Inhibición Artrogénica y sus

efectos sobre el sistema

neuromotor.
Jorge Ugarte Ll.
¿Qué es la Inhibición Artrogénica?
 CHAPTER 2 Physio

Generalidades.
Nerve
Artery

Ligament
Fibrous
Muscle
capsule
Synovial fringe

Fat pad Proteolytic enzym

Meniscus attack synovial a
Synovial other joint tissu
membrane
Articular cavity
containing
synovial fluid
Bursal wall
Articular
cartilage
Tendon
F I G U R E 2 - 3 Cont
Ephyseal line in perpetuation of
cycle. This keeps th
 Aferencia Localización Velocidad de
conducción (m/s)
Grupo I HNM - OTG Músculo, cápsula 79-114
articular y ligamentos
Grupo II HNM - Propiocepción Músculo, cápsula 30-80
articular y ligamentos
Grupo III Tejido conectivo 2-30
Proppiocepción, muscular y articular,
Nocicepción ligamentos
Grupo IV Tejido conectivo <2
Nocicepción muscular y articular,
ligamentos
 a s kina e s the s ia . This ro le ha s be come ology with re cordings from s ingle ne rve this ha d be come a kind o f d o g rm , ~l'icl-,.
controve rs ia l, a nd I s ha ll a tte m p t to putfibre sa, th e tonic type o f re ce ptor wa g ha s s ince be e n e ffe ctive ly cha lle nge d.
it into pe rs pe ctive by dis cus s ing re ce nt s hown to ha ve a s pra y-like or Ruffini
re s ults re la ting to the phys iology o f jo in tne rve e nding, while the pha s ic type o f Function of joint re ce ptors- r:~-e;alu~:tion
re ce ptor ha d a la me lla te d s tructure s imila r
re ce ptors for our u n d e rs ta n d in g o f the ir The re is now e vide nce tha t ra us cle re -

Receptores articulares. role in kina e s the s iaa nd be ha viour.

Function o f joint re c e p to rs -dogma

to th a t o f the P a cinia n corpus cle , a nd wa s ce ptors c o n trib u te s ignifica ntly 'o kina e s -
ca lle d a pa ciniform e nding (Fig. 1). the s ia , a nd th a t joint re ce gt,)rs ~lone
(Othe r ne rve e ndings a re p re s e n t-fo r ca nnot s igna l s te a dy joint a nglt o~e r tF.e
All o f the me cha nore ce ptorsme ntione d e xa mple , fre e ne rve e ndings which ~na ybe wa ole ra nge o f limb move me nt. How did
Receptores de Ruffini: 2 a 6 corpúsculos a bovedelgados
- mus cle ,ys kin, a nd jo in t re ce ptors- a s s ociaEstos
encapsulados te dwith pa 4 in.)
tipos de receptores s uchinforman
a re ve rs a l oal f opinion come a b o u t?
inervados por un axón mielinado. sistema de la posición, desplazamiento,
could c o n trib u te in fo rm a tio n a b o u t the It wa s s hown tha t a lthough e a ch s low y h rs t, the obs e rva tions on co, ling o f joint
Receptores dinámicos y estáticos, sensanpos ition o r move me nts o f o u r limbs . a d a p tinvelocidad
posición y desplazamiento articular, g re ~:e ptor fire y daceleración
only ove r a del movimiento
a ngle by the re ce ptors we re c,~.a lle nge d.
velocidad angular y presión intraarticular. como también de algún estímulo
P e rha ps the firs t e xpe rime nta l a tte m p t to limite d ra nge o f joint a ngle , with a Burge s s a nd Cla rk~ s hmse d tha t in a
dis tinguis h be twe e n the s e a lte rna tive ma ximum
nociceptivo
ra te in the middle
en la
o f the ra nge
articulación,
la rge s a mple o fsin 209 s lowly a da pting re -
embargo, parecen tenerce una
ptors
fuerte
fro m the ca t's kne c joint, ru n n in g
s ource s o f informa tion for pe rce ption wa s a t the influencia 'be s t a ngle ',sobre
the s e r~nge s ove r-
las neuronas fusimotoras
th a t o f Golds che ide P6, who a na e s the tize d la ppe dque in s uchsobrea wa y tha last the motoneuronas
whole in the p o s te rio r a rticula r ne r'.'e , only fo u r
alfa,
the jo in t ca ps ule s o f the inde x finge r a nd e xte nt modulando o tjo in t move measí ntv,ala actividad
s cove re d - a t del
we reHNM.
s pe cifica lly a ctiva te d a t inte rme dia te
Corpúsculos de Pacini: terminaciones conclude
gruesas dencapsuladas.
th a t impuls e s aPoseen
ris ing fro m the
bajo
umbral al estrés mecánico y sensan aceleración.
joints , we re mos t im p o rta n t, a n d th a t
s e ns ory in fo rm a tio n fro m liga me nts , te n-
dons , a n d ra us cle s a ls o pla ye d a role .
S imila r e xpe rime nts in the 1950's e m-
pha s ize dth e ~mporta nceo f jo in t re ce ptors
in kina e s the s ia6,~ while the im p o rta n c e o f
re ce ptors an mus cle s o r te n d o n s wa s
Receptores Golgi: corpúsculos fusiformes d o wnencapsulados
ra d e d a s a resimilares d e al OTG.
Poseen alto umbral y monitorean tensión engligamentos, s ult o f todo
sobre m oen
n s tra tio n s
rangos extremos. th a t pulling on the te ndons o f e xtra ocula r
mus cle s6 a n d wris t fle xors~ in m a n
p ro d u c e d no cons cious s e ns a tion. Little
e vide nce c-n the involve me nt o f s kin
re ce ptors in kina e s the s iais a va ila ble .
While e vide nce wa s a c c u mu la tin g on
which o f the s e ns ory in p u ts a ctiva te d
Terminaciones nerviosas libres: ampliamenteduring: limb distribuidas,
move meparte del sistema
r'.s a ctua lly re a ch I J
nociceptivo. lO0/am
cons cious ne s s ,a p rim a ry role fo r jo in t
re ce pt()rs wa s s upporte d by d e mo n s tra -
tions ;:hat the y had the appropriate pro- Fig. 1. S ke tcho f ne rveendingsfound in the joint cap.~Me.
pe rtie s to s ignal jo int angle (or limb ( A) R uffinior s pray e ndings(s lowly adapting),(B) Paciniformendings.( Afte r Polti~eM~.)
Mecanoreceptores y su velocidad de adaptación.
Nociceptor.
TNL.

