coluna lombar, na regio da quinta vrtebra lombar e primeira sacra, estendendo-se pelos membros inferiores at os ps. Embora o problema esteja localizado apenas na coluna, a dor se propaga ao longo desse nervo sem que haja nenhuma leso em todo o seu trajeto. As principais causas das dores so as seguintes: Hrnia de disco

(pelo inchao do disco intervertebral a qual sentida no local em que o disco est sendo pressionado), Osteoartrose e Dores reumticas . O quadro clssico de uma hrnia de disco uma dor de incio aguda na regio da coluna lombar e que vai se irradiar, caminhar, em direo perna at chegar no p. Alm da dor, o paciente pode se queixar de formigamento e falta de fora na perna afetada. Este quadro conhecido como lombociatalgia, pois a dor ao longo do nervo citico, que o nervo principal da perna. E como ela ocorre? O disco constituido por duas estruras bsicas: uma central gelatinosa conhecida como ncleo pulposo que realmente a estrutura que causa a hrnia, e uma poro mais externa chamada anel fibroso. Basicamente devemos falar de dois tipos de hrnia de disco: Protruso Discal em que o ncleo pulposo empurra uma parte enfraquecida do anel fibroso contra as estruturas nervosas da coluna. Hrnia Discal Extrusa em que h o rompimento total do anel fibroso e extravasamento de parte do ncleo pulposo para dentro do canal onde esto as estruturas nervosas. Quando o indivduo acometido da dor citica deve procurar imediatamente um mdico especialista para que possa ser feito um exame detalhado e ser encaminhado por ele ao fisioterapeuta para os devidos tratamentos especficos. Na fase aguda, os especialistas aconselham fazer repouso, mas de curta durao. Pois, existe ainda a tendncia de condenar inatividade uma pessoa acometida de citica at que se estabelea. A inatividade prolongada somente tende a enfraquecer a musculatura e dificultar a recuperao. Atividade moderada e precoce, acompanhada de movimentos que fortaleam a musculatura deve ser assumida to logo quanto possvel. Eles explicam que muito importante que a manuteno do tratamento para dores citicas envolva atividades fsicas e estilo de vida ativo. Pois, muitos pacientes percebem a volta das manifestaes dolorosas quando abandonam hbito de se exercitarem regularmente. Os mdicos observam que esse tipo de dor muito frequente em tabagistas pois o cigarro diminui a circulao do sangue nas vrtebras, causando uma degenerao precoce. Outro ponto importante o emagrecimento. muito comum a hrnia ocorrer em pessoas obesas. O excesso de peso uma sobrecarga para os discos intervertebrais e ainda provoca um desvio do centro de gravidade do indivduo para frente, no caso das protuberncia abdominal. O livro Waterpower Workout Book, 1995. cita a importncia de pacientes com problemas de hrnia de disco levarem uma vida mais ativa evitando a inrcia. Ainda indicam que o paciente deva passar por 3 etapas: proteo da regio afetada, exerccios teraputicos e aplicao de gelo. Devem procurar uma atividade que possa fortalecer os msculos abdominais e da regio afetada da coluna e ainda trabalhar a flexibilidade (pacientes com hrnias causadas na hiperflexo da coluna devem exercitar a hiperextenso para centralizar o ncleo pulposo da vrtebra) e ainda ter cuidado com a postura do dia-a-dia, no trabalho, no carro, etc.... O mesmo autor aconselha que os alongamentos para este tipo de problema sejam feitos na gua, pois o meio aqutico proporciona segurana e facilita o trabalho de determinados grupos musculares, diminuindo a dor. A aplicao do gelo vai diminuir a inflamao, inchao, dores e espasmos musculares. Outros alongamentos (Andrea Norm e Bates Hanson, 1998): Extenso e flexo de coluna (segura na barra com 2 mos e leva a pelve para frente e para trs) , Elevao de joelho (segura um joelho na barriga apoiando as costas), Flexo lateral de tronco (1 mo na barra), Alongamento lateral em p (leve o tronco para o lado enquanto ps e cabea ficam alinhados), Alongamentos laterais de pescoo (puxa a cabea ao lado), Alongamento de trapzio (queixo no peito). Glossrio: Sciatica: Sciatica is an inflammation of the sciatic nerve, the longest nerve in your body. It runs from your lower spine, through your buttocks, and into your leg and foot. When the sciatic nerve is inflamed, it can cause numbness, tingling, pain, or weakness in your lower back and leg. http://images.google.com.br/imgres? imgurl=http://www.angelfire.com/fl/DrPat/images/ciatic2.jpg&imgrefurl=http://www.angelfire.com/fl/DrPat/ sciatica.html&h=177&w=171&sz=11&tbnid=50JCJXPaRzoJ:&tbnh=94&tbnw=91&start=5&prev=/images %3Fq%3Dciatic%26hl%3Dpt-BR%26lr%3D%26ie%3DUTF-8 Inflamed Joint If a bone (vertebra) in your lower back isn't moving properly or is out of position, the joint can become inflamed and irritate the sciatic nerve. Anatomy of the Lumbar Spine Back to the Top http://images.google.com.br/imgres? imgurl=http://www.espine.com/diagnosis/dlmlam67.gif&imgrefurl=http://www.espine.com/diagnosis_dll03. html&h=209&w=309&sz=16&tbnid=eyUTlCugPGAJ:&tbnh=75&tbnw=110&start=28&prev=/images%3Fq %3Dpinched%2Bnerve%26start%3D20%26hl%3Dpt-BR%26lr%3D%26ie%3DUTF-8%26sa%3DN www.espine.com/ diagnosis_dll03.html The Spinal Column and Vertabrae Your spinal column consists of 24 separate bones, called vertebrae, plus the five fused bones of the sacrum and the four fused bones of the coccyx (often referred to as the "tail bone") (Fig. 1). The vertebrae are stacked one on top of another and can be divided into: 1. the cervical (neck) spine: the top seven vertebrae; 2. the thoracic (chest) spine: the middle 12 vertebrae; and

