Fizioterapija s poudarkom na ekscentrični vadbi pri pacientu s kronično bilateralno patelarno tendinopatijo - poročilo o primeru : diplomsko delo

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

Uvod: Patelarna tendinopatija ali drugače poznana kot »skakalčevo koleno« je klinična diagnoza bolečega in disfunkcionalnega patelarnega ligamenta in najpogostejši znani vzrok bolečine v predelu patelarnega ligamenta. Pacienti s patelarno tendinopatijo so zaradi bolečine omejeni v športnih aktivnostih kar negativno vpliva na zdravje in kakovost življenja in lahko pomeni konec kariere profesionalnega športnika. Mehanizem nastanka patelarne tendinopatije je še vedno neznan. Poznanih je več postopkov za obravnavo patelarne tendinopatije, vendar jih je le malo podprtih z dobrimi dokazi. Kot najučinkovitejša metoda se je izkazala terapevtska vadba za mišice ekstenzorje kolenskega sklepa. Namen: Namen je predstaviti primer individualnega programa fizioterapije s poudarkom na ekscentrični komponenti vadbe pri pacientu s kronično bilateralno patelarno tendinopatijo. Metode dela: Primer predstavlja 20-letni košarkar, ki je imel kronične bolečine v predelu narastišča patelarnega ligamenta na pogačico. Na podlagi ugotovitev fizioterapevtskega pregleda smo oblikovali individualen program fizioterapije. Program je obsegal začetni del s postopki instrumentalne fizioterapije in individualiziran program terapevtske vadbe, ki je obsegala koncentrične, ekscentrične in izometrične vaje. Kot merilo napredka pacienta smo uporabili subjektivno oceno intenzitete bolečine na 10- stopenjski vizualni analogni lestvici, izračun skupne količine vadbe in izmerjen tri-ponovitveni maksimum na trenažerju za potisk noge. Po letu in pol je bilo izvedeno ponovno testiranje. Rezultati: Stopnja intenzitete bolečine se je pri pacientu znižala iz začetnih 8 za desno nogo in 6 za levo nogo v mirovanju na 0 za obe nogi med obremenitvijo. Med izvajanjem vadbenega programa se je izračunana skupna količina vadbe povečala iz začetnih 2700 kg vse do 5600 kg. Maksimalno ekscentrično breme treh ponovitev na trenažerju za potisk noge se je povečalo iz 50 kg na 165 kg. Razprava in zaključek: Fizioterapija pacienta s kronično bilateralno patelarno tendinopatijo je zapleten proces, ki zahteva individualen pristop. Zaključimo lahko, da je bil izvedeni program fizioterapije pri našem preiskovancu uspešen tako z vidika fizioterapevtske obravnave kot tudi iz vidika zdravstvene vzgoje pacienta. Izboljšanje stanja, ki je bilo doseženo med fizioterapevtskimi obravnavami, se je ohranilo vse do ponovnega testiranja leto in pol po zadnji fizioterapevtski obravnavi.

• Language: Slovenian
• Keywords: bolečina patelarnega ligamenta, terapevtska vadba, preobremenitev
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-109084
• COBISS.SI-ID: 5664619
• Publication date in RUL: 21.08.2019

Secondary language

• Language: English
• Title: Physiotherapy program with an emphasis on eccentric exercise in a patient with chronic bilateral patellar tendinopathy - a case report : diploma work

Abstract

Introduction: Patellar tendinopathy, commonly known as jumper's knee, is a clinical diagnosis of a painful and dysfunctional patellar tendon. It is the most common cause of patellar tendon pain. Patients with patellar tendinopathy can engage in limited sporting activities, which is negatively affecting their health and quality of life. For elite athletes, patellar tendinopathy can often lead to a forced finishing of career. The mechanism of developing patellar tendinopathy is not well known and there are few therapeutic interventions with good evidence to support their use. Currently, the most effective treatment is eccentric resistance training for knee extensor muscles. Purpose: To present an individualized physiotherapy program with an emphasis on eccentric exercise in a patient with chronic bilateral patellar tendinopathy. Methods: The patient was a 20-year-old basketball player who had been having problems with patellar tendon pain for the last two years. Based on the data gathered from the evaluation, we developed an individualized physiotherapy program. The program consisted of the initial phase comprising passive physiotherapy interventions and the intermediate phase comprising therapeutic exercise. The training program placed emphasis on eccentric exercise, but it also included some concentric and isometric exercise. Subjective pain intensity was measured with a visual analog scale, total training volume and a three-repetition maximum on the leg press machine were used as outcome measures. After a year and a half, we did a follow-up evaluation. Results: Subjective pain intensity has reduced from 8 for the right leg and 6 for the left leg to 0 for both legs. Total training volume has increased from 2700 kg to 5600 kg. The three-repetition maximum on the leg press machine has increased from 50 kg at the first training appointment to 165kg at the last training appointment. Discussion and conclusion: Physiotherapy of patients with chronic bilateral patellar tendinopathy is a complex process, which demands an individualized approach. It can be concluded that our physiotherapy program was successful from both the therapeutic and educational point of view. The patient successfully integrated the strategies used in our therapy program into his sporting activities and remained pain-free at the follow-up evaluation.

• Keywords: patellar tendon pain, therapeutic exercise, overuse