Učinek ishemične vadbe na bolečino in subjektivno oceno funkcije sklepa pri osebah z okvaro kolena : diplomsko delo

Teran, Ajda (author), Kacin, Alan (mentor), Ipavec, Matej (comentor), Hlebš, Sonja (reviewer)

Uvod: Po travmatski poškodbi in operativnem posegu kolenskega sklepa običajno opazimo šibkost štiriglave stegenske mišice. Neuspeh aktivacije mišice se pripisuje artrogeni mišični inhibiciji – procesu, ki zaradi živčno-mišične inhibicije preprečuje popolno mišično aktivacijo in prispeva k atrofiji mišice. Za izboljšanje mišične jakosti pri posameznikih s poškodbami kolenskega sklepa se je uveljavila ishemična vadba, tj. vadba proti majhnemu uporu s sočasnim oviranim pretokom krvi skozi aktivne mišice, ki se kot posebej uporabna kaže v primeru, ko so velike mehanske obremenitve sklepa kontraindicirane. Namen: Namen raziskave je bil preučiti učinek ishemične vadbe pri osebah s poškodbo kolenskega sklepa, pri čemer smo se usmerili na subjektivno oceno funkcije kolenskega sklepa ter na stopnjo občutenja bolečine v predelu kolenskega sklepa. Metode dela: Pacienti so bili razdeljeni v ishemično in placebo skupino. Vadbeni program za krepitev štiriglave stegenske mišice je s po tremi vadbenimi enotami na teden potekal štiri tedne. Ishemična skupina je vadila z oviranim pretokom krvi, povzročenim z napihljivo manšeto, medtem ko manšeta, napihnjena z nizkim tlakom in nameščena v placebo skupini, ni ovirala pretoka krvi skozi aktivne mišice. Pred in po obdobju vadbe so preiskovanci ocenili funkcijo kolenskega sklepa z Lysholmovim vprašalnikom. Intenziteto bolečine v kolenu so preiskovanci sistematično ocenjevali med vadbenim programom s številsko lestvico. Rezultati: Preiskovanci ishemične skupine z vadbenim programom niso dosegli značilnega (p = 0,359) povečanja subjektivne ocene funkcije kolenskega sklepa (6,8 %), medtem ko se je v placebo skupini značilno (p < 0,001) izboljšala za 17 %. Značilnih razlik v intenziteti bolečine med ishemično in placebo skupino med vadbenim programom nismo zaznali. Razprava in zaključek: Do izboljšanja subjektivne ocene funkcije kolenskega sklepa je prišlo v obeh skupinah, vendar je do večjega izboljšanja prišlo v placebo skupini. Naše ugotovitve ne potrjujejo izhodiščne hipoteze, da ishemična vadba povzroči večje izboljšanje subjektivne ocene funkcije kolenskega sklepa in občutenja bolečine v predelu kolenskega sklepa kot standardna vadba enake intenzitete. Potrebne so nadaljnje raziskave, z boljšo metodologijo.

• Language: Slovenian
• Keywords: diplomska dela, fizioterapija, šibkost štiriglave stegenske mišice, artrogena mišična inhibicija, ishemična vadba, Lysholmov vprašalnik, funkcija kolenskega sklepa
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [A. Teran]
• Year: 2024
• Number of pages: 28 str.
• PID: 20.500.12556/RUL-164347
• UDC: 615.8
• COBISS.SI-ID: 212583171
• Publication date in RUL: 23.10.2024

Secondary language

• Language: English
• Title: Effect of ischemic exercise on pain and subjective assessment of joint function in subjects with knee impairment : diploma work

Abstract

Introduction: Weakness of the quadriceps femoris muscle is usually observed after traumatic injuries and surgical procedures on the knee joint. The lack of muscle activation is attributed to arthrogenic muscle inhibition, a process that prevents full muscle activation due to neuromuscular inhibition and contributes to muscle atrophy. Low-load resistance exercise with blood flow restriction (ischemic exercise) have been shown to improve muscle strength in individuals with knee joint injuries, as they appear to be particularly useful when large mechanical loads on the joint are contraindicated. Purpose: The aim of the study was to investigate the effect of ischemic exercises in patients with knee joint injuries, focusing on the subjective assessment of knee joint function and pain sensation around the knee joint. Methods: Patients were divided into an ischemic group and a placebo group. The training program to strengthen the quadriceps femoris muscle was carried out for four weeks with three training sessions per week. The ischemic group trained with obstructed blood flow through the active muscles caused by an inflatable cuff, while the placebo group trained without blood flow obstruction. Before and after the training program, the patients evaluated the function of the knee joint using the Lysholm questionnaire. The intensity of knee pain was systematically assessed by the patients during the training program using a numerical scale. Results: In the ischemic group, no significant (p = 0.359) improvement in the subjective assessment of knee joint function (6.8 %) was achieved by the exercise program, while it improved significantly (p < 0.001) by 17 % in the placebo group. We found no significant differences in pain intensity between the ischemic and placebo groups during the training program. Discussion and conclusion: Subjective assessment of knee joint function improved in both groups, but the improvement was greater in the placebo group. Our results do not confirm our original hypothesis that ischemic exercises cause a greater improvement in the subjective assessment of knee joint function and the perception of pain in the knee joint region than standard training of the same intensity. Further studies with better methodology are needed.

• Keywords: diploma theses, physiotherapy, quadriceps femoris muscle weakness, arthrogenic muscle inhibition, ischemic exercise, Lysholm knee scoring scale, knee joint function