3. the lumbar (lower back) spine: the bottom five vertebrae. Support for the Vertebral (Spinal) Column Attached to the vertebrae are muscles, tendons and a group of strong bands, called ligaments. Together, they support the spinal column and help to protect its delicate nerves. The Role of the Vertebral (Spinal) Column Your spinal column enables you to walk upright. It is the central support for your upper body and carries the weight of your head, chest and arms. The vertebrae in the lumbar (or lower back) portion of your spine carry the majority of this weight. The constant pressure from this weight, even when you are simply sitting in a chair, is what usually leads to problems associated with the lower back. The Role of the Invertebral Discs The bony vertebrae of your spinal column are separated from one another by pads of tough cartilage, called intervertebral discs (Fig. 2,above). These discs act like shock absorbers during activity, preventing the individual vertebra from rubbing against one another. Healthy discs, with their gelatin-like inner core, allow the spine to move freely and provide much of the flexibility found in a young person's spine. The Invertebral Disc Nucleus The gelatin-like center of each intervertebral disc (called the nucleus) is surrounded by a tougher, fiberlike outer lining (called the annulus) (Fig. 3). As your body ages, the disc's nucleus begins to "dry up" and stiffen, increasing the chances that the central bundle of nerves and/or a spinal nerve may eventually become pinched. The Spinal Canal The spinal cord, which begins at the base of the brain and runs within the spinal canal, ends in the lumbar spine area in a bundle of nerves known as the cauda equina (Fig. 3,above). The spinal canal runs through the center of the spinal column and protects the spinal cord and other delicate spinal nerves. The Spinal Nerve Roots and the Foramen At each vertebral level, a pair of spinal nerve roots branch off from the spinal cord or the cauda equina (Fig 3,above) and pass through an opening in the vertebra called the foramen (Figs. 3,above & 4). "Plump" and healthy discs help to cushion the vertebra and keep the opening of the foramen wide enough for the spinal nerve roots to pass through without being pinched. The Body's "Electrical" System The spinal nerve roots are part of the body's "electrical" system, carrying "current" (for sensation and movement) to specific parts of the body. These nerves are protected by an "insulated" covering in the same way a "live" electrical line is coated to prevent contact with the bare wire. When a nerve root is damaged, all or part of its protective coating may be rubbed off at the point of injury. Prior to surgery there is no way of telling how much of this "insulation" has been rubbed off or how much damage has been done to the nerve itself (the body's "live electrical wire").

Page 1 The patient's responsibilities The anatomy of the lumbar spine Page 2 The 'aging' spine Treatment options Page 3 The operation Page 4 What to expect after surgery The recovery process The decision-making process

DECOMPRESSIVE LUMBAR LAMINECTOMY Page 3 of 4 top

The Operation The Surgeon's Role Your surgeon will: 1. review your neurological history and examination; 2. review your diagnostic tests; 3. plan a surgical approach; and 4. review the procedure with you. Your Role You must have a thorough understanding of the diagnosis (what is causing your back or leg symptoms) and the risks and benefits of the proposed surgery. Once you are confident that surgery is the correct option for you, turn your thoughts to the future and the recovery process Beginning the Operation In the operating room, a decompressive lumbar laminectomy begins with an incision in your lower back (Fig. 6). Through this opening, your surgeon will reach the area where your cauda equina and/or spinal nerve(s) are being pinched. Reaching the Pinched Nerve After the incision is made, the surgeon will use a retractor to pull aside fat and muscle until the vertebra is exposed. A fine drill is then used to remove a section of the vertebra (dotted lines in Figs. 7,above & 8). Next, an opening is cut in the ligamentum flavum through which the spinal canal can be reached. Removing the Cause of Pressure Once the spinal nerve root(s) and cauda equina have been exposed, the surgeon will use a fine drill to remove bone spurs or rough edges of the intervertebral disc (Fig. 9). This will make the openings of the foramen and the spinal canal larger and help to relieve pressure on your spinal nerves (Fig. 10,next page). Fusion And Instrumentation On some occasions it may be necessary to stop the movement between two adjacent vertebrae. This is called a fusion. Your surgeon will place bone graft chips between the vertebrae to create a solid section of bone which prevents the motion. The surgeon may also elect to use metal implants (Fig. 11) to prevent any motion while the bone graft hardens. Closing the Incision The operation is completed when each layer of the incision is closed with suture material (stitches) or surgical staples. If the outer incision is closed with staples or non-absorbable sutures, they will have to be removed after the incision has healed. Bulging Disc If one of the cushions (discs) between your vertebrae is bulging, it can irritate or put pressure on the sciatic nerve. Muscle Spasm If a muscle in your lower back or buttocks is inflamed or tightening (in spasm), it can irritate or put pressure on the sciatic nerve http://images.google.com.br/imgres? imgurl=http://www.energycenter.com/ec_graphics.folder/med5.gif&imgrefurl=http://www.energycenter.co m/grav_f/anatomy.html&h=251&w=252&sz=11&tbnid=vZo5O3CkwDwJ:&tbnh=105&tbnw=105&start=14 &prev=/images%3Fq%3Dsciatica%26hl%3Dpt-BR%26lr%3D%26ie%3DUTF-8 Anatomy of the Spine Briefly explained, your spine is made up of the following components: 1) Vertebrae - the bones that make up your spine 2) Nerves - your entire nerve system runs through your spine 3) Discs - spongy material that separates your vertebrae, allowing the nerves to run between each bone segment. Discs act like shock absorbers and allow the spine to flex. To understand the sources of your particular back problem and/or how to prevent back pain, it helps to understand the anatomy of your spine. Each vertebrae is held in its proper place by three different kinds of soft tissue-discs, ligaments, and muscles. Almost all back problems are related to the dysfunction of one of these three.

