Fizioterapevtski postopki pri pacientih s patelofemoralnim bolečinskim sindromom - pregled literature : diplomsko delo

Klopčar, Gea (author), Vauhnik, Renata (mentor)

Uvod: Patelofemoralni bolečinski sindrom je bolečina okoli pogačice ali pod njo. Nastane kot posledica neravnovesja sil, ki nadzirajo drsenje pogačice. S klinično oceno se oceni položaj spodnjih udov in kolenskega sklepa ter ugotovijo mišična neravnovesja. Zdravljenje je primarno konzervativno. Vključuje vadbo, namestitev trakov, ortoze in patelarne opornice, kombinirano terapijo, akupunkturo in edukacijo pacienta. Terapija je individualna in mora biti prilagojena posameznemu pacientu. Namen: Ugotoviti in primerjati učinkovitost različnih fizioterapevtskih postopkov pri pacientih s patelofemoralnim bolečinskim sindromom. Metode dela: Izveden je bil pregled randomiziranih kontroliranih raziskav v elektronski podatkovni zbirki PubMed. Rezultati: V analizo smo vključili sedem raziskav. Nadzorovani terapevtski program je v primerjavi z mirovanjem učinkovitejši pri zmanjševanju bolečine in izboljšanju funkcije, ne prispeva pa k boljši samooceni okrevanja. Dodatek stabilizacijskih vaj k vajam za koleno pozitivno učinkuje na bolečino, moč, funkcijo in nadzor drže pri ženskah s patelofemoralno bolečino. Program vaj zaprte kinetične verige z dodatnimi vajami za krepitev kolčnih mišic v primerjavi s programom, ki dodatno ne krepi kolka, izboljša funkcionalnost in zmanjša bolečine, ne poveča pa tudi moči kolčnih mišic. Oba programa vaj, tako za kolčni kot za kolenski sklep, privedeta do zmanjšanja bolečine in izboljšanja funkcije, vendar brez značilnih razlik med programoma. Uporaba ortoze za stopalo ni učinkovitejša od fizioterapije, vendar pa v kombinaciji z ravnim vložkom za čevelj privede do večjega splošnega izboljšanja. Dodajanje patelarne opornice vadbenemu programu vodi v manj bolečin med hojo po stopnicah in med izvajanjem športnih aktivnosti kot pa zgolj vadbeni program. Namestitev elastičnih lepilnih trakov ima poleg vaj za krepitev enak učinek na bolečino, podaljšanje tkiva in funkcijo kot zgolj vaje, prispeva pa k hitrejšemu zmanjšanju napetosti zadnjih stegenskih mišic. Razprava in zaključek: Rezultati kažejo na učinkovitost vadbenega programa za zmanjšanje bolečine in izboljšanje funkcije. Dodatno k izboljšanju prispevajo vaje za stabilizacijo in izolirana krepitev kolčnih mišic. V primerjavi z vadbenim programom uporaba ortoze ne vpliva na izboljšanje simptomatike, patelarna opornica zmanjša bolečino med aktivnostjo, elastičen lepilni trak pa prispeva k hitrejšemu izboljšanju mišične raztegljivosti.

• Language: Slovenian
• Keywords: koleno, konzervatino zdravljenje, preobremenitveni sindrom, vadba
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2018
• PID: 20.500.12556/RUL-105957
• COBISS.SI-ID: 5564523
• Publication date in RUL: 05.01.2019

Secondary language

• Language: English
• Title: Physiotherapeutic techniques for treating patients with patellofemoral pain syndrome - literature review : diploma work

Abstract

Introduction: Patellofemoral pain syndrome is pain around or behind patella. It is a result of imbalances in the forces controlling patellar tracking. The malalignment of lower limbs and the knee should be examined in clinical evaluation and established if any muscular dysfunctions are presented. Treatment is primarily conservative. It includes exercise, application of tapes, orthosis and patellar brace, combination therapy, acupuncture and patient education. Treatment should be individualized for each patient. Purpose: To determine and compare effects of different physiotherapeutic techniques for treating patients with patellofemoral pain syndrome. Methods: A literature review of randomized controlled trials was conducted in electronic database PubMed. Results: Seven studies were included in the analysis. Supervised exercise therapy is, compared with usual care, more effective for pain relief and improving function. It does not however improve self-reported recovery. Adding stability exercises to knee exercise program has positive effect on pain, strength, function and posture control for women with patellofemoral pain. Adding hip strengthening exercises to closed kinetic chain exercise program improves pain and function, but does not improve hip muscle strength, compared to exercise program alone. Hip and knee exercise protocols both results in less pain and better function, without significant differences between programs. Using foot orthosis is not more effective then physiotherapy, but is superior to flat inserts in global improvement. Patellar brace leads to less pain during stair climbing and sports activities in comparison to exercise program alone after 6 and 12 weeks. Adding application of kinesiology tapes to strengthening exercises, contributes to faster release in hamstring tightness. Discussion and conclusion: Results show effectiveness of exercise program for improving pain and function. Stabilization exercises and isolated strengthening of hip muscles lead to even greater improvements. Compared to exercise program, foot orthosis does not improve symptoms, patellar brace relieves more pain during activities and kinesiology tape leads to faster improvements in flexibility.

• Keywords: knee, conservative treatment, overuse syndrome, exercise