¡Hola a todos!
Me propongo realizar una serie semanal sobre las teorías de la biomecánica moderna que tienen gran influencia en los tratamientos actuales.
Una de los más importantes es la teoría del estrés de los tejidos descrita por Mc Poil y Hunt en 1995. Estos autores plantean que aunque la teoria de Root et Al es ampliamente usada como referencia en la explicación y tratamiento de los problemas y la patología de los pies actualmente es muy discutida por la baja calidad (muy poca muestra, en mi opinión) de los criterios de normal alineación de los pies y la posición de la articulación subastragalina en la marcha.
¿Que dicen estos autores?
De una manera básica viene a decir que el estrés provoca lesión. A más estrés en una estructura, más lesión. ¿Suena lógico no?
¿Cómo funciona el estrés en los tejido?
El estrés (las fuerzas) actuan sobre los tejidos provocando tensión. Todas las estructuras vivan soportan la tensión: primero deformándose sin perder su forma original, después deformándose completamente y por último rompiéndose.
Imaginemos una goma elástica. De las de toda la vida.
Si tiramos de ella despacito se deformará, si la soltamos volverá a su forma original. Eso se llama deformación elástica.
Si tiramos de ella mucho se deformará y no volverá a su forma original. Se quedará estirada para siempre. Deformación plástica.
Si tiramos de ella mucho se romperá. Punto de ruptura.
Esto se resume aún más en esta curva, la curva de tensión – deformación:
Vale. Pues según Mc Poil y Hunt los tejidos humanos se comportan igual, lo cual suena muy lógico.
Aplicaciones clínicas
Ahora imaginemos un pie plano infantil. Ya sabemos que todos que parece que la evidencia científica (Wenger D.R., Mauldin D., Speck G., Morgan D., Liebar R.L.. Correctives shoes and inserts as treatment for flexible flat foot in infance. J. Bone Surg. (am). 1989. 71-A: 800-810) indica que no hay diferencia desde el punto de vista de la deformación tratándolo o no con ortesis plantares u otros dispositivos (pincha para ver el artículo completo).
Vale. Eso puede ser. ¿Pero si los tejidos de ese niño van a tener una deformación plástica debido a esa tremenda pronación? Imaginemos su fascia o sus ligamentos plantares… Esto justifica el tratamiento aunque no se modifique el ángulo de valgo del retropié. Unicamente para evitar la deformación plástica de sus estructuras plantares.
Imaginemos al corredor pronador, o al obeso. Esto explica muchas cosas y justifica muchos tratamientos. Es más, no justica, explica la patología y la necesidad de tratarla o compensarla biomecánicamente.
Espero que os guste.
Evaluation and Management of Foot and Ankle Disorders: Present problems and Future Directions. McPoil, Hunt GC. JOSFT Volume 21 Number 6 June 1995
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