The natural curves of the spine are vitally important for giving your back strength and resilience. There are 24 vertebrae in your spinal column. The lumbar vertebrae are approximately two inches in diameter reflecting their weight-bearing role. The cervical vertebrae are smaller, since they must support only the head. Facet joints are located in pairs on the back of the spine, where one vertebra slightly overlaps the next. The facet joints guide and restrict movement of the spine. To the rear of each vertebra is a hole and when the vertebrae are stacked up, these holes form a continuous channel which holds the spinal cord. The spinal cord provides a vital link between the brain and all body functions below the neck. Spinal nerves emerge from the spinal cord through gaps between the main body of the vertebrae and the facet joints. One frequent cause of back pain is a worn facet joint, which can result in a pinched nerve. Therefore, it is very important to keep your vertebrae in good shape. Today back pain is one of the most common of all physical complaints in the world. About 70 to 90% of men and women in the U.S. have had or will have a least one bout of incapacitating low back pain. Back pain contributes to lost work time and may cost as much as $100 billion annually (if lost productivity is included). Low back pain can be acute or chronic, manifesting in the lumbosacral region and associated musculoskeletal structures. Low back pain is extremely prevalent. Low back pain can become a life long struggle. When performing even the simplest tasks of everyday life, we may turn, twist, lift, and either push or pull something the wrong way and be crippled with low back pain that is constant and debilitating in nature. Low back pain injuries may often be overlooked and under diagnosed. Consequently, the injuries may progress and delayed initiation of appropriate therapy may prolong the treatment course. Low back pain injuries may be as simple as muscle aches or as severe as spinal cord paralysis from lumbar compression secondary to osteoporotic fractures. This drawing shows a normal disc. The main function of your discs is to act as shock absorbers and provide separation between each vertebrae. The outer layers of your discs are formed from tough cartilage. The inner core of your disc is a jelly-like nucleus. In total, your discs account for one-quarter the length of your vertebral column- 4.50" to 6" (12 to 15 cm) for most people. The disc acquires its nourishment through fluid-attracting and fluid-absorbing qualities of its jelly-like nucleus. This is one reason using an inversion table can be so beneficial in disc healing and regeneration. The rocking motion is extraordinary in creating an intermittent traction and compression that can assist in the regenerative process. One reason discs degenerate and and regenerate slowly is due to the passive nature of the circulation to the ruptured or compressed discs. With no blood supply of its own, the disc is dependent on sponge action for attracting and absorbing nutrients from adjacent tissues. During non-weight bearing activities (sleeping) the discs expand as they soak up fluid, increasing the length of the spine by as much as one inch overnight. During weight bearing activities (sitting, standing, exercising), this fluid is squeezed back into the adjacent soft tissue. Low back pain can range from acute to chronic. Ranging from a dull, intermittent, nagging ache to an unbearable, tear eliciting pain. Your vertebra are supported and moved by many different muscles. Muscles are used for three basic functions; support, movement, and posture control. If muscles are tight or weak, they create or worsen back pain. Joints are controlled by at least two sets of muscles, flexors which bend the joint, and extensors which straighten it. In addition, most joints have rotator muscles that twist and rotate your bones. Good posture is only possible if the flexors, extensors, and rotators are in proper balance. Your paraspinal muscles (which run parallel to your spine) rotate your spine, bend it backwards, and sideways, and influence posture by creating and maintaining the curves of your spine. Your erector spine muscles are involved in movement and run the length of your spine. These muscles help you to bend over by resisting the force of gravity, and to straighten up by contracting and exerting great compressive force on your spine. Your abdominal muscles play an important role in helping to support the spine by maintaining pressure inside the abdomen. This pressure is an essential measure of counter support to the spine. Understanding the physiology responsible for the symptoms will guide us in understanding the treatment. Most back pain is caused by musculoligamentous strain, degenerative disk disease, sciatica, or arthritis and responds to symptomatic treatment. Occasionally, back pain may result from problems originating outside the spinal axis. Serious underlying problems such as tumor, infection, or vertebral compression must be kept in mind. (1) Your psoas muscles (hip flexors) are a large group of muscles in the abdomen. These muscles help to flex your hips when walking or climbing stairs. They play an important role in maintaining posture for sitting and standing.

The perception of pain is experienced on an individual basis, but the physiologic basis of pain receptors are the same. Nociceptors are pain receptors of the body. They are located all over the body and maldistributed. The skin being largest organ and also extremely sensitive, has the most nociceptors. Impulses are generated by nociceptors, which travel along the spinal cord and relay pain that is either diffuse or localized. Fast pain travels through the A Fibers along the neospinothalamic tract. A Fibers produce pain that is sharp and well localized. On the other hand, slow pain travels through C Fibers along the paleospinothalanic tract producing pain that is dull and aching in nature. (2) Intravertebral joints are supported by ligaments, tough and inelastic fibers which support the spine and hold it together by allowing only a limited range of movement in any one direction. Ligaments require regular movement and loading, otherwise they will eventually become stiff and weak. Using the inversion table can give an excellent controlled workout to the muscles and ligaments necessary for a healthy spine. The etiology of the pain depends on the injury sustained. Nerves, spinal cord, disks and vertebrae make up the complex structure of the lower back. Muscles and ligaments provide strength and power and at the same time