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Stabilization of knee joint in Female football players while respecting their menstrual cycle without the use of hormonal contraceptives
VOCEDÁLKOVÁ, Simona
The issue of the knee joint and its structures is nowadays in the field of sport very current. It has to do with the increasing demands that are placed on the muscular and ligamentous apparatus. The knee joint is a complex functional unit, which consists of many bones and intraarticular services. Tibia, femur and among themselves to create articulation femorotibiall and femoropatellar. Both of these joints form one jointknee anatomy. In connection with its specific structure allows this complex anatomical element of two seemingly incompatible features-stability and mobility. The stable position of the knee from the energy point of view, it is economical. On both of the functions involved in dynamic and static stabilizers. The first group consists of the active support and is represented by the muscles. The second group provides passive support joint and this includes ligaments, menisci, joint capsule, and the shape of the joint surfaces. In the women's football are the most traumatized by the lower limb especially the ankles and knees. According to Engebretsena and Steffena (2006) make up 26% of all knee injuries in women's football. In the world of football is more than men's soccer players to injury knee ligament-mainly anterior cruciate ligament. 70% of this ligament is injured uncontact mechanism. In the LCA is the receptor of sex hormones-estrogen and progesterone. These hormones have a direct effect on the structure of the LCA. The menstrual cycle (MC) is increeasing laxity of the knee joint during ovulation and the luteal phase (15. day of the MC-the end of the MC). In this period, the female knee is the most susceptible to injury. This thesis deals with the issue of just the knee joint in the world of football. It also discusses the regular fluctuations in endogenous female hormones and their effects on the ligament laxity . The theoretical part is focused on football, the differences between women and men and predilection places in the women's football injuries. Special chapter then describes the specifics of the female knee. The end of the theoretical part is devoted to the physiology of the menstrual cycle, the female sex hormones and their effects on ligaments. The main task of this work was to build a specific system of exercises for the world of football. The SSC is focused mainly on strengthening muscles involved in the movement in the knee joint and to stabilise this joint. The SSC should serve as a complement to the classical training and was included in the training units for a period of two months. Another aim was to compare the effectiveness of SSC groups A and B. Members of the group A trained in the different phases of the menstrual cycle for exercise, which should positively affect the stability of the knee joint in relation to increased or decreased ligament laxity, due to the action of female hormones. The group B then didn´t take account of the MC physiology. In the practical part of the thesis was used the method of qualitative research. Four players in one of the South Bohemian football team were examined. Research file is moved between the ages of 19 to 26 years of age. The girls did not use hormonal contraception at the time of reserch. For the refinement of the input and output of measurement results, I investigated the players between 5.-6. on the day of their MC with the opening two months. Objectification of the results I achieved by using four specific tests. One of these tests was to score one of the Functional movement screen. Input rating in the FMS range 22-25 points. When the output rating rose to 27-30 points. My work is probably the first of this focus. Its contribution could be a reduction in the number of injuries of the knee joint in the world of football. I consider the work of the information material for trainers, implementation teams and the female football players. In the future, can become a catalyst for further research into the issue.
