The clinical entity ankylosing spondylitis (Marie-Strümpell Parkinson's disease Bechterew, pelviespondilite ossificans, rheumatoid ankylosing) spondylitis is a form of negative serum disease characterized by progressive joint involvement and iliac-sacral vertebrae ossification in these joints can be around her and called anquilose (Salter, 2001).
Until the last decade, EA was not considered a disease common with rheumatoid arthritis found mostly young men (SCOLA et al, 2003). And 'know that today, when less severe forms of illness are recognized and included, ankylosing spondylitis is almost as common as rheumatoid arthritis and also that young women are affected almost as often as young men (Salter, 2001).
Although the cause is not known precisely, the importance of a predisposing genetic factor has been underlined by the discovery that 96% of Caucasians are carriers of the EA with inherited tissue antigen HLA-B27, which serves as a genetic marker . This particular antigen is present in 05% to 15% of all Caucasians, including the holders of antigen, only 20% develop the EA (DOUGADOS, 2005).
In contrast to rheumatoid arthritis that attacks the synovial membrane, ankylosing spondylitis affects the insertion site of tendons, fascia and fibrous joint capsule (Salter, 2001). The disease process is a progressive fibrosis and ossification in peri-articular soft tissue, called enthesopathy this process eventually leads to bone anquilose across the joint (Wilfred, 2005).
Some of the manifestations of EA are cardiovascular complications occur in up to 10% of patients with clinically over 30 years, and the proliferation of fibrous closure of the aortic valve and aortic regurgitation due to aortitis and occasionally può verificarsi mitrale. Fibre di Purkinje può essere compromesso che porta a un difetto di guida (Shinjo, 2007).
Altri eventi extra - articolare può apparire come acuto anteriore uveite, noto anche come irite acuta o iridocyclitis, sintomi come lacrimazione, fotofobia, ed evitare di visibilità; cardiovascolari coinvolgimento è raro, da 3 a raggiungere il 10% della popolazione tra 15 e 30 anni di malattia, ma quando presente, può manifestarsi di insufficienza aortica, aortite verso l'alto, insufficienza vascolare, cardiomegaly, pericardite e disturbi del sistema delle patenti di guida; pregiudizio del parenchima polmonare, si verifica in circa il 1,3% dei pazienti.
In generale, 20 anni after the onset of the disease, neurological damage, such as cauda equina syndrome tends to follow in the late stages of the disease, renal events such as a deposit of amyloid is an occasional complication, appears to be present in 10% of patients, enteric mucosal injury silent or asymptomatic in the third terminal ileum and colon, were found in ileocolonoscopia 30 to 60% of patients with EA (YOSHINARI & Bonfire, 2000).
peripheral joints can be characterized by the presence of oligoarthritis that predominate in the joints of the lower extremities like the ankle, knee and coxofemurais upper limbs and joints, and then esternoclavicular costocondrais because of limitations in chest expansion. The demonstrations are enthesopathy initial attack and the calcaneus and plantar fascia (Oliveira, 2007).
The radiographic examination shows reduction in the initial stages of the sacrum and pelvis cartilage subchondral sclerosis, a bone scan, although not specific, can be positive in the initial phase. Later, the ossification of the fibrous ring of intervertebral sínfises produces X-ray image classic "column of bamboo" (West, 2000).
Regarding the salicylate drug regimens are the most satisfactory among the non-steroidal anti-inflammatory drugs, are usually not very effective in ankylosing spondylitis. Among the many NSAIDs evaluated correctly indomethacin is more appropriate with infliximab, although it may be replaced in future by other newer drugs (KITADAI & Meirelles, 2001).
These young patients, previously healthy, they need to be aware that at least one third of them will develop the classical form of ankylosing spondylitis.
But even psychological support to accept the importance of developing good habits of posture and exercise per day for the rest of their lives (Salter, 2001).
For there is a reduction in symptoms and improvement in the performance of the exercises hidrocinesioterapia together with the principles of physics play important role in water treatment of patients with EA.
2.1 Hydrotherapy
The beginning of the use of hydrotherapy as a treatment, is unknown. Since then, the sport is moving forward with regard to study and become very popular (Turn et al, 2000).
through the centuries and are the places where research was conducted, the treatments hidroterápicos have been recognized for its technical point out that water activities as an integral part of any physical treatment, in order to complete rehabilitation of the patient. The
Hydrotherapy is one of the oldest physical therapy, defined as the external use of water for therapeutic purposes. It is a therapeutic method that uses physical therapy that combines the principles of natural water (Carom et al, 2000).
