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Tengo una pesadilla: me lesiono por octava vez el bíceps femoral.

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La peor pesadilla que he tenido últimamente es que mi bíceps femoral vuelve a sufrir una distensión o rotura fibrilar.  Pero lo peor es que cuando estoy despierto siento que hay muchas probabilidades de hacerse realidad,  mi vida deportiva se ha convertido en una obsesión con los isquiotibiales.

Si no queremos tener esta pesadilla, debemos crear las adaptaciones necesarias para que no se vuelva a repetir el mismo cuadro. En una entrada anterior (¿que hago con mi séptima lesión del bíceps femoral?)  veíamos como debe ser la recuperación de una lesión isquiotibial por distensión o rotura fibrilar. Pero el trabajo preventivo es algo mucho mas amplio. En la primera entrada de esta serie (¡Que alguien me explique porqué me he lesionado por seṕtima vez el bíceps femoral!) explicamos los factores de riesgo, donde la fatiga por sobreuso es uno de ellos; y tenemos que saber que hay varios factores que van a estar provocando un sobreuso isquiotibial, por lo que si no queremos una recaída, tendremos que mejorarlos.

 

La debilidad de los sinergistas:

Debilidad glútea en la extensión de cadera. Todo un clásico en el mundo del entrenamiento y la rehabilitación.

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Debilidad abdominal y glútea en la retroversión pélvica:  Los músculos de la cara posterior del muslo son extremadamente susceptibles de un síndrome de sobreuso cuando son dominantes debido a una ejecución inadecuada de los músculos abdominales y del glúteo mayor. La musculatura que debe oponerse a la anteversión de la pelvis son los abdominales por arriba, y el glúteo mayor y los isquiotibiales por abajo. En presencia de unos glúteos débiles, los isquiotibiales tomarán el protagonismo formando un par de fuerza con los abdominales.


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Anteversión pélvica: El acortamiento/rigidez de los flexores de cadera provocan una limitación al movimiento de extensión de cadera y al de retroversión pélvica. Se ha encontrado asociado a posteriores lesiones de isquiotibiales5,41,50,88. Por cada grado de acortamiento de los flexores de cadera en el Test de Thomas modificado, el riesgo de lesión en los isquiotibiales incrementa en un 15%42.

El acortamiento de los flexores de cadera provoca la anteversión pélvica. Esta posición proyecta el tronco hacia delante con respecto a la base de sustentación. La anteversión será mayor o menor en función del ratio de acortamiento entre flexores de cadera e isquiotibiales. En deportistas de fútbol, rugby y fútbol americano, tan sólo un 26.5% mantenían la alineación postural lumbar correcta. El 51.9% presentaban un aumento de la lordosis. El índice de lesión muscular (en general, no sólo de isquiotibiales) entre el grupo con desalineación lumbar fue del 67% por sólo un 36% del grupo con columna lumbar correctamente alineada. Una línea postural correcta pasa por el maleolo del tobillo, la rodilla, la cadera, el hombro y la oreja87.

 

Síndromes de alteración del movimiento que provocan sobreuso isquiotibial:

Síndrome de extensión de cadera con extensión de rodilla:  

  • Dominancia de los isquiotibiales sobre el glúteo mayor en la extensión de cadera, sobre el cuádriceps en la extensión de rodilla cuando el pie está fijo, y del bíceps femoral sobre los rotadores externos.
  • Al subir un escalón o levantarse de una silla la rodilla realiza un desplazamiento posterior, cuando se debería observar que está fija y es el cuerpo el que se desplaza hacia delante.
  • En bipedestación la cadera puede estar en extensión y rotación externa, y la rodilla en hiperextensión.
  • Estas personas suelen tener sobrecarga en los isquiotibiales y debilidad de los cuádriceps  (son sinergistas en los movimientos de triple extensión,  (ver: La Paradoja de Lombard)

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Síndrome de rotación lateral de la cadera:

  • Dominancia de los rotadores externos sobre los internos.
  • Participación insuficiente de los músculos rotadores laterales intrínsecos de la cadera: piramidal, obturadores, géminos y cuadrado crural. El bíceps femoral es dominante.
  • Puede haber distensiones isquiotibiales y síndrome glúteo profundo.
  • Camina con la cadera en rotación externa.
  • A nivel estructural puede haber retrotorsión femoral.
  • Estas personas suelen tener sobrecarga en los isquiotibiales

Estas personas necesitan trabajar los rotadores internos para corregir este desequilibrio entre antagonistas, y la rotación externa con la musculatura más proximal,  para evitar que el bíceps femoral tenga que asumir esa acción.

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A veces sueño con un mundo mejor, donde todo el mundo se quiere, las personas cuidan la naturaleza, ya no hay hambre en el mundo, …. Y mi bíceps femoral no se vuelve a lesionar. Es maravilloso sentir que todo va bien. La curva longitud-tensión me confirma que mi bíceps femoral está preparado para frenar las aceleraciones de mi pierna, y el fortalecimiento de los sinergistas le está quitando el exceso de trabajo que antes tenía. Pero lo mejor es que siento que es real, empiezo a darlo todo en los entrenamientos y se me olvida la tensión en la parte posterior del muslo. Por fin me siento tranquilo, creo que no volveré a tener esta pesadilla.

 

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  • […] como ¡Que alguien me explique porqué me he lesionado por séptima vez el biceps femoral! o Tengo una pesadilla: me lesiono por octava vez el bíceps ceps femoral., tratan de dar respuesta a algunos de los rompecabezas que giran en torno a una de las lesiones […]

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