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Specificities of physioterapy care after the convetional implantation of a total knee-joint in relation to its different surgical solutions
ŠMITMAJER, Jakub
The main aim of this bachelor study is concentrated on an after- total- knee- joint endoprosthesis physiotherapy from the surgical solution point of view. The total endoprosthesis is used as the very last possible option of an invasive means of therapy that is possible to take an advantage of when there is extensive damage of biomechanics of a knee joint. When speaking about the frequency of this operation, it is very high, and it is becoming a more and more common way of surgery that is nowadays being practised. The only more frequent orthopaedic surgery these days is a total hip endoprosthesis implantation. As a result of longer durability of the endoprostheses as well as better joint stability and owing to the great technological development it is possible to use various materials for making endoprostheses. However, there are appropriate demands on both the competence of the operational and consequently the rehabilitative staff working with a complicated structure of the prostheses. The study is divided into the theoretical and practical part. First, in the theoretical part there you can find analysed anatomy and biomechanics of a knee joint. Secondly, there are described indications and contra- indications of the total endoprosthesis implantation, types of total endoprostheses as well as the possibility of consequent physiotherapy. In addition, a method of qualitative research was used in the practical part of the study. There were two groups of patients under the reseach- including two women aged between 61 and 70 in each group.A different means of surgery for the total endoprosthesis of the knee joint was applied in each of the groups. There was also the same amount of time for the research of both groups. An entry kinesiological analysis was taken the sixth day after the surgery. Consequently the output kinesiological analysis was done after the second orthopaedical check- up (approximately the third month after the surgery), when a hundred per cent tread on the operated limb was permitted. The research itself took place in a hospital, afterwards it continued in domestic surrounding at home using available aids. Providing anamneses of all patients a goniometrical, anthropometrical and palpational check- ups of the knee joint were done. Furthermore, according to Janda, a muscle test and a check- up of shortened muscle groups related to the knee- joint were done as well. A functional check- up of a knee- joint muscles and an endoprosthesis itself was included in the output kinesiological analysis. All the patients were offered the same exercise unit to make better evaluation of the research. The frequency of regular exercise was set to a four-time period per week. An anthropometric check up showed that a post surgical swelling was more significant with the patients after the lateral parapatelar cut, that slows down patients' active joining the short- period kinesiotherapeutic schedule. The range of the movement in the operated knee joint was one of the main observing aspects that much differed already at the entry kinesiological check- up. The aim of the therapy was to achieve the minimum of 90 degree- active flexion of the knee joint at the end of the research. Both the patients after the medial parapatelar cut achieved the given point a few days earlier because the patients after the lateral parapatelar cut were provided with a motorial splint. This motorial splint enabled the patients to extend the range of movement in the joint. The power of muscles did not fundamentally differ comparing the output check- ups of both the groups, however the patients after the medial parapatelar cut achieved the muscle power degree 5. In addition, after the third month from the surgery, permitting 100 per cent tread on the operated limb, a functional check- up of muscles and the endoprosthesis of the operated knee joint was taken. It revealed stronger stability of the patients after the lateral parapatelar cut
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The importance of regular fitness activities before planned orthopedic surgery
KOTLABOVÁ, Sandra
The bachelor thesis deals with the influence of regular fitness activities before the scheduled orthopedic surgery. The thesis discusses the use of special methods of physiotherapy and physical therapy to help patients prepare for their surgery and post-operative rehabilitation. The most common scheduled orthopedic surgery in the Czech Republic is a total hip joint prosthesis, it is applied up to 10 000 refunds anually. The total hip joint prosthesis is followed by a less frequent knee joint prosthesis. Implementation of any suitably chosen fitness activity before the surgery may be very useful and desirable for the patient.The current knowledge of the anatomy and biomechanics of bearing joints of the lower limb - knee and hip is summarized in the theoretical part of the thesis. This part also describes the joint compensation in detail. After that, there is mentioned the development of compensations in the course of history, as well as the different types of prosthesis and inserted components. Last but not least, there are described surgical approaches of implantation of the compensation. The theoretical part also includes appropriate physiotherapeutic procedures and methods of physical therapy that can be applied in a pre-operative period. The aim of this thesis is to explore whether regular fitness activities applied before the surgery have an impact on the course of post-operative rehabilitation. The qualitative research method was used to achieve the objectives in the practical part. The collect the data there were used case reports, interview, observation and photographic documentation. Three patients participated in the research, all diagnosed with osteoarthritis of the joint, two of them of the hip joint and one of them of the knee joint. Not a single one of those patients was cured by the conservative treatment, so they all were recommended for surgical treatment consisting of the replacement of the damaged joint. At the first meeting the medical history and the kinesiological analysis were taken. After evaluating the input data, patients were acquainted with therapeutic method. The therapy continued for one month, three times a week. After ending the therapy, the output kinesiology analysis was taken. Each of the patients told her subjective opinion about the course of the therapy and the changes experienced after treatment. All data were recorded and subsequently evaluated. During the therapy local findings were threated at the first place. Specifically the limited joint mobility, swelling of soft tissues around the joints and shortened or weakened muscles. They were used sensomotor techniques that are suitable for correction of flat foot or hallux valgus. The stabilization techniques PNF and activation HSS were used to strengthen the entire trunk and to restore the stabilizing function of the diaphragm. This was followed by the strengthening of the upper limbs to prepare them for future walking on crutches. The last point after the treatment of local findings was the setting of the joint in proper movement stereotype. When the therapy was finished, patients reported a mild pain relief and greater stability of their limb and the entire body. The collected data show also an improvement of the muscle strength of damaged joints for at least half a degree The indicator of the progress is the comparison of the goniometric examination before and after the therapy. The joint mobility was incresed. Surgical procedures were carried out without any complications and subsequent rehabilitation was with no problem for our patiens.