Fig. 4. Schematic overview of the receptor molecules in the membrane of a nociceptive ending. For reasons of brevity, only four
addressed: (1) Nociceptive nerve endings possess a special type of Na+ channel that is tetrodotoxin-resistant, meaning that it cannot
 2778 J. SERRA, M. CAMPERO, H. BOSTOCK, AN

Submodalidades de TNL. FIG.

3. Electroreceptive fields of mechano-insensitive C-fibers. Electrorece
sive (CMiHi, marked) mechano-insensitive C fibers on the lower leg, the foo
50-mA (crosshatched, tested for all units) fields were much larger than the 1
Mecanosensibilidad. (white) produced relatively little further increase in the electroreceptive fields
anatomical receptive field. Note that even for 100 mA, no proximal elongation
There were no major differences in electroreceptive fields based on location (l
Ten-milliampere mapping stimuli produced an eRF in the units tested— units
10 mA. Units lacking a 70- or 100-mA field in the figure were not tested wi
RECEPTIVE FIELDS OF MECHANO-INSENSITIVE C-NOCICEPTORS 1863
Variability of chemical and heat responsiveness
• CM inside the eRFs
Temperature thresholds were measured at multiple locations
within the eRFs of all CH units except three. In some units,
activation thresholds to heat and chemical responsivenesse
• CMi (Receptores silentes). c
c
R
p
Entonces, porqué se produce
la Inhibición artrogénica?
• Mecanismos periféricos.

• Mecanismos centrales.
Mecanismos periféricos.
• Disminución actividad EMG músculos según evolución.

• Inflamación – Infusión articular è Reflejo H.

• Grupos III-IV è Sensibilización periférica en Artritis Reumatoide.

Mecanismos periféricos.
• Laxitud e inestabilidad articular è Cambios estructurales o degeneración
articular.

• Daño en receptores articulares (Cápsula - Ligamentos).

• Daño en estas estructuras puede reducir aferencias.

Mecanismos centrales.
Modulación espinal.
Excitabilidad motoneuronas alfa.

• Vías inhibitorias Grupo I (Ib).

• Reflejo de flexión.
• Loop Gamma (Fusimotor).
Mecanismos centrales.
Excitabilidad corticoespinal.

• Importancia de los centros supraespinales en la actividad de las

interneuronas y motoneuronas espinales.

• Cambios en la excitabilidad cortical.

• Tronco cerebral y excitabilidad de WDR.

