Učinki terapevtske vadbe za mišično dezinhibicijo pri pacientki z izrazito pooperativno oslabelostjo mišice quadriceps femoris – poročilo o primeru : diplomsko delo

Mlakar, Marko (author), Kacin, Alan (mentor)

Uvod: Po poškodbi ali operaciji kolena je običajno opažena izrazita šibkost in atrofija mišic ekstenzorjev kolena, zlasti m. quadriceps femoris. Jakost in vzdržljivost m. quadriceps femoris sta bistvenega pomena za normalno funkcijo kolenskega sklepa. Pomemben osnovni dejavnik dolgotrajne šibkosti m. quadriceps femoris po poškodbi kolena je artrogena mišična inhibicija. Kljub vadbi proti uporu, ostaja zaradi artrogene mišične inhibicije mišična zmogljivost m. quadriceps femoris nespremenjena ali se celo zmanjša. Namen: Namen diplomskega dela je ovrednotiti učinkovitost fizioterapevtskih postopkov za mišično krepitev in aktivacijo pri pacientki s kronično oslabelostjo m. quadriceps femoris zaradi pooperativne okvare kolenskega sklepa. Metode dela: V diplomskem delu je opisana 44 letna pacientka, ki je bila vključena v 16 vadbenih enot. Pacientko smo testirali in merili dvakrat, pred in po terapevtskem programu. Pri tem smo izvedli inspekcijo, palpacijo, goniometrične meritve kolenskih sklepov, merjenje obsegov spodnjih udov, kožne gube in telesne mase, Y-ravnotežni test, test sestopanja s stopnice z eno nogo in meritve maksimalnega navora hotene izometrične kontrakcije (angl. maximum volitional isometric contraction) ekstenzorjev in fleksorjev obeh kolenskih sklepov. Rezultati: Po terapevtskem programu se je večina merjenih spremenljivk operirane noge izboljšala. Pusti obseg stegna operirane noge se je distalno povečal za 1,3 cm (3,9 %), proksimalno pa za 2,3 cm (5,5 %), telesna masa pacientke se je povečala za 3,1 kg, pri izvedbi Y-ravnotežnega testa se je doseg operirane noge v smeri anteriorno povečal za 10,5 cm, posterolateralno za 29 cm in posteromedialno za 32,5 cm. Maksimalen navor hotene izometrične kontrakcije ekstenzorjev operiranega kolena se je povečal za 6 Nm (14 %). Razprava in sklep: Uspelo nam je doseči večino zastavljenih ciljev, in sicer povečati mišično jakost in vzdržljivost, spodbuditi hipertrofijo in dezinhibicijo m. quadriceps femoris operirane noge, izboljšati funkcijo in zmanjšati bolečino operirane noge, odpraviti strah med hojo in obremenjevanjem ter doseči normalen vzorec hoje. Na podlagi rezultatov lahko zaključimo, da je bila izbira protokola fizioterapevtskih postopkov ustrezna in učinkovita.

• Language: Slovenian
• Keywords: šibkost mišice quadriceps femoris, artrogena mišična inhibicija, ishemična vadba, operacija kolena, terapevtski program
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-107940
• COBISS.SI-ID: 5636971
• Publication date in RUL: 10.06.2019

Secondary language

• Language: English
• Title: Effects of therapeutic exercise for muscle disinhibition in a patient with substantial postoperative weakness of quadriceps femoris muscle – case report : diploma work

Abstract

Introduction: After knee injury or surgery, there is usually a marked weakness and atrophy of knee extensor muscles, especially m. quadriceps femoris. Strength and endurance of m. quadriceps femoris are of vital importance for normal knee joint function. An important underlaying factor of long-term m. quadriceps femoris weakness after knee injury is arthrogenic muscle inhibition. Regardless of resistance training m.quadriceps femoris strength remains unchanged or is even reduced due to arthrogenic muscle inhibition. Purpose: The aim of this diploma work is to evaluate the effectiveness of physiotherapeutic procedures for strengthening and activation of muscles in a patient with chronic m. quadriceps femoris weakness because of postoperative knee joint impairment. Methods: In diploma work a 44 year old patient is described, which was included in the 16 exercise units. The patient was tested and measured twice, before and after the therapeutic program. Inspection, palpation and goniometric measurements of knee joint were performed as well as measurements of lower limb circumference, skin fold and body mass, Y-balance test, single-leg step down test and measurements of maximal volitional isometric contraction of extensors and flexors of both knee joints. Results: Most of the measured variables of the operated leg improved after the therapeutic program. Lean thigh circumference of the operated leg increased distally by 1,3 cm (3,9 %), and proximally by 2,3 cm (5,5 %), the body weight of the patient increased by 3,1 kg, in the performance of the Y-balance test with the operated leg reach increased in anterior direction by 10,5 cm, posterolateral by 29,0 cm and posteromedial by 32,5 cm. Maximal volitional isometric contraction of knee joint extensors of operated knee increased by 6 Nm (14 %). Discussion and conclusion: We managed to achieve most of our goals, which are increase muscular strength and endurance, stimulate hypertrophy and disinhibition of m. quadriceps femoris of the operated leg, improve function and reduce pain in the operated leg, eliminate fear during walking and loading, and achieve normal gait pattern. Based on the results we can conclude that the choice of the protocol of physiotherapy procedures was appropriate and effective.

• Keywords: muscle quadriceps femoris weakness, arthrogenic muscle inhibition, ischemic exercise training, knee surgery, therapeutic program