support and stability. Small joints of the lower back allow functional movement and further stability. The spinal cord and nerves are the electric cables which travel through a central canal in the lumbar vertebrae, connecting your brain to the muscles of your legs. The five lumbar vertebrae connect the upper spine to the pelvis and sacrum. The disks, like shock absorbers, act by both supporting and cushioning the lumbar vertebrae. (3) We need strong back, abdominal, and hip muscles to resist gravity and to hold us up. Besides holding us up they act to keep the spine and pelvis in alignment. As societies around the world become more mechanized and computerized, they have also become less exercised. We lock ourselves behind desks and in front of computers. When we sit, our back muscles hold us erect, but our stomach and hip muscles are inactive. When they are not exercised, stomach and hip muscles become weaker, putting a painful strain on the back muscles. Sitting places higher loads inside the lumbar disc than standing (between 150% to 250% depending on posture). Compressed Disc, Slipped Disc, Herniated Disc, Ruptured Disc Leading to a Pinched Nerve & Sciatica A ruptured disc in the back occurs when all or part of the soft, gelatinous central part of the vertebral disc is forced through the bones of the spinal column. What is going on in the body? Sandwiched between the vertebra of the spinal column are discs that act like shock absorbers. A disc is made up of two parts. The outer ring or annulus is a tough, fibrous material. The inner part or nucleus is a soft, jelly-like material. A ruptured disc occurs when the outer ring tears or break, allowing the jelly-like material to poke through the crack. This can result in pressure on nerves, often causing pain. Sometimes leading to sciatica & leg pain. The terms ruptured disc, slipped disc & herniated are often used in the same context. There is an enormous body of evidence that a compressed disc, whether or not it is actually ruptured can be aided by inversion therapy. Inversion increases the intervertebral space and allows the disc to return to is shock absorber and spacer function. Everyone's spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. But some people have spines that also curve from side to side. Unlike poor posture, these curves can't be corrected simply by learning to stand up straight. This condition of side-to-side spinal curves is called scoliosis. On an x-ray, the spine of a person with scoliosis looks more like an "S" or a "C" than a straight line. Some of the bones in a scoliotic spine also may have rotated slightly, making the person's waist or shoulders appear uneven.We have found in working with doctors & their patients for more than 20 years that inversion therapy can be a great adjunct in the treatment of scoliosis. In children as well as teens and adults the symptoms associated with scoliosis in many many cases are reduced when a person receives the benefits of gravity traction. In conjunction with stretching, exercises and inversion therapy we have also taken note of the benefits of daily deep muscle massage. This is easy to achieve with an electronic massager or very effectively with BONGERS Massage Tools. Also if muscles are particularly affected and a doctor is advised, in many cases a moist heat hydrocollator can be of great benefit.We have had reports from people who have used gravity inversion therapy for scoliosis and reduced pain symptoms in their lower backs they had previously accepted as chronic and intractable. They did not correlate these symptoms with the scoliosis but when they achieved benefits from the gravity inversion therapy they started for scoliosis a side or direct benefit was a relief from chronic low back pain that had become so common that they did not even realize how uncomfortable it was until it disappeared.Can inversion help children with scoliosis? Does age matter? Our medical advisor prefers to get patients involved with inversion as early as possible. Using inversion to help slow or reverse the effects of scoliosis is helpful at any age, but especially before the bones fully harden at ages 12-14. The size of the equipment may be an issue, so younger children will need an attendant. Children love inversion and many many scoliosis patients report excellent results after starting inversion therapy. It is a great way for

parents to get involved in assisting their child. Also don't forget to be sure your child has excellent nutritional support. Three fantastic supplements that are great for anyone are New Vision's Essential Minerals, Essential Calcium & Essential Vitamins. There are many causes of scoliosis. Some causes may be problematic for inversion (bone infection, cancer, compression fracture). Most scoliosis in children is related to bone anomalies or calcification disorders, both of which do well with inversion. Of course, if you have any doubt, you should always consult with a licensed physician. We have found the stretch & straightening of inversion therapy to be beneficial in working with people with scoliosis. Many physicians who use inversion therapy recommend getting patients involved while they are still young and bones have not fully matured. Here are some useful links if you would like to learn more about scoliosis: I-Scoliosis Scoliosis Research Society. Amazon Scoliosis Reading List Excellent nutrition is of course important in trying to prevent or correct a musculoskelital problem. The best calcium supplement we have found is Essential Calcium. Nutritious, delicious and easy to take as a sparkling beverage. And to be sure the body has the proper mineral balance we recommend the best selling liquid mineral supplement in North America - Essential Minerals. Inversion Therapy And Scoliosis One example of the many testimonials about scoliosis we have received. Hi, The pediatrician who had sent our daughter to the Scottish Rite hospital becasue she had a bit of a curvature in her spine, saw her for his referral last week. He was amazed at how straight her back was and asked her how she did it. She said that when she started using the inversion table, that in just a few months her shoulders were level and she had no more trouble will ill-fitting clothes due to one shoulder lower than the other - great, huh!? Martha Ylitalo - 4-15-04 Summary There are 26 vertebrae in your back which encase your spinal cord. In childhood there are 33 vertebrae they fuse into 26. 