dismissal considering the physiological process of growth , often not predictable . The regular sports medicine examination should be particularly rigorous and vigilant .
Using orthoses for correction of segmenting alignment is sometimes recommended , despite of little evidence . Bonanno et al . have shown in their latest review that orthoses can be effective in preventing all kinds of injuries and stress fractures , except for soft tissue lesions , while the insoles that absorb the shock are not effective either preventing skeletal injuries and stress fractures or on soft tissue injuries .
Although there is no consensus among specialists , the most serious biomechanical changes ( referred to the lower limbs ) may justify surgical correction . In the long run , the benefits arising are a little consistent and low evidence .
15 , 17 , 18
Muscular strengthening The new millennium has brought great acceleration and focus on injury prevention . Today it is known the period of heating and cooling down are of utmost importance to prevent of any injury . Analytical muscular strengthening reduces joint overhead . In relation to the knee , the work of the anterior and posterior muscles of the thigh ( quadriceps and hamstring , respectively ) can lessen the pain and prevent the joint lesion . All the methods used to enhance analytical muscular strengthening are valid . Here we can highlight , with or without supporting the stimulation and exercises with elastic resistance , type Thera-Band ®. Several studies show that resistance elastics and dynamic exercises with supporting adjunctive stimulation when well done boost muscle mass gain and promote injury prevention . Rossler et al . Recently showed that exercise programs to prevent injury to pediatric age , when applied as a routine , can significantly reduce injuries related to sports practice . Staying active also helps in body weight control , a determining condition in the control of the joint lesion . Physical exercise and weight control are fundamental pillars in the non-pharmacological approach to prevention and treatment of the cartilaginous lesion . Counselling and aerobic conditioning complement the therapeutic indications .
Joint mobilization and static stretching / stretching
15 , 19
The techniques of stretching / stretching are one of the most present discussions in the sports and in sports medicine community . The debate is centered on its effectiveness and the differences between static and dynamic stretching . Today we know that the two components are important to prevent muscular and tendon lesions . The ability to move joints across the joint amplitude is a very important component to health . Some authors argue that the effect of the technique is related to the sport practiced , the population , the duration , the type , the presence of heating and the time of application . proprioceptive neuromuscular facilitation techniques are very important in therapeutic intervention and also in the prevention of lesions ( muscle rebalancing and static stretching work ).
Proprioceptive training 20-22 It intends to stimulate dynamic stability , being particularly used in the lower limb in a closed kinetic chain , knee pathology ( patellofemoral and tibiotarsi ). It should be appropriate to the phase of the rehabilitation program and the pathology of cartilage presents a recoverable relief in the preventive context .
23 , 24
The manual massage The massage has analgesic and myorelaxant characteristics and is usually framed in the rehabilitation program . In general , the evidence concerning the prevention and treatment of chondral lesions is low . The existing studies are particularly directed to their use in adults .
Physical agents of thermotherapy and radiotherapy
25 , 26
• The cryotherapy Using cold in the treatment of acute lesions and in the rehabilitation the process is widely accepted . The cold can be static or dynamic and there are several modalities for the application : ice bags , cold water , massage with ice , ethyl chloride , among others . Based on available evidence , static cryotherapy is effective in pain control . Algafly et al . have shown that cryotherapy increases the threshold and tolerance of pain , with no relevant effect on the conducting speed of the peripheral nerve . It is a widely used technique in the treatment and rehabilitation of joint and musculotendinous injuries , with no significant evidence as to its effectiveness in prevention . The dynamic cryotherapy , particularly the massage with ice , has trophic and hyperemic effects used in the pathology of chronic evolution .
27 , 28
• Iontoforese Iontophoresis is widely used in the treatment of lesions of the musculoskeletal system , particularly with the application of anti-inflammatory drugs . There are no formal counterindications for its use . Its evidence in the treatment of chondral pathology is moderate and there is little discussion about its application in the child and adolescent . There are no studies that prove their effectiveness in preventing injury .
Pharmacological measures
Non-steroidal anti-inflammatory drugs ( NSAIDs ) 29-32 Millions of people around the world consume NSAIDs , considering their effectiveness in reducing pain and controlling inflammation . There are no studies on their effectiveness in the prevention of cartilage lesions , either in adults or in adolescents . However , in some studies it was showed by its strong anti-inflammatory and chondroprotective power in patients with osteoarthritis . Their use should be tested individually on athletes . The iatrogenic potential cannot be ignored even in this population group .
Chondroprotective therapies
• Supplementation with glucosamine
30 , 33-35
Some studies show that supplementation with glucosamine sulfate will reduce the rate of collagen degradation and the risk of osteoarthritis . The supplementation in athletes is frequent considering that a dose of 1500 to 3000mg of glucosamine per day may delay the degradation of the joint , and this effect is clearer in athletes who practice high impact sports , notably in sports
12 may 2018 www . revdesportiva . pt