this time (concedetemelo) I do not write the post. After careful research, and readings, I just have to let the "word" to CONI, Institute of Sports Science, Department of Physiology and Biomechanics
, Rome
ed in particolare al lavoro svolto del Dott.C. Gallozzi
Dal punto di vista motorio, ogni essere vivente deve essere in grado di adattarsi all’ambiente in cui si trova per sopravvivere e svolgere la propria attività statica e dinamica.
Tale adattamento richiede la possibilità di cogliere ciò che succede nell’ambiente stesso e conseguentemente, di assumere le posizioni più consone alla situazione e alle proprie esigenze di comportamento. Possiamo definire “postura“ ciascuna delle posizioni assunte dal corpo, contraddistinta da particolari rapporti tra i diversi segmenti somatici.
Il concetto di postura, quindi, non si riferisce ad una condizione statica, rigid and mainly structural. She identifies, however, with the more general concept of balance understood as "optimization" of the relationship between subject and environment, ie the same condition in which the subject assumes a posture or series of postures than ideal environmental situation, in that particular time for the planned motor programs.
A very important function can not be entrusted to a single organ or system but requires a whole system, called System-Posture-Tonic (STP), a set of interconnected structures and processes which is tasked with:
•
fight against gravity;• resist external forces;
• structured in space-time around us;
• allow the balance in the movement, to guide and reinforce it. To accomplish this exploit
neuro-physiological, the body uses different resources: • the
esterocettori: position us in relation to the environment (touch, vision, hearing);
• the proprioceptors: position the different parts of the body in relation to the whole, in a predetermined position;
• higher centers: integrate the switches of strategy, cognitive processes and rework the data received from the two sources above.
The organs of the tonic postural system
We recognize several receptors in postural and proprioceptive primary function overseas, who are able to inform the central nervous system of their state and induce a postural response specific for that particular time, changing the state of the powertrain muscle and therefore the balance osteo-articular.
• The esterocettori
These sensory receptors capture the information coming from the STP and sent to the three receptors are universally recognized: the ear
Internally, the eye and the plantar skin surface.
1. The inner ear
receptors in the inner ear are accelerometers, they provide information about movement and head position in relation to the vertical gravitary. The entrance to the vestibular system includes a semi-circular and otolithic system. The system is a system of three semicircular canals arcuate located in three planes perpendicular to each other, sensitive to angular accelerations (head tilt). The
semicircular canals do not participate in fine balance, because their threshold of sensitivity to acceleration is greater than the accelerations oscillatory postural system in the end, however the system works in balance dynamically. The otolithic system is contained in two vesicles: the saccule el'utricolo sensitive to gravity and linear acceleration. The inner ear senses the angular accelerations (head tilt)
through receptors located in the semicircular canals and linear acceleration via the utricle-saccule. It seems that only the latter are involved in the postural control order. As early in 1934, Tait J. MacNelly and WH showed that denervation of the semicircular canals does not interfere with muscle tone, while the results in deep dell'utricolo disruption to its allocation.
Because the information coming from the inner ear can be interpreted by the STP should be compared to the proprioceptive information that allow to know the head position in relation to the trunk and the trunk in relation to the ankles and above the information breech pressure , the only fixed reference.
2. The eye
The visual entry through the retina allows the postural stability for movement front to rear, thanks to the vision device. By contrast, the left-right movements, central vision becomes predominant. The visual input is active when the environment vision is at hand if the visual aims is 5 feet or more, the information coming from visual receptor become so unimportant as not to be taken more into account by the STP
To ensure that the STP can use visual information to maintaining balance, visual information that must be compared to those who come from the inner ear and the support foot. In fact, the eye can not say if the slip of images on the retina is due to eye movement, the movement of the head or moving your whole body mass.
3. The foot
The esterocettore Plantar allows to place the entire body mass in relation to the environment through measures pressure at the plantar surface of the skin. This is the interface between constant
the environment and the STP. It is rich in receptors and has a very high threshold of sensitivity (the baropressori also feel the pressures of 0.3 g). They provide information on changes in whole body mass and therefore act as a platform stabilometric. The footbeds are the only information to be derived from a receptor fixed in direct contact with an environment represented property from the ground.A foot level are collected, However, even information about proprioception, muscle and joint (see below). In the context of postural problems, the foot can occur in three ways:
- as a causative
: Chief of postural imbalance;- as a adaptive
: buffers imbalance that comes from (usually eyes and teeth). At first, the adaptation is reversible then fixed feeding postural imbalance;- as a mixed
: have both a slope and a slope adaptive causative.
• The endocettori
These sensory receptors inform the STP of what happens within the individual. Allow the system to recognize the permanent location and status of each bone, muscle, ligament or body in relation to the balance. They shall in particular on the position of cephalic esocettori (inner ear and retina) in relation all'esocettore breech. They fall into two broad categories: receptor and proprioceptive receptors or enterocettivi viscerocettivi.
