Przymusowe unieruchomienie podczas kolejnej fazy pandemii sprzyja nadwadze: gdy mniej się ruszamy, a jemy wciąż tyle samo (lub więcej) – skutki są oczywiste. Eksperci podkreślają jak ważna jest dziś troska o kręgosłup, dla którego każdy dodatkowy kilogram to zagrożenie.
Nadwaga i otyłość już dziś stanowią ogromny problem w Polsce – ponad połowa z nas ma zbyt dużą masę ciała. W połączeniu z unieruchomieniem – może to być źródłem problemów ortopedycznych.
– Już po pierwszej fali pandemii trafiło do nas bardzo wielu pacjentów z bólami kręgosłupa – mówi Ewa Kunik, fizjoterapeutka z kliniki ortopedycznej Carolina Medical Center. – U części z nich problemy wynikają z tego, że – o ile wcześniej byli bardzo aktywni, uprawiali sporty – to w obliczu pandemii zaprzestali jakiejkolwiek aktywności.
Jakie symptomy świadczą o tym, że powinniśmy odciążyć kręgosłup? Oczywiście ból. Nadmierna waga może być źródłem dolegliwości bólowych nie tylko w obrębie kręgosłupa, ale i w całym ciele.
– Brak ruchu powoduje, że mięśnie i pozostałe tkanki nie są odżywiane, zmniejsza się ich elastyczność, a zwiększa napięcie – tłumaczy ekspertka. – Wtedy bywa tak, że przy prostych czynnościach dnia codziennego możemy nabawić się urazu.
Które części kręgosłupa najbardziej obciążone?
Dodatkowe kilogramy wyjątkowo źle działają na odcinek lędźwiowy kręgosłupa.
– Dzieje się tak, ponieważ odcinek lędźwiowy jest stabilizowany m.in. przez mięśnie brzucha – gdy są one osłabione, wówczas nie ma też odpowiedniej stabilizacji i kontroli mięśniowej – mówi Ewa Kunik. – Przy najczęstszym rodzaju otyłości – brzusznej – nasz brzuch „wypychany” jest do przodu, co powoduje pogłębienie lordozy lędźwiowej, czyli „wcięcia” w tym odcinku kręgosłupa. To z kolei może powodować dodatkowe napięcia mięśni przykręgosłupowych, rozciągnięcie mięśni brzucha oraz przodopochylenia miednicy, co może powodować większy nacisk na struktury w odcinku lędźwiowym kręgosłupa.
Ale to nie jedyne zmiany, wymuszane przez dodatkowe kilogramy. Odcinek szyjny nadmiernie wysuwa się do przodu, klatka piersiowa często jest zapadnięta i zmniejsza się jej ruchomość, stawy żebrowo-kręgowe są mniej elastyczne, a mięśnie międzyżebrowe – przykurczone. Może dochodzić do nadmiernego docisku na krążki międzykręgowe: gąbczaste struktury, które znajdują się w kręgosłupie, pomiędzy kręgami. Mają one m.in. funkcję amortyzującą: przenoszenia obciążeń w obrębie kręgosłupa, ale w przypadku stałego docisku (czyli np. w długotrwałej pozycji siedzącej) nie mogą być właściwie odżywione, wówczas mogą powstawać dodatkowe zmiany patologiczne – przepukliny, wypukliny, mogące powodować długotrwałe dolegliwości bólowe kręgosłupa.
– Kolejny negatywny efekt to zwiększenie napięcia mięśniowego w okolicy obręczy barkowej i odcinka szyjnego kręgosłupa – mogą pojawić się bóle głowy, szumy uszne, zaburzenia widzenia – ostrzega Ewa Kunik. – Zmienia się też statyka ciała. Gdy nasz środek ciężkości przesuwa się ku przodowi, zmienia się oś kończyn, powstają problemy z płaskostopiem, mogą tworzyć się tzw. halluksy, czyli paluch koślawy – w wyniku nadmiernego obciążenia tego punktu podparcia stopy.
Eksperci przestrzegają przed utrwaleniem się nadwagi. Jeżeli dodatkowe kilogramy towarzyszą nam przez dłuższy czas, to nastąpiły już pewne zmiany w naszym ciele, które nie zawsze są odwracalne. Oczywiście schudnięcie to pierwszy i ważny krok – przy czym ważna jest równoległa dbałość o kondycję i aktywność fizyczną.
Od czego zacząć?
Jeżeli chcemy ograniczyć tkankę tłuszczową, najlepiej wybrać się do fizjoterapeuty, który określi poszczególne etapy utraty wagi. Pamiętajmy, że organizm osoby otyłej przez dłuższy czas wytworzył różnorodne mechanizmy kompensacyjne, czyli przystosowawcze. Fizjoterapeuta nas skonsultuje i najlepiej, gdy wspólnie z trenerem ustali plan treningu dla pacjenta, dostosowany do jego warunków i ograniczeń. Gdy fizjoterapeuta współpracuje z trenerami personalnym, wówczas na bieżąco mogą wymieniać spostrzeżenia dotyczące pacjenta, dzięki temu proces ewentualnego leczenia i treningów jest sprecyzowany i indywidualnie dobrany pod potrzeby pacjenta.
Jeżeli do fizjoterapeuty zgłasza się pacjent, który ma dolegliwości bólowe lub ograniczenia wynikające z układu mięśniowo-szkieletowego, wówczas po skonsultowaniu pacjenta fizjoterapeuta przekazuje trenerowi informacje nt. priorytetowych zagadnień, na których trzeba się skupić – na co zwrócić uwagę, którą partię mięśniową wzmocnić. Eksperci ostrzegają, że nie jest najlepszym pomysłem korzystanie z ćwiczeń z Internetu – gdy ćwiczenia nie są indywidualnie dostosowane do pacjenta, mogą powodować pogorszenie stanu zdrowia zamiast jego polepszenia.
Jeśli natomiast fizjoterapeuta lub trener zaobserwują podczas pierwszej wizyty pacjenta jakieś niespecyficzne symptomy – złożone dolegliwości bólowe (np. z promieniowaniem do nogi) – po głębszym wywiadzie i badaniu mogą zalecić wizytę u lekarza. Jeśli pacjent ma takie problemy, jak zaburzenia układu krwionośnego, oddechowe – również wtedy proces ograniczania wagi powinien zacząć się od wizyty u lekarza, który może zalecić badania diagnostyczne (np. obrazowe), by wykluczyć ewentualne patologie.
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