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Physiotherapy for patients with LCA rupture during surgical and conservative therapy
PÍCHA, Radek
The bachelor thesis deals with the issue of an anterior cruciate ligament (ligamnetum cruciatum anterius ? LCA) trauma. The anterior cruciate ligament is an important stabilizer of the knee joint. During the LCA lesion serious biomechanical changes occur. The LCA trauma most frequently happens due to forced hyperextension or rotation of the knee joint. Nowadays this injury is quite frequent, in the sports medicine it occurs in the incidence of 1 / 1750 inhabitants. The therapy of the injured LCA has been very efficient recently mainly due to modern approaches both in the medicine and the following rehabilitation. The thesis contains the analysis of the anatomy and biomechanics of the knee joint, the next part describes LCA trauma mechanisms, methods of its examination and possibilities of the successive therapy. One part of the thesis is focused on the comparison of the conservative and the surgical therapy, there are described the circumstances under which it is decided which one of these therapies will be chosen. It is necessary to mention that the most important criterions for the proper therapy choice are the individual needs of the patient. The basic aim of the thesis is the comparison of the efficiency of therapeutic procedures for particular patients and the assembly of the short-term and the long-term treatment plans. The practical part of the thesis is processed by the qualitative research method. Three probands after the surgical therapy and two probands after the conservative therapy were examined. The observation and the therapy for surgically treated patients were carried out between the second and the sixth post-operative week, the examination for conservatively treated patients was carried out for six weeks. Patients were predominantly athletes in the age of 18 ? 24 years. They passed the initial and the final kineziologic examinations and the rehabilitation therapy; the treatment efficiency was rated by the Lysholm score. The initial Lysholm score for surgically treated patients varied between 32 and 34 points and after the therapy it increased to 48 ? 75 points. For conservatively treated patients the initial score varied between 73 and 76 points and the final score was 76 ? 81 points. There is one more important detail in the thesis ? the anthropometry results. The quadriceps femoris perimeter increase was around 1,5cm and the triceps surae perimeter increase was around 1cm. The final examination showed that the majority of the patients is missing minimally 1cm in the quadriceps femoris perimeter compared to the healthy leg. The similar indicator has been found also for the muscular strength testing. The examination was focused mainly on the knee joint extensors and flexors testing. All patients proved the increase of the muscular strength; surgically treated patients reached muscular strength maximally 4+. The short-time rehabilitation plan is initially based on the edema and pain elimination. Subsequent rehabilitation step is the training of the walking with the help of French canes and the knee joint motion range recovery and its stabilization. The aim of the long-term rehabilitation plan is the gradual return to social and sport activities. The basic factor of the long-term rehabilitation plan is good muscular training. In the conclusion it is important to mention that it is not possible to state which therapy (surgical or conservative) is more suitable or efficient, during the decision making process it is necessary to consider individual needs of a particular patient. The thesis may be utilized in the clinical practice of physiotherapists for the improvement of the care of the patient who is diagnosed with rpt. LCA.
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