mercoledì 22 agosto 2012

Contusioni ossee

Una delle esperienze più frequenti che abbiamo avuto tutti, mentre ci alleniamo con il nostro sparring partner è che invece di colpire il nostro avversario in un punto bello morbido, colpiamo osso contro osso. A volte mentre tiriamo un calcio, non abbiamo nemmeno l'intenzione di colpire il nostro avversario, ma andiamo a contatto pieno con una superficie ossea.
Se veniamo colpiti sul tessuto muscolare o morbido nel corso di questi incontri, comprendiamo il perchè dei lividi, lo scolorimento e il gonfiore che si verifica e possiamo curare noi stessi di conseguenza. Tuttavia, quando veniamo colpiti su di una superficie ossea, non sembra esserci un qualsiasi scolorimento o gonfiore, ed è difficile per noi capire perché la zona fa male e continua ad essere dolorosa per così tanto tempo. In effetti, non è raro che tali lesioni possano protrarsi in alcuni casi estremi anche per 8 o 12 settimane.
Per capire il perché di tutto ciò: dobbiamo innanzitutto sapere che quando colpiamo con un osso un'altra superficie dura, si causano delle piccole fratture negli strati esterni dell'osso che sono chiamati corteccia. Il termine laico per questa condizione è: contusione ossea.
La corteccia dell'osso è composta da piccole fibre che il corpo stabilisce in una sorta di modello di tratteggio incrociato. È questo modello di tratteggio trasversale di fibre che riempie poi con il calcio per produrre la forza insita in un osso. Quando sollecitiamo l'osso in modo abbastanza duro, in realtà rompiamo alcune di queste fibre. Se ne rompiamo abbastanza di queste fibre, l'osso può separarsi e viene quindi chiamata “frattura”. Tale separazione può essere vista con i raggi x, ma quando sono solo poche le fibre rotte, non è possibile vedere i danni ai raggi X.
Anche se la lesione non può essere vista con una lastra, il corpo deve trattare l'area come una qualsiasi altra frattura. Prima deve rimuovere il calcio e le fibre danneggiate dalla zona, questo processo viene denominato rimodellamento osseo, e poi si può ri-iniziare a ricostruire nuove fibre e innestare del nuovo calcio nella zona. Questo processo può richiedere fino a 8 o 12 settimane, a seconda della dimensione della lesione.
Una cosa importante, però, è che se si colpisce nuovamente la zona dopo che si è parzialmente riparata, verrà danneggiata nuovamente, perchè è scarsamente protetta dalle fibre che il corpo ha appena ricreato. Così, il corpo dovrà smettere il suo processo di ricostruzione nella ri-superficie danneggiata e rimuoverà queste fibre e il calcio associato prima che possa riprendere la ricostruzione. Ora per chiarezza, in generale un nuovo infortunio aumenterà in modo significativo il tempo di guarigione. Quindi per contribuire a migliorare il tempo di guarigione, utilizzeremo il calore (come descritto più avanti in questo post) e utilizzeremo dei farmaci anti-infiammatori per ridurre al minimo il gonfiore, che ritarda il processo di guarigione.
Cosa fare dopo essersi infortunati è una domanda difficile a cui rispondere, soprattutto perché non c'è una risposta giusta, varia a seconda del tipo di trauma e dalla sua gravità.
Non cercherò di diagnosticare o di insegnarti come diagnosticare una lesione. Ovviamente non posso. Posso solo (moralmente e legalmente), dirti che dovresti cercare un competente parere medico, quando hai un dubbio. Vi ricordo, che molti infortuni che all'inizio potevano apparire di minore entità si sono trasformati in problemi cronici, quando non sono stati trattati in modo corretto.
Se riscontrate uno qualsiasi di questi segni allora vi consiglio di cercare il parere di un medico. NOTA: L'assenza di uno di questi sintomi non esclude un significativo danno.
  • La lesione non migliora in un tempo ragionevole.
  • Vi è un movimento eccessivo del giunto.
  • Non vi è un eccessivo rigonfiamento della zona dolorante.
  • Il livello di dolore è notevolmente superiore a quello che dovrebbe essere presente per il gonfiore e lo scolorimento. (Ciò può indicare un osso rotto che spesso non causa molto gonfiore).
  • C'è deformità del giunto.
  • Vi è una limitazione della gamma di movimenti (soprattutto se la diminuzione nella gamma di movimenti non è causata dal dolore).
  • C'è una decolorazione significativa della zona interessata (lividi).
Se si è stabilito con mezzi propri o professionali che non si dispone di un grave infortunio, allora ecco qualche consiglio generale che si potrebbe prendere in considerazione.
Le lesioni muscolari sono la causa più comune di un dolore lieve. Quando si strappa un muscolo possono accadere diverse cose. Prima di tutto vi è una fuoriuscita di sangue nella zona dolorante. Questa emorragia è ciò che provoca la colorazione che vedete, anche se questa potrebbe non essere visibile sulla superficie della pelle per diversi giorni.
In secondo luogo c'è un gonfiore che si verifica nelle immediate vicinanze della lesione. Questo gonfiore è dovuto al fatto che il tessuto danneggiato (strappo muscolare) rilascia una sostanza chiamata prostaglandina. Ci sono diversi tipi di prostaglandine, ma i tipi che vengono rilasciati in loco alla lesione causano sia un gonfiore che un aumento del dolore nella zona stessa. Lo scopo del dolore è dirti che qualcosa non va e quindi impedirti di causare ulteriori danni alla zona. Questa comprensione, tuttavia, non lo rende più facile da sopportare.