Entry oculo-motor allows you to compare the position information provided by the vision a quelle fornite dall’orecchio interno grazie ai sei muscoli oculo-motori, che assicurano la motricità del globo oculare. L’entrata rachidea ha per scopo di informare il sistema posturale sulla posizione
d’ogni vertebra e quindi sulla tensione d’ogni muscolo. L’entrata propriocettiva podalica, grazie al controllo dello stiramento dei muscoli del piede e della gamba, situa il corpo in rapporto ai piedi.
L’entrata rachidea e l’entrata propriocettiva podalica formano una continuità funzionale, un’estesa catena propriocettiva che riunisce i recettori cefalici ai recettori podalici e dunque permette di situare l’orecchio interno e gli occhi in rapporto ad un recettore consists of the fixed foot. This allows for a space-time coding information cephalic.
• The stomatognathic
A growing number of jobs tends to analyze the role of disorders of the spine and posture in relation to the skull, jaw problems, the attention that many private investigators to the hypothesis of correlation between occlusion and posture is justified by the evidence of anatomical and functional relationship between the stomatognathic system and the structures that control of posture. As part of the skull, jaw disorders, occlusion, defined as the ratio between static and dynamic elements of two opposing jaws, is considered one of the main etiological factors. Some authors have identified a number of occlusal conditions that may be a risk factor for the occurrence of cranio-mandibular dysfunction, they are identified as: •
anterior open bite (non-contact, occlusion between upper and lower incisors) ;
• "Overjeet" greater than 6 mm, whereas for overjeet mean the horizontal distance between the upper and lower incisor group that in the standard ranges from zero to four millimeters
• difference between real and ideal jaw position greater than 2 mm;
• reversal of the relationship cross interarch (crossbite) and after unilateral;
• Class II Division 2;
• absence of five or more teeth in the posterior.
have been shown to relations between intimate proximity to the spinal cord and the trigeminal nerve endings of the first cervical plexus so as to assume the existence of pathways of convergence or interconnection at the core cord, which would explain the occurrence of Symptoms vary in the face, temporomandibular joint and portions of the dermatomal first cervical nerves when mioartropatia of each of these districts and could be the cause of widespread pain and reported that often accompanies some forms of headache and craniofacial pain-gold. The innervation of the stomatognathic system is provided primarily by the trigeminal nerve. The proprioception of the same district is entrusted to hearing nerve fibers whose cell bodies are located in the mesencephalic trigeminal nucleus. Have also been suggested correlations between jaw, suprahyoid muscles and cervical vertebrae form a complex that would be the anatomical and functional link which would then be the hyoid bone. The same hyoid bone could be the mediator of changes in postural head due to changes in the position of the mandible.
The postural pain syndromes-
When determining dysfunction of the tonic postural system can establish a clinical picture usually characterized by pain of the musculoskeletal system (musculo-tendon, joint and bone ) called "postural pain syndromes." More specifically, the elements that must contribute to make this happen are:
1. Individual predisposition.
2. The morpho-functional.
3. The action of the internal and external to the individual.
etiopathogenesis of postural pain syndromes-all components are present. This means that the patient should be predisposed to dysfunction (for example, his sedentary lifestyle), that receptors posture must be in some state of deterioration or that are present or paramorphism dysmorphism of the musculoskeletal system and, finally, that the work habits
or sports training leads to a hypercharge of the fabrics that are then subject to degenerative-inflammatory reaction. As for the 'internal environment "refers to certain emotional states and / or psychological factors that contribute to alter the pattern and postural muscle tone
di base. La triade è potenzialmente presente in ogni individuo, ma non si realizzerà
nessuna manifestazione clinica della disfunzione finché tutte le componenti non siano coinvolte. Non appena si sviluppa la triade, la sindrome precipita e si osservano i sintomi della disfunzione.
Il grado di predisposizione, di alterazione morfologica, o di alterazione dell’ambiente interno ed esterno, necessario per la comparsa della sindrome è diverso per ogni individuo. Per questo si potranno trovare persone con livelli minimi delle componenti che possono presentare anche delle sintomatologie molto importanti. Ricapitolando, perché la sindrome posturale abbia la sua estrinsecazione clinica, sono necessarie tutte le componenti described. The variables of this principle lies in the degree of incisiveness that each of these individual factors may be at any particular individual. This degree of variability to account for differences among individuals, as well as in the same individual at different times. Are also possible triggers of and / or aggravating
such as trauma, stress, the outcome of orthopedic surgery, some scars and parafunctions (bruxism), which can suddenly precipitate a pathological findings. These factors are considered as contributing factors for the onset of a postural pathology.
dysfunction of receptors
A second receptor postural dysfunction can be classified into disease-postural algic:
Simple, occurs when there is dysfunction in a single receptor primary posture, such as the support breech, which induces a particular adaptive schema. Complicated, occurs when more receptors are in the primary postural dysfunction, such as the support and the equipment stomatognathic breech.