You could say that the movement of water (hydrodynamics), makes it unique and exclusive with respect to their therapy. The knowledge of hydrodynamic and hydrostatic allow you to select the location of the patient, the depth of immersion and equipment ideal for hydrotherapy treatments.
2.1.1 physical principles of water
Every physical principle has its specific response, which when combined with mechanical actions of the therapist and the water temperature produces a quick and satisfactory end by the patient, which are:
Density : The density of water is 1.0. A person boyars if its density is less than 1.0, afundará if greater than 1.0 and will be just below the surface (float) if it is equal to 1.0 (Candeloro & SILVA, 2002).
Surface tension: It 's the attraction of water molecules on the surface of the pool. Important factor when a member of the human body breaks the water surface (Candeloro & SILVA, 2002).
Turbulence: The principle of turbulence is related to the pressure and velocity across a flowing stream. A term used to describe the redemoinhos to follow a moving object in water, while in front of the object creates a positive pressure that resists the movement is and there is una pressione negativa, che facilita lo spostamento (Fiorelli & ARCA, 2002).
Rifrazione: E 'il fenomeno fisico causato quando la luce si diffonde in media con differenti densità. A causa della rifrazione vedere gli oggetti sommersi distorta, circa il 25% al 30% più grande e più vicino (Candeloro & SILVA, 2002).
Viscosità: L'acqua è un liquido di copertura più densa di aria, e crea la resistenza nei movimenti a causa di attrito con le molecole di acqua nel nostro corpo.
Principio importante sul luogo di lavoro per il rafforzamento dei muscoli (Candeloro & SILVA, 2002).
Pressione idrostatica: La legge di Pascal afferma that the liquid pressure is exerted in all areas of the surface of an object varies with the depth and density of the liquid. With the pressure increases with depth, the swelling is reduced more easily if it performs below the water surface. This principle helps to develop the coordination of movements, provide better support and maintain the body in positions that require more balance (BATES & Hanson, 1998).
Buoyancy: When a body is completely or partially submerged in a liquid at rest is increased force equal to the weight of the displaced liquid, called buoyancy. According to Archimedes the result of the effect buoyancy is the fluctuation. The buoyancy force acts in the opposite direction of gravity and is responsible for the sensation of weightlessness in water. (Fiorelli & ARCA, 2002).
The therapeutic effects of hydrotherapy are linked to promote muscle relaxation, reduce pain, allow the execution of movement, without pain, all of its normal range of motion, reducing intra-articular forces compressivas; reduces chronic inflammation ; maintain muscle strength and endurance, maintain the functional capacity of the locomotor system, improve breathing capacity, reduce swelling, allowing better balance and coordination, promote the socialization of the patient, to improve the patient's self-esteem, improve the attitude of the disease, improve activities of daily living (FREITAS JUNIOR, 2005).
also submerged the physiological effects will depend on such factors as water temperature, pool depth, type and intensity of exercise, duration of therapy, the patient's posture and pathological (Fiorelli & ARCA, 2002).
greater the depth, the greater the hydrostatic pressure, causing increased venous return to heart, this is considered the basis for all the physiological changes associated with immersion in the cardiovascular system, the system and the kidney hormone, central nervous system, respiratory system, musculoskeletal (Turn et al, 2000).
The aquatic environment makes the patient relax and feel more freedom of movement, which helps in rehabilitation. The risk of falls and fall, with the fear that too much. The pleasure of water sports leads the individual to a sense of relaxation, lightness, freedom and experimentation, to make the sessions more enjoyable and mode of social interaction (Roque, 2007).
2.2 Water Pilates techniques
It started with Joseph Pilates, the German who lived between 1880 and 1967, developed a series of exercises and equipment to help the wounded from the war to recover mobility and strength. Then he emigrated to New York and his method has become popular among the dancers to provide at the same time, tonifying, strength and stretching muscles (Gonzalez, 2006).
2.2.1 Performance of Water Pilates
stretching, stability and core strength, injury prevention, stress reduction and back pain, improved posture, increasing balance and coordination, improved athletic performance, efficiency in post-rehabilitation, increased body awareness, improvement in self
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