• Esfuerzo voluntario.
Recapitulemos…
n at other time intervals after: immediately after, 5, 10,
25, 35, and 40 minutes after (Bonferroni p,0.05). The
wave of the peroneus longus before injection was
aller than at all time intervals after (Bonferroni
0.05). No difference was detected in the H/M 28 ratio

Table 1 Peak to peak amplitude (mV) of the maximum T

H-reflex for all muscle groups at each time interval w
Time Soleus Peroneus Tibialis anterior

1 9.82 (2.39) 3.07 (1.29) 1.10 (0.49)

2 11.08 (2.57) 3.98 (1.28) 1.40 (0.48)
3 11.15 (2.83) 3.96 (1.15) 1.39 (0.47)
4 10.94 (2.62) 3.85 (1.00) 1.33 (0.42)
5 11.00 (2.73) 3.86 (1.01) 1.34 (0.47)
6 10.98 (2.73) 3.85 (1.05) 1.35 (0.47)
7 10.96 (2.67) 3.80 (1.01) 1.32 (0.45)
8 10.73 (2.85) 3.79 (1.00) 1.31 (0.44)
9 10.95 (2.56) 3.80 (1.05) 1.31 (0.45)
ure 1 Ankle after injection of saline. Note the swelling around the10 11.01 (2.69) 3.79 (1.03) 1.33 (0.48)
ral malleolus. 11 10.88 (2.58) 3.74 (1.04) 1.28 (0.43)
12 10.85 (2.58) 3.77 (1.09) 1.28 (0.43)
13 10.82 (2.63) 3.77 (1.05) 1.28 (0.44)
14 10.80 (2.66) 3.76 (1.06) 1.27 (0.45)

www.bjsportmed.com
Values are mean (SD).
 above 5% of MVC and remained above this level for 0.5 s. The ‘end’ of the in the control group. Thus, this value was compared to both the

ctional tasks performed in each exercise session: a) supine pelvic bridge, b) prone hip extension, c) active straight leg raise, d) active hip abduction. Fig. 1. Functional tasks performed in each exercise session: a) supine pelvic bridge, b) prone hip extension, c) active straight leg raise, d) active hip
 yses were performed using

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sus Statistical Parametric Mapping by the images set at a threshold of z scores of movement was always completed with

Copyright © 2017 Journal of Orthopaedic & Sp

Journal of Orthopaedic & Sports Physical Ther
Wellcome Trust Centre for Neuroimaging) greater than 3.5 and a corrected cluster
Centre for Functional MRI
the left knee) or ipsilateral (being the
same side of motion,Software Library.
side). Image an
82
and scanning parameters (3-T Siemens significance level of P = .01. The higher or the left
scanner versus 1.5-T Philips scanner). threshold and lower P value for both the withas
The results are presented standard prestatistic pr
z score (ac-
The subject-level analysis of knee participant- and group-level analyses tivation level relative to the contrast of
plied to individual data, wh
movement relative to rest was completed were selected to mitigate interparticipant ACLR versus control participants) and
nonbrain removal,
group spatial s
Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

using a z score greater than 4.6 and Move

a variability, decrease probability of motion Stop
percent signal change for each
(corrected) cluster significance thresh- artifact in the data, as well as further de- from baseline to knee 6 mm, and standard
movement in motio
Rest 30 seconds Move 30 seconds Rest 30 seconds
and realignment parameters
Regions with lower activation in ACLR Regions with higher activation in ACLR
FIGURE 1. to
group compared Experimental
control 3-Dthe
setup. The stimuli for render
flexion/extension movements were cuedgroup
with compared
a visual prompt
to control and 3 translations) as covar
and paced with a metronome. confounding effects of head
Ipsilateral
Cerebellum Ipsilateral Contralateral secondary
High-pass temporal filterin
(vermis) motor cortex motor cortex Lingual gyrus somatosensory
ion to terminal extension of the involved to assess brain activation for knee move- and time-series statistical a
or matched control knee, in this case all ment,36,37 with limited head motion arti- carried out using a linear
Journal of Orthopaedic & Sports Physical Therapy®

on the left side. The movement was trig-
gered by a 2-second visual prompt and
paced with an auditory metronome that
provided a cue to flex or extend the knee
at 1.2 Hz or 36 knee extension/flexion cy-
cles per 30-second stimulus (FIGURE 1).36,37
The knee movement session included 4
blocks of 30-second knee movements in-
terspersed with 5 blocks of a 30-second
rest. This movement paradigm was se-
lected because it is a validated technique
fact and participant discomfort.36,37 local autocorrelation corre
Knee flexion/extension is a critical tional images were coregiste
component of daily physical function, respective high-resolution T
and fMRI is limited by any accessory the standard Montreal Neu
head motion; therefore, completing a stitute template 152 using
more dynamic weight-bearing lower ex- registration. This registratio
tremity task is exceedingly difficult and lowed data from each part
has high risk to generate excessive acti- spatially aligned on a standa
vation artifact. Head movement artifact template for comparison.
was limited with padding and straps to at To our knowledge, the pre
most 1 mm absolute and 0.30 mm rela- the first to perform a whole

182 | march 2017 | volume 47 | number 3 | journal of orthopaedic & sports physical therapy
Dudas y consultas.
jugarte@ucsh.cl