The characteristics of the clinical
a program that has a postural dysfunction can induce a clinical dysfunction at various levels of the locomotore come:
• I muscoli
• Le articolazioni
• Le ossa
• I tendini e i legamenti
• Il tessuto nervoso
• I visceri
A livello muscolare possiamo evidenziare ipertono, contratture, squilibri di trofismo e stenia o la formazione di zone algiche chiamate trigger-point. A livello osteo-articolare possiamo evidenziare artrosi, condropatie e, raramente, fratture da stress. A livello dei tendini e dei legamenti si osservano tendiniti, tendinosi o infiammazioni inserzionali. Per quel che riguarda il tessuto nervoso si riscontrano spesso delle patologie da compressione dei fasci sensitivi e/o motori. Per the viscera are seen various types of visceral symptoms often secondary to a neurological disease of the spine or secondary overtone of the skeletal muscles that exert compressive action. From a clinical point of view we can get a picture:
• Mild • Medium • Severe
When mild symptoms may be present from time to time, especially after episodes of physical and psychological stress, the patient mentions it only if asked the doctor, you can enjoy mild tenderness on finger pressure in one or more muscles of postural kinematic chains. There are no changes in quality of life and physical activity of the subject. When is the average patient has symptoms true even if punctuated by periods of acute and partial remissions. The symptoms, causes one or more specialist visits and instrumental tests. There are changes in quality of life and physical activity of the subject. When the patient suffers from a severe clinical picture algic-standing dysfunctional and often resort to medication for pain and / or inflammation. There are some significant changes in quality of life and physical activity of the subject.
Diagnosis and rehabilitation in pain syndromes, postural
The diagnosis of syndromes algic-posture is essentially based on a correct anamnesis collection and careful examination. We must go over well the history of the patient both from a physical point of view (history of trauma or episodes of joint pain and / or muscle), both from a biochemical point of view (allergies, menopause, endocrine disorders), both from the point of psychologically (stress, depression).
also must consider whether there have been major changes of the stomatognathic system such as extraction of teeth or occlusal rehabilitation with fixed prostheses and orthodontic treatment or through especially in children (it is not uncommon to hear that after a change in occlusion was sviluppato un cambiamento della funzionalità del rachide e non solo).
Esame obiettivo
• Esame morfologico e studio della verticale di Barrè
Si ricercano nei tre piani (frontale, sagittale e trasverso) variazioni di posizione dei principali punti di repere rispetto ad un modello di posizione ortostatica ideale con particolare riferimento al cranio, alla colonna vertebrale, al bacino delle estremità inferiori. Si valuteranno, inoltre, asimmetrie e rotazioni dei segmenti scheletrici nonché la presenza di zone di alterato trofismo e/o tono muscolare.
• Valutazione dei recettori
Per quello che riguarda l’apparato stomatognatico si studia prima lo stato di salute dei muscoli masticatori e si valuta l’armonia del movimento mandibolare rilevando la presenza di rumori a livello dell’articolazione temporo-mandibolare e le sue eventuali disfunzioni e/o discinesie, si registra lo stato di salute dei denti ed eventuale presenza di bruxismo. Infine si può variare l’appoggio occlusale con dei cotoni inseriti fra le arcate dentarie ed osservare cosa avviene sulle catene muscolari posturali del corpo e cosa cambia a livello del bacino e del rachide cervico-dorso-lombare, aiutandoci con uno scoliosometro sia sul piano frontale che sagittale e orizzontale o con
una pedana stabilometrica. Parallel with the evaluation must be studied stomatognathic support breech through examinations (baropodometry). The functionality of the foot should be evaluated both under static and dynamic
for the presence of paramorphism as piattismo the cavismo
or excess pronation and supination. Complete diagnostic evaluation of the ocular system, with particular reference to the function oculomotrice, and inner ear. Rehabilitation treatment, against which we will focus not so very complex subject and still not codified, is divided into two distinct phases, but which often proceed in parallel. On the one hand we proceed to resolution of the receptor dysfunction (etiological therapy) with the obvious difficulties that arise from the fact that very often the dysfunction of other organs involves a receptor that changes to adapt to a new body schematic. This can lead to misinterpretation of the clinical and therapeutic interventions that may paradoxically aggravate the symptoms (such as the indiscriminate use of orthotic insoles foot "adaptive"). The other must be followed by rehabilitation program on the locomotor apparatus that
must have the characteristics of individual action is absolutely dependent on the type of injury, but also the patient and his lifestyle. This is particularly important if the patient is an athlete.
Exercise, especially intense in fact determines the strong muscle adaptations induced by the tonic-postural dysfunction (hypertonia, and localized fibrosis), which if not removed, preventing the restoration of a fair and balanced body schema.
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