7 cervical, 12 thoracis, 5 lumbar, 1 sacral (5 fused into one bone, the sacrum) and 1 coccygeal (4 fused into one bone the coccyx). Your 23 discs act as shock absorbers. If they are compressed the nerves can be pinched. Traction had been the treatment of choice before pain relieving drugs and surgery came into common use. The benefits of decompressive traction are accomplished easier with an inversion table than perhaps any other known method. Spinal nerves run through each vertebral joint in your spinal column. With no blood supply of their own, discs depend on sponge-like action to soak up nutrients and eliminate waste products. Many doctors believe rhythmic intermittent traction which is easy to do with an inversion table by creating a simple rocking motion may facilitate disc healing and regeneration. The pumping action of traction and compression may speed up the healing process. Muscles and ligaments require regular movement in order to maintain flexibility. An imbalance or weakness in the strength of the muscles can affect the alignment of the spine & pelvis. A bilateral imbalance in this muscle strength (often the gluteus maximus) can lead to a tilting of the pelvis & nerve pain. The combination of proper exercise, nutrition and inversion therapy can greatly improve the quality of our general health and especially reduce or reverse previously intractable back problems. 1. Goroll, A H & Mulley, Jr A G. (2000). Primary Care Medicine: Office Evaluation and Management of the Adult Patient. (4th ed). Philidelphia, Pa. Lippincott Williams & Wilkins. 2. McCane, K L & Huether, S E. (1998). Pathophysiology:The Biologic Basis of Disease in Adults and Children. (3rd ed.). St. Louis, Missouri. Mosby 3. Low Back Pain. Your Orthopaedic Connection. American Academy of Orhtopaedic Surgeons. 2000. (Online) http://orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_ID=10&topcatagory=Spine 4. Bratton, R L. Assesment and Management of Acute Low Back Pain. American Family Physician 1999; 60:2299-308. (Online) http://www.aafp.org/afp/99111ap/2299.html Clasificacin del dolor lumbar http://images.google.com.br/imgres? imgurl=http://www.iladiba.com.co/upr/1998/No81998/IMAGENES/FIGURA3.JPG&imgrefurl=http://www.iladi ba.com.co/upr/1998/No81998/HTM/dolor2.asp&h=448&w=472&sz=39&tbnid=ubpOdOM5NAJ:&tbnh=117&tbnw=124&start=18&prev=/images%3Fq%3Dci%25C3%25A1tico%26hl%3Dpt-BR%26lr %3D%26ie%3DUTF-8 En trminos generales, la dorsolumbalgia comprende tres patrones dolorosos claramente diferenciados de dolor, a saber, local, referido y radicular. El primero aparece como resultado de la irritacin de las

terminaciones nerviosas sensitivas, ubicadas en las estructuras musculoesquelticas de la regin lumbar; como rasgo distintivo, se agrava con el movimiento o con ciertas posturas y es ms frecuente en los sujetos con sobrepeso. El dolor referido puede ser de origen espinal o visceral y suele ser penetrante y difuso; sin embargo, cuando est originado en estructuras viscerales se manifiesta por una sensacin dolorosa profunda y mal localizada. A dIferencia del anterior, la intensidad y otras caractersticas de este tipo de dolor no se modifican con los movimientos de la columna o los cambios posturales. Por ltimo, el dolor radicular es provocado por el estiramiento o compresin de una raz nerviosa. En consecuencia, es ms circunscrito, suele irradiarse hacia los miembros inferiores, se exacerba con maniobras que desplazan o comprimen la raz nerviosa y casi siempre est acompaado de alteraciones neurolgicas tales como hiporreflexia, disestesias, disminucin de la fuerza muscular y parestesias. Segn la duracin del dolor, el cuadro clnico es clasificado en agudo, cuando tiene menos de tres meses de evolucin o crnico, si persiste por ms de doce semanas. En ste ltimo se distinguen tres fases: temprana (entre 3 a 6 meses), intermedia (de 6 a 24 meses) y tarda (ms de dos aos) y en cuanto a la intensidad, puede ser leve, moderado, severo o intolerable. Otro sistema til para clasificar el dolor lumbar, est basado en la etiologa y es el ms recomendado por muchos expertos, pues permite orientar el manejo de la enfermedad (tabla 1). Causas de dolor lumbar Las causas de dolor lumbar son mltiples y comprenden, entre otras, alteraciones mecnicas, inflamatorias, infecciosas, neoplsicas o metablicas, de curso variable desde condiciones benignas y de evolucin satisfactoria que slo ameritan tratamiento sintomtico, hasta enfermedades graves que requieren un diagnstico y tratamiento especfico y rpido (tabla 2).Si bien son mltiples las alteraciones de la columna vertebral generadoras de sntomas dolorosos, en varias ocasiones no existe una clara asociacin entre la alteracin fsica detectada y la distribucin o la mejora del sntoma. Las enfermedades degenerativas de la columna implican diversos cambios resultantes del proceso de envejecimiento y es por ello que su incidencia aumenta con la edad. Entre ellas, las de mayor relevancia son la osteoartrosis, la espondilosis deformante y la espondilolistesis. La osteoartrosis lleva a un deterioro de las funciones del cartlago articular y el disco intervertebral, como resultado del incremento en la tasa de degradacin de la matriz cartilaginosa. A medida que la enfermedada avanza, hay una prdida progresiva del cartlago en las articulaciones intervertebrales, incremento de la actividad osteoblstica subcondral, neoformacin sea y fibrosis de la cpsula articular. La espondilosis deformante lleva a la aparicin de osteofitos en la cara anterior y lateral de las vrtebras, por lo que no se acompaa de compresin de las estructuras nerviosas o dficit neurolgico, y tal parece que es el resultado de la lesin de las fibras perifricas del anillo fibroso del disco intervertebral. Aunque el crecimiento de los osteofitos es bastante lento, ciertos factores tales como el trauma y la actividad fsica excesiva favorecen su desarrollo.La espondilolistesis es una entidad que afecta a un alto porcentaje de individuos mayores de 60 aos y en la mayora de los casos compromete las articulaciones interapofisiarias de las ltimas vrtebras lumbares. El cartlago articular experimenta un engrosamiento transitorio, luego se adelgaza y termina por desaparecer, mientras que el hueso exhibe un proceso de remodelacin e hipertrofia. Con el tiempo la cpsula articular se hace laxa y ocurre la subluxacin de un cuerpo vertebral sobre el adyacente (figura 3). El disco interarticular puede sufrir herniacin, bien sea en sentido vertical u horizontal; esta ltima distiende la duramadre que recubre las races nerviosas y provoca dolor de distribucin radicular; la herniacin ms comn es de tipo postero-lateral y suele acompaarse del signo de Lasgue (es decir que se despierta el dolor al inducir la extensin del nervio citico). Ciatalgia e Nervo