Dolor y disfunción miofascial. El manual de los puntos gatil

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Sección 2  Dolor de cabeza y cuello

carga. Las fibras pectorales se pueden estirar realizando el ejer- cicio de estiramiento en la puerta (v. fig. 42-10) o colocándose en posición supina sobre un rodillo de espuma (v. fig. 42-11). Para tratar los PG de los músculos pectorales, se pueden utilizar las herramientas de autopresión para liberar los PG. Cada pro- ceso de liberación va seguido rápidamente por un rango com- pleto de movimiento activo de la región tratada. Debido a que el trapecio inferior suele ser débil, el objetivo no es estirarlo, sino liberar la tensión en la banda tensa. Así, el pa- ciente puede aplicar autopresión para liberar los PG recostado sobre una pelota de tenis posicionada para presionar los PG. También se pueden usar otro tipo de herramientas de autopre- sión para liberar los PG, aplicando presión sobre ellos (fig. 6-12). Cada procedimiento de liberación es seguido de inmediato por un rango completo de movimiento activo y calor húmedo en la región tratada. También se ha demostrado que el movimiento de inclinación escapular posterior (fig. 6-13), junto con el estiramiento asistido del pectoral menor, son eficaces para mejorar la activación del músculo trapecio inferior 57 . Cuando se utiliza una almohadilla térmica caliente y húmeda o una compresa caliente para aliviar el dolor referido por PG en las fibras inferiores del músculo trapecio, el paciente debe apli- car calor en la zona media de la espalda donde se encuentran los PG, en lugar de solo en la región supraescapular y el cuello, donde se siente el dolor. Nunca debe acostarse en la almohadi- lla; en cambio, la almohadilla debe colocarse en la parte poste- rior mientras el paciente está en semipronación. Las mujeres deben considerar usar sujetadores con tirantes cruzados en lugar de paralelos, ya que se ha demostrado que mejora la actividad del músculo trapecio inferior y reduce la actividad del músculo trapecio superior 88 . Bibliografía 1. Cooper G, Bailey B, Bogduk N. 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