RIGIDITA’ DEL CORPO E DOLORE

Esiste un tratto comune che unisce disturbi e sindromi come l’artrite reumatoide, la fibromialgia, l’ipertensione epatica, l’ipertensione arteriosa e il Parkinson: si chiama rigidità. Insufficiente la definizione del “dizionario di medicina” Treccani, per il quale trattasi della “Perdita della motilità attiva o passiva per lesione di una articolazione, come nelle anchilosi, o per uno stato di ipertonia muscolare…”, la rigidità è un termine che tutti noi operatori di terapia manuale diamo molte volte per scontato senza conoscerne appieno il significato etimologico né quello diagnostico.
Prima di essere una caratteristica organica, la rigidità (“stiffness” in inglese) è una proprietà fisica misurabile dei materiali (compreso il materiale organico) e più precisamente è la capacità che ha un corpo di opporsi alla deformazione elastica provocata da una forza applicata. (In generale si dovrebbe usare il termine rigidezza quando si parla di una struttura, di rigidità quando si parla di un materiale, ma per semplicità useremo solo “rigidità”). Il suo contrario è flessibilità (o flexibility).
La rigidità è determinata:
• dal materiale, proprietà estensiva, e cioè dalla quantità e dal tipo di materiale;
• dalla forma della struttura, che riesce a conferire una diversa rigidità a parità di materiale, come nel caso di un tubo ovale o rotondo;
• dai vincoli a parità di forma e materiale (p.e. si ha una maggiore rigidezza di un palo vincolato ai due estremi, piuttosto che a un estremo solo) [Wenham 2001].
La rigidità in Osteopatia
Questa proprietà può essere applicata a tutti i materiali e strutture ed anche al tessuto biologico; per valutarne l’importanza dell’impatto nel mondo osteopatico si rende necessaria una sua contestualizzazione all’interno della diagnosi osteopatica.
La diagnosi osteopatica si pone principalmente due obiettivi:
A. elaborazione di una diagnosi differenziale allo scopo di valutare la competenza del trattamento;
B. individuazione delle disfunzioni somatiche
e si basa in sintesi su tre fattori:
1. l’anamnesi;
2. la valutazione visiva;
3. la palpazione osteopatica.
Le prime due sono patrimonio di ogni esame obiettivo in qualsiasi ambito medico, ma la terza (la palpazione) è altamente caratterizzante della figura dell’osteopata, enfatizzata dalla pratica e dall’ambiente osteopatico. Tale prezioso elemento diagnostico si basa a sua volta e in ogni momento sulla valutazione di due fattori principali:
1. bilanciamento termico;
2. bilanciamento, esperienzale e soggetto-dipendente di una proprietà fisica dei materiali: la rigidità o stiffness (e il suo opposto flessibilità).
Organicamente la rigidità potrà essere determinata :
• dalla quantità di tessuto e dal tipo di tessuto stesso ( p.e. dalla concentrazione del collagene, dalla congestione di un muscolo, dalla disposizione delle proteine di titina ecc.);
• dalla forma della struttura, che riesce a conferire una diversa rigidità a parità di materiale (come nel caso di una cifosi);
• dai vincoli a parità di forma e materiale, vincoli che possono essere mio tendinei, articolari, connettivali: più ce ne sono o più forti sono e più il comparto è rigido.
Quando la rigidità è disfunzionale
A partire dal citoscheletro (Ingber,1998), l’organismo umano è caratterizzato da strutture di tensegrità. Il termine inglese Tensegrity, (coniato nel 1955 dall’architetto Richard Buckminster-Fuller, dalla combinazione delle parole tension e integrity) caratterizza la capacità di un sistema di stabilizzarsi meccanicamente utilizzando contemporaneamente forze di tensione e di compressione. Compressioni e trazioni si equilibrano all’interno di un sistema vettoriale chiuso. 
Le strutture di tensegrità sono costituite da barre rigide e cavi flessibili. I cavi costituiscono una configurazione continua che comprime le barre disposte in maniera discontinua in seno ad essa. Le barre, a loro volta, spingono verso l’esterno i cavi. In una struttura di tensegrità la resistenza dell’insieme supera di molto la somma delle resistenze dei singoli componenti, tanto che, rispetto ad una struttura a compressione e a pari capacità di resistenza meccanica il peso è circa la metà ela flessibilità è simile a quella di un sistema pneumatico; in tale sistema gli effetti delle forze di deformazione locale vengono modulati dall’intera architettura.
L’interconnessione meccanica e funzionale di tutti gli elementi costitutivi consente una continua comunicazione bidirezionale al pari di un vero e proprio network. A livello macroscopico, nell’organismo animale, gli assi rigidi (le barre) sono costituiti dalle ossa e le strutture flessibili (i cavi) dal sistema mio fasciale.
La tensegrità animale, al contrario di quella vegetale, è variabile e adattativa, si attivano cioè mappe e schemi per creare e variare i poligoni di resistenza tensegritiva, riorganizzando le strutture osteo-connettivali secondo la funzione che si appresta a compiere, trasformando le mappe, che fanno parte delle rappresentazioni cerebrali del movimento, o engrammi motori, in codice nervoso che, attraverso la via tronco-encefalica e poi midollare, arrivano ai motori muscolari periferici; questa riorganizzazione aumenta in maniera transitoria e fisiologica la rigidità (stiffness) della struttura in funzione. Un esempio di funzione tensegritiva è la manovra di Valsalva nell’azione del sollevamento pesi: la contrazione sinergica dei muscoli dell’addome e degli altri muscoli respiratori trasforma la cavità addominale in una vera e propria camera gonfiabile, racchiusa da pareti molto rigide e resistenti; alcuni studi hanno dimostrato che questa azione permette di aumentare sensibilmente l’efficacia della leva di estensione del tratto lombare (Essendrop et al.2004).
La messa in tensione di specifiche strutture sta alla base del movimento di qualità, ma un irrigidimento delle strutture diaframmatiche si rende indispensabile anche per l’esecuzione di un piccolo passo. All’aumentare della richiesta di velocità, potenza o precisione, la struttura corporea deve aumentare l’offerta di stabilità.
Al termine della funzione la rigidità decade, se al termine della funzione la rigidità non dovesse decadere si strutturerà una rigidità (o stiffness) disfunzionale.
In ogni momento l’osteopata bilancia lo stato del tessuto valutando più livelli, dal più superficiale al più profondo, e più strutture, dalla più semplice alla più complessa. Egli esprime perciò una diagnosi palpatoria riferendosi ad uno stato di rigidità (stiffness) che riguarda la fascia, i visceri, i muscoli, le articolazioni, le ossa, e le strutture complesse come per esempio il complesso C0-C1-mandibola della testa.
Le disfunzioni possono essere determinate da cambiamenti della natura del materiale (alterazioni metaboliche), della forma (asimmetrie), o dei vincoli (restrizioni di mobilità); tutte comporteranno una variazione nel senso restrittivo della rigidità (stifness). Il percorso didattico-esperienziale dell’osteopata lo porta a riconoscere uno stato di rigidità anomala che possiamo definire RIGIDITA’ DISFUNZIONALE.
Ogni Rigidità disfunzionale racchiude in sé le evidenze della “disfunzione somatica”:
• restrizione di movimento/mobilità;
• asimmetria anatomica;
• alterazione della qualità tissutale o del tono dei tessuti molli.
Possiamo perciò affermare che la RIGIDITA’ DISFUNZIONALE è una disfunzione somatica e può essere effetto e allo stesso tempo causa di una restrizione di mobilità.
dr. Luongo Luca
cell 3394565506

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