Se stiamo trattando un lieve infortunio, la cosa migliore che potete fare per esso è, ovviamente, tenere a riposo la zona. La seconda cosa da diminuire è la quantità di gonfiore. La ragione di questo è che il rigonfiamento sembra aumentare la quantità di tempo necessario per guarire una lesione.
Il modo migliore per ridurre il gonfiore della zona è di elevare la zona stessa. NON mettere un bendaggio costrittivo sull'area del gonfiore. La zona probabilmente si gonfierà comunque. Essa si espande verso l'esterno e quindi comprimere la zona danneggierà anche i vasi sanguigni. Quando ciò accade si rischia di ridurre l'afflusso di sangue alla zona interessata il che potrebbe comportare gravi complicazioni.
La seconda cosa che potete fare è di applicare del ghiaccio. Poiché il ghiaccio tende a contrarre i vasi sanguigni nella zona raffreddata (ma non li chiude completamente), il ghiaccio è uno strumento prezioso. Ci sono alcune cose importanti da sapere sul ghiaccio: per prima cosa, assicurarsi che il ghiaccio sia avvolto in qualcosa. MAI mettere il ghiaccio direttamente contro la superficie della pelle per un certo periodo di tempo. Può causare congelamento. In secondo luogo, il ghiaccio inizialmente rende il dolore della zona leggermente peggiore a causa dei brividi. Questo effetto dura per circa uno o tre minuti. Quindi la zona perderà la sensazione del dolore (sia quella del ghiaccio e il dolore originale) diminuiranno drasticamente. Il ghiaccio e il tenere la parte dolorante in una posizione elevata devono essere utilizzate esclusivamente per le prime 24 o 36 ore dopo l'infortunio.
Dopo il periodo iniziale delle prime 24 o 36 ore dopo la lesione, si utilizzare il calore. Vi sono, tuttavia, alcune regole importanti sull'uso del calore di cui la maggior parte delle persone e anche alcuni professionisti medici non sono consapevoli. Se non si presta attenzione a queste regole allora il calore farà più male che bene. La cosa importante da ricordare è che il calore non sempre aiuta in un infortunio, anche se apparentemente vi fa sentire meglio nell'area interessata. Quando si applica il calore ad una zona, si induce il corpo a dilatare i vasi sanguigni nella zona che viene riscaldata.
La dilatazione è una buona cosa perché quando i vasi sanguigni si dilatano è possibile portare più materiali e ossigeno per ricostruire la zona danneggiata e rimuovere i prodotti di scarto che si sono accumulati. Tuttavia, i vasi sanguigni sono come tubi fatti di un materiale poroso. Quando sono piccoli ci sono molti piccoli fori nelle pareti dei vasi sanguigni. Quando si espandono i tubi i fori diventano anche loro più grandi. Più a lungo applicheremo il calore a un'area, più grandi i vasi sanguigni diventeranno, fino al punto in cui non potranno più espandersi. Quando saranno completamente espansi i vasi sanguigni perderanno come un setaccio (perdonate il gioco di parole). Avranno lasciato piccole quantità di globuli rossi e una notevole quantità di perdita di proteine nel tessuto circostante i vasi sanguigni. Queste cellule rosse del sangue e le proteine si convertiranno in un breve periodo di tempo in sostanze che causano irritazione e quindi rilasciando più prostaglandine, provocando più gonfiore e più dolore.
Quello che abbiamo è una situazione in cui un po' di calore per periodi prolungati può effettivamente fare più male che bene.
Il periodo ottimale per l'applicazione di calore è di circa 15 - 20 minuti. Durante questo periodo l'importo di una maggiore quantità di ossigeno e la rimozione dei residui dalla zona superano la piccola quantità di rigonfiamento che viene prodotto. Dopo questo periodo la quantità di gonfiore supera i benefici.
Una volta che si è utilizzato un trattamento termico è necessario attendere che i vasi sanguigni tornino alle loro dimensioni normali prima di applicare nuovamente del calore. L'attuale convinzione è che il corpo richieda circa due ore per tornare alla sua linea di base. Se si attende per un periodo di tempo che è almeno così lungo, allora si può probabilmente beneficiare della successiva applicazione di calore.
Il modo corretto di applicare il calore è quello di usare un panno abbastanza caldo da poterlo sopportare, ma solo per un limite di 15 - 20 minuti di tempo. Il calore umido è meglio di un caldo secco. Alcuni dispositivi medici possono utilizzare gli ultrasuoni che utilizzati in simbiosi con il calore sulla zona interessata penetrano il tessuto molto meglio e effettivamente provocano meno gonfiore sulla superficie.
In sintesi, la cosa migliore che puoi fare per un infortunio è di tenere a riposo la zona lesionata. Utilizzare del ghiaccio e tenere in elevazione per i periodi di tempo indicati, quindi utilizzare il calore pper brevi periodi di tempo con intervalli di tempo sufficienti tra i trattamenti affinchè il vostro corpo possa tornare alla sua linea di base vascolare.

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