Ciatico http://www.saudeemmovimento.com.br/conteudos/conteudo_exibe1.asp?cod_noticia=749 Ciatalgia a dor que ocorre no trajeto no nervo citico. A causa mais comum no adulto a compresso de uma das 5 razes do mesmo por uma hrnia de disco intervertebral lombar. A dor ocorre numa das pernas, ao longo do dermtomo que esta raiz corresponde (e que est comprimida), podendo ocorrer, tambm, alteraes de sensibilidade (parestesias, dormncias, agulhadas), alterao da fora da musculatura que esta raiz inerva (mitomo) e alterao do reflexo. Por exemplo, se a raiz comprometida for L4, haver diminuio do reflexo do tendo patelar (aquela marteladinha que o dor d no joelho do paciente...). Outras causas para uma ciatalgia so: neurite (como no herpes zoster, uma virose); sndrome do piriforme (compresso do citico ao passar sob este msculo); tumores intravertebrais; fraturas da coluna. O tratamento depende do caso. Se for uma citica por hrnia de disco, tentamos sempre o tratamento conservador, com medicamentos, repouso e fisioterapia. Este tratamento deve ser no mnimo por 4 a 6

semanas. A cirurgia feita somente em casos em que no houve melhora, o paciente tem dor muito forte acompanhada das alteraes neurolgicas citadas acima, ou se ocorre piora do problema apesar do tratamento bem realizado. A nica situao que uma hrnia de disco ser operada de urgncia na chamada sndrome da cauda equina, onde uma volumosa hrnia comprime completamente todo o saco dural. O paciente, alm da dor forte, ter incontinncia vesical e intestinal. Os exames complementares a serem solicitados so Rx, ex de laboratrio e TC. A hrnia de disco no provoca dor nas costas. Isto uma coisa importante, pois muitos pacientes com lombalgia e uma Tc que mostra a hrnia so operados com resultados muito ruins, pois a dor lombar permanece. Fonte: Jenner Randam. Data da Publicao: 29/08/2002 Problems With the Spinal Column http://images.google.com.br/imgres? imgurl=http://www.bestcorpus.com.br/images/ciatico_5cm.gif&imgrefurl=http://www.bestcorpus.com.br/pr ivate_ing/problemas_ing.HTM&h=107&w=400&sz=21&tbnid=zQLIb6Oc-EJ:&tbnh=32&tbnw=119&start=1&prev=/images%3Fq%3Dh%25C3%25A9rnia%2Bci%25C3%25A1tico %26hl%3Dpt-BR%26lr%3D%26ie%3DUTF-8 INTRODUCTION Based upon the discovery of skeleton misalignment made by the Physiotherapist Pedro Liasch Filho, a new and sole therapy for the problems of the spinal column, sciatic pains and muscular pains, is making a revolution in medicine; resulting in the publication of the book Problemas de Coluna: Causa e Soluo, published by Editora PioneiraWe would like to point out the special chapter: Something Else for Sports Medicine, which shows impressive facts in respect of muscular wrenches, kinetic harmony, elongation limits and athletic disability, as well as cases of recovered athletes, and further the declaration made by some famous players, physically recovered through the new therapeutic technique. We submit below the facts, as mentioned by the author himself: Constituting a new theme on problems of the spinal column, the facts which I submit below will evidence that the column symptomatology, has actually nothing, or very little, to do with the spinal column itself. Actually, most of the symptoms, the most common ones, derives from other problem of which you will know, and that are, no doubt, real problems of spinal column. Therefore, whenever we mention in this work the expression problems of the spinal column, symptoms of the column, pathology of the column, column disturbs, spinal column sufferers, column patients, column symptomatology, column patients, column therapy, column treatment, etc., we shall always write them between quotation marks, using a figure of speech with the evident purpose of giving another meaning to the expression. The medicine, through several therapeutic modalities and evidently for not knowing the true causes of the column pains, does not have the solution for these problems. An evidence of this are the world statistics, according to which 80% of the people suffer symptoms attributed to the spinal column, the disturbs of which attack men and women of all classes, in every country in the world, bringing them pain and suffering and, worst of all, leaving these people disillusioned in respect to the fact that they may find a solution for said problems. The statistics show also that the problems of column constitute one of the main reasons for leaving work, and they are the worry of world health authorities, for the cause and solution of the problem remain unknown by the therapeuticscience. Besides, both conventional treatments, as well as the alternative ones, are inadequate, evidently for not knowing the cause of the problem, becoming therefore inefficient or just palliative, or even harmful in some cases. Following the researches made by the Rhodia Center of Social Medical Studies in 1997, the pains which strike most persons who suffer from column are, in %: Lumbalgia 65.9%, head ache 60.2, migraine 48.2; back pain 41.2. The problem is that some time the pains are just temporary, but that they return, are chronic and increase the number of persons who have to request leave from work. Following said research, those pains answer for 8.4% of all absences of workmen from work. However, the losses are not due only to the absentees, but for the bad professional performance of those who work with pain. There are million of people who suffer column pain, with bad temper, unhappy, and many times irate, working without a good production level. THE SKEPTCISM BARRIER It is noted that the health professional are in a maze of skepticism, doubts and contradictions, they do not know to solve satisfactorily such old and known health problems which, for centuries, have been making unhappy a good portion of the world population. In spite of some discoveries or therapeutic innovations, the impervious system of medicine prefers to ignore them, keeping itself within the academic conventionalism. A large number of physicians, blind by false therapies, have been fighting against any new therapeutic, even against those which have scientific basis. These professionals will not only know the possible and categorical therapeutical novelties but are also eliminating the possibility of use of important discoveries that could become a remedy for all of them. These are the reasons for which the skepticism, the dissatisfaction, and sometime the despair, reach all those who are directly involved in the suffering with Problems of column. Upon being a disoriented, suffered, and even revolted people, they only have a hope that some day their suffering will terminate.

DISCORVERY OF THE CAUSE The good news for problems of the column is that now there is a therapy which is evidently efficient, based upon the discovery of the skeleton misalignment which, although was discovered by the therapeutic classes, will be adopted and acknowledged, within a short time, by million of sufferers. Even declaring, when we discuss today in an inconsequential way, that column pains do not have a cure, all those who will know this new therapeutics, professional of health or those who are the sufferers of column, will realize that for said problems there is really a solution. Actually, the imprudent medical statements that column pains will never have a complete and final cure, for the column is an organ which grows old and wears out, are inconsistent and untrue declarations, for all organs of the human body grow old, but this not the reason for all of them become sick. Following my discovery, made in 1969, the column pains are just a lack of leveling of the hip at the sacrum-lumbar articulation level, taking the whole skeleton out of alignment, stretching the nerves from their root, in the vertebral column, causing sciatic, neuralgic, muscular, tendon and articulation pains, and other symptoms which apparently are not directly related to the column such as an example, chronic headache, neuralgia of the trigeminal nerve, digestive disturbs, nervousness, anguish, insomnia, tiredness, etc. I that said lack of alignment of the hip, characterized by a positional displacement of the hip, which may be caused by shocks in sports or in accidents of large and small proportions, or by sudden movements, or by weight lifting with the body in a bad position, etc., it actually takes the whole skeleton out of alignment, stretching the rachidian nerves, causing all those symptoms, and the disk, which has been wrongly accused as the cause of lumbarsciatalgia. LUMBARSCIATALGY AND DISCK HERNIA Following publications made by French scientists in 1973, and as informed by the then Brazilian Ministry of Health, Dr. Almeida Machado, with whom I had a meeting in 1974, the sacrum-lumbar articulation, which is between the 5th. lumbar vertebra and the sacrum bone, through which the hip moves, constitutes the center of gravity of the skeleton, namely, the point of equilibrium of the human body. For this reason, the hip bone moves naturally, following always a leveled order so you may walk, run, work, etc. Being the center of gravity of the human body,, the sacrum-lumbar articulation should not be changed. That point of equilibrium does not have to be displaced to right or to left, which would normally occur with the lack of alignment of the hip. If this happens, not only symptoms of column will appear, including lumbarsciatalgia, but also irrecoverable damages may occur to the intervertebral disk, such as a disk hernia. Actually, if the body is in the correct symmetry, its weight is distributed uniformly on the sacrum-lumbar disk. However, when the body is not aligned, the weight falls only laterally. With the disk not aligned, it does not support the load and the hernia appears. We should note that by changing the nervous network, said skeleton lack of alignment, besides being the cause of hernia, causes also the stretching of the rachidian nerves all over the bode, creating active aggressions to the muscles, and passive aggressions to the nerves themselves, both brachial as well as sciatic nerves. However, it should be noted that, once occurred, the disk hernia is only one aggravating circumstance of the lumbarsciatalgia, but it is not the cause of the problem. If the lack of alignment of the skeleton is corrected, with the body in full symmetry, not only the disk hernia will be liberated from pressure but also the symptoms of the column will disappear, with the patient living peacefully with the hernia. PATHOLOGIES, SYMPTOMS, REGIONS AND POPULAR TERMS See below a list of symptoms and regions of the body which are most affected, including popular terms, attributed to deviations or pathologies of the vertebral column, or a problem of the nervous system, or other pathologies, which, however, constitute the most common symptoms derived from the skeleton lack of alignment, the real cause of problems of column. Angina pectoris, anxiety, arthritis, muscular atrophy, bursitis, cramps, cervicalgia, sciatic, muscular contraction, costalgia, discomfort when standing, seating, bending the body, walking, running, making exercises, crouching, turning the body, turning the neck, emotional unbalance, muscular stretching. Chest pain, pains in the joints, cervical pains, sciatic pains, pains in the column, lumbar pain, muscular pain, nape pain, back pain, pain in the omoplate, pain in the legs, pains in the urinary tract, pain in the groin, nerve pains, belly ache, pains in the neck, pain in the pubis, pain in the wrist, chest pain, pain in arms, pain in the face nerves, pain in the shoulder, pain in the hip. Stress, formication, insomnia, irritability, pain due to repetitive effort, lumbargia, lumbarsciatalgia, myalgia, nervousness, neuralgia of the sciatic nerve, neuralgia of the trigeminal nerve, general neuralgia, plexobrachialgia, nervous stretching, syndrome of the wrist, symptomatology of the column, tendinitis, muscular stretch, nervous tension, toraxalgia, stiff neck. We should also point out that the problems of the column, characterized by the above mentioned symptoms, do not constitute a pathology, if they are symptoms derived from a mechanical problem, namely, from the corporal mechanism which is not adjusted by the above mentioned skeleton lack of alignment, does not operate appropriately, attacking the muscular mass. CONFIRMING THE CAUSE Having affirmed that the hip actually displaces itself and that, for this reason, the whole skeleton remains out of alignment causing the symptoms known as column pains, we not only

give the basis of the facts relative to the clinical experiences performed for over three decades, as well as of the computerized scientific data. Actually, the satisfactory therapeutic results not only evidence the results obtained in treatment of more than 30 thousand patients, but also the evaluation of skeleton symmetry with compared scanometric tomographic images, made at the Unidade Radiolgica Paulista (So Paulo State Radiology Unit), with images of the trunk before and after the corporal realignment. After extensive tests, weve noticed that in all cases there were important symmetric alterations; the measures were clarifying, evidencing that after said alignment of the skeleton, made by the Elevating Table, the body of each of the patients turned back to the regular symmetry. As an example, we may see the trunk of patient Thirso, with two comparative images - one of the left side of the iliac crest towards the 1st. thorax vertebra, and the other one of the right side of the humerus bone, towards the 5thlumbar vertebra. Notice that before the skeleton alignment the measure taken at the left side iliac crest to the 1st. thorax vertebra was 42.72 cm, while the same measurement taken after the skeleton adjustment was 42.43 cm. showing a difference of 029 cm which, with the average of 0.145 cm, corresponds to the alignment of the hip. As for the measures taken in the right side, from the humerus bone towards the 5th. lumbar vertebra, the data are the following ones: before the skeleton alignment, the measure was 48.91 cm, and after the alignment, the measurement made in the same points was 46.80 cm. with a difference of 1.220 cm., with a 1.055 cm average corresponding to the return of the shoulders to the normal level. Notice that the data of these images show that Thirsos body, before the alignment, had an asymmetric corporal disposition, with the left shoulder higher, by 1.055cm, than the right side. This proves that the skeleton of said patient was out of alignment, returning to its normal symmetry immediately after the correction of the hip made by the Elevating Table. (See the Computer Thomografy) In another example, with images relative to patient Mauro, the measurements were made in a different way, namely, from the iliac crest to the clavicle, taken from both sides. It was noticed, in the example of said images, that the iliac crest line of the right side, towards the left clavicle and before the treatment of skeleton alignment measured 42.61 cm. After the treatment the measurement was 42.14 cm, reducing by 47 hundredths. We see also that in the inverse straight line, namely, from the left side iliac crest to the right side clavicle, before the skeleton alignment, the line measured 41.65 cm. After the correction, 41.96, increasing by 31 hundredths. It should be noted that while in the prior comparison said line reduced to 47 hundredths, in the inverse measurements it increased 31 hundredths, showing the return of the body to its natural symmetry. (See the Computer thomografy) NEW THERAPEUTIC TECHNIQUE Said problems, however, may now be settled by a new therapeutical technique, totally without pain, created and developed by us. We have received in our clinic thousands of patients, with the results being evidently satisfactory, along 3o years, amongst which people well known here in Brazil. Amongst them, we may point our Silvio Santos (entrepreneur, president of the SBT television network), Jos Sarney, former president of the Republic, Governor Dante de Oliveira, Agnaldo Timteo (Brazilian popular music singer), Gugu Liberato (television showman), Cafu (soccer player of the Rome and the Brazilian national team), Carlos Alberto Torres (former soccer player of Kosmos, Santos F./C. and the Brazilian national team), Gerson de Oliveira Nunes (the golden left handed player of the Brazilian soccer team), and many others. In general, said therapeutic technique is based upon the idea that in order to end with the pain,, first it is necessary to eliminate the cause. Therefore, we constructed the elevating table for skeleton alignment which, forcing the skeleton to its normal symmetry, it leaves the nervous roots totally mitigated, eliminating the pains of the column, as well as other symptoms mentioned above. (Elevator Table) TAKE GOOD CARE OF YOUR COLUMN AND LIVE BETTER Always Avoid Lifting loads in a bad posture, as well as with your back curved or twisted. Movements or efforts with your body twisted. Works with prolonged efforts or in inappropriate position. Dragging furniture, etc. Carrying bags, water buckets, liquid gas containers or any other load with only one hand. Coughs or sneezes facing sideways or with your body in a bad position. Sitting on low seats or seats without back, such as benches and footstools. Remaining up on your feet or sitting down for a very long period, or even in an uncomfortable position. Change your posture frequently. Long trips in an uncomfortable position. Practicing violent or vigorous sports, either ingroup or individually, which involve unexpected danger or high impact. Severe gymnastics or exercises which require your back to be curved forwards, as well as any effort involving a back-twisting movement. Running, jumping, riding a horse or motorcycle. Be Very Careful When lying down. First sit on the bed and, lying sideways, find other positions. When getting up, lie sideways and, sitting up first, stand up afterwards.

When lowering or rising from the floor, especially when lowering to lifting a load. Bend your legs when lowering to avoid curving your back. When getting in and off vehicles, sit first when getting in, and move your legs out first when getting off. On public transportation (trains, buses and subways): If you have to travel standing up, hold yourself with both your hands. When walking down stairs, never loosen your body. Walk down slowly. Housewives or Housemaids When you do the bed, do it leaning your knees on cushions, on the edge of the bed. Avoid washing the dishes at low basins to prevent from curving your back too much. When sweeping underneath the furniture, do it with your knees on cushions, too, or squatting down in order to prevent from making efforts with your back in a curved position. Mothers With Small Children Mothers must not take their children out of the cradle or lift them from the floor or carry them in arms. Try to receive them on your knees. When changing their diapers, do it on a high surface to prevent from making efforts with your back in a curved position. Risks Regarding High Heels Women must not wear exaggeratedly high heels to prevent from harming the stability of the walk and thus increasing the risk of feet torsion. These small accidents can unexpectedly cause the skeleton to come out of alignment. Also avoid wearing high and low heels alternately, once this alternation can promote posture muscle contractions in different parts of the body, which can cause discomfort, weariness and even muscular pains. This predisposes the body to come out of alignment again. Therefore, get used to wear a single kind of heel, preferably medium-height heels. Common Causes of Back Pain www.lowbackpain.com/ causes.htm There are many conditions that can cause back pain. Some of these are congenital, such as scoliosis. Most causes of back pain, however, result from injury or trauma. Common causes of back pain include: Muscle Strain Bulging or Herniated Disc Degenerative Disc Disease Spinal Stenosis Sciatica or Pinched Nerve Sacroiliac Joint Inflammation There are also many other conditions which can contribute to back pain. These conditions may almost always treated non-surgically, resulting in a successful outcome the majority of the time. Medical Evaluation and Diagnostic Testing procedures should be performed prior to beginning any treatment in order to determine the treatment process that will be most effective. The following pages describe some of the evaluation testing procedures that we perform. History & Physical Understanding your personal medical history begins with a thorough evaluation that will help to determine the treatment option most likely to provide pain relief. X-Rays An X-Ray provides an image that can be used to evaluate bones, joints and degenerative lesions in the spine. CT Scan/Myelogram A CT Scan is a simple non-invasive procedure that enables medical professionals to obtain diagnostic information on the brain, chest, abdomen, pelvis, spine and extremities. MRI An MRI is a type of powerful radiographic study that provides a clear diagnostic picture without using radiation. EMG / Nerve Conduction Study The EMG/Nerve Conduction Study is a useful test to study the nerves in the arms and legs. Discography Discography is a diagnostic procedure used to determine the level of the painful disc. Quando um msculo fica mais tensionado que o seu par, ele acaba puxando a coluna para o seu lado e, assim, provoca a escoliose. http://www.magnaspine.hpg.ig.com.br/escoliose_lordose_cifose_portugues.htm Para os casos onde as deformidades da coluna no forem causadas por doenas nos ossos ( osteoporose, tuberculose etc ) ou deformaes nas vrtebras, obvio que o tratamento deve reconduzir a coluna para a posio normal e, atravs da fisioterapia, desenvolver a musculatura interessada para mant-la na posio corrigida. A reconduo da coluna para a sua posio normal poder ser feita com o emprego de uma fora de trao na mesma. A trao aumenta o espao entre as vrtebras e alem disso reduz a curvatura nos

pontos crticos. A aplicao de trao na coluna uma forma engenhosa para promover o seu "endireitamento" sem que seja necessrio pegar ou manusear vrtebras e discos. Na figura abaixo mostra-se a ao fsica de uma fora de trao na coluna. MAGNASPINE aplica a trao ideal para esses objetivos. A cada aplicao ocorrer uma reduo nas curvaturas, nos pontos mais crticos, em um processo totalmente indolor. recomendvel que o emprego de MAGNASPINE seja acompanhado por uma fisioterapia que v adaptando a musculatura s novas posies alcanadas pela coluna. Entretanto, mesmo sem esse acompanhamento, MAGNASPINE conseguira reduzir as curvaturas mas, obviamente, com um tempo maior. Neste caso seria recomendvel um acompanhamento com natao.