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Utesnitveni sindrom kolka in kineziološki pristop k rehabilitaciji : magistrsko delo
ID Adler, Monika (Author), ID Pori, Primož (Mentor) More about this mentor... This link opens in a new window, ID Hadžić, Vedran (Co-mentor)

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Abstract
Utesnitveni sindrom kolka je z gibanjem povezana klinična motnja kolka, ki predstavlja simptomatski prezgodnji stik med proksimalnim delom stegnenice in acetabulom. Bolečina v sprednjem delu kolka se diagnosticira z utesnitvenim sindromom kolka, kadar so prisotni simptomi (bolečina, klikanje, občutek zaklenjenosti sklepa, šibkost in togost v kolku), klinični znaki (pozitiven FADIR test, omejen obseg giba v kolku, disfunkcionalni gibalni vzorci v kolčno-medeničnem sklopu) in pozitivna slikovna diagnostika (»stegnenični« in/ali »acetabularni« tip utesnitve). Trenutno so načini zdravljenja sindroma usmerjeni predvsem v operacijske tehnike. Glavni namen monografskega magistrskega dela je bil oblikovati gibalno-terapevtski program zdravljenja utesnitvenega sindroma, ki bo v pomoč pri sistematični in celostni rehabilitaciji tega sindroma. V prvem delu naloge je bil cilj podati temeljne informacije o anatomiji in biomehanskih značilnostih kolka, opredeliti morfološke značilnosti, dovzetnejše za razvoj utesnitvenega sindroma kolka in omeniti najpogostejše poškodbe kolka. Cilj drugega dela naloge je bil sistematičen pregled literature s pridobitvijo informacij o etiologiji in epidemiologiji sindroma ter predstavitev patomehanskega modela nastanka utesnitvenega sindroma kolka. V zadnjem delu magistrske naloge je bil izdelan gibalno-terapevtski program, in sicer od začetne anamneze in funkcionalnega pregleda do primera vadbenega programa za utesnitveni sindrom kolka. Ugotovljeno je bilo, da je nastanek sindroma posledica kombinacije naslednjih dejavnikov: spremenjena kostna morfologija, rizična populacija in rizične aktivnosti ter spremenjena kinematika kolčno-medeničnega sklopa. Pri spremenjeni kostni morfologiji gre za »stegnenični«, »acetabularni« ali mešani tip utesnitve. Prizadeta je predvsem mlada, aktivna populacija, katere aktivnosti vključujejo intenzivna, ciklična gibanja v smeri upogiba kolka ali ponavljajoča gibanja izven fizioloških ravnin. V določenih primerih pa so težave odraz vztrajanja v statičnem položaju upogiba kolka, in sicer kot posledica prevladujočega sedečega načina življenja. Pri obolelih so dosledno ugotovljene naslednje kinematične spremembe med gibanji, kjer je potrebna velika amplituda upogiba kolka: povečana anteverzija medenice v fazi največjega upogiba kolka, zmanjšana retroverzija medenice v ekscentrični fazi giba, zmanjšana aktivnost iztegovalk kolka, zmanjšan celotni obseg giba medenice ter pogosto povečan primik in zmanjšana notranja rotacija kolka. Oblikovani gibalno-terapevtski program temelji na prilagoditvi rizičnih aktivnosti in odpravi neugodnih gibalnih vzorcev. Program vključuje vsebine, namenjene zmanjševanju bolečine, vnetij ter kapsularne togosti (multidisciplinarno sodelovanje), razvoju kinestezije ledveno-medeničnega in kolčno-medeničnega sklopa, razvoju jakosti, sklepne stabilizacije in moči kolčnih mišic (poudarek na zadnji mišični verigi) ter mišic trupa, v zadnjih fazah pa še razvoju koordinacije v športno specifičnih situacijah s poudarkom na upogibu kolka. Program vadbe mora biti individualno prilagojen in mora upoštevati osnovna gibalno-terapevtska načela, pomembna pa je tudi aktivna vključenost posameznika pri samem procesu zdravljenja. Z učinkovitim interdisciplinarnim sodelovanjem zdravstvenih delavcev lahko odpravimo ali vsaj upočasnimo napredek sindroma in zmanjšamo tveganje za razvoj nadaljnjih patologij.

Language:Slovenian
Keywords:utesnitveni sindrom kolka, sprednja bolečina kolka, spremenjena kostna morfologija, upogib kolka, kinezioterapija
Work type:Master's thesis/paper
Typology:2.09 - Master's Thesis
Organization:FŠ - Faculty of Sport
Year:2021
PID:20.500.12556/RUL-126287 This link opens in a new window
COBISS.SI-ID:62200323 This link opens in a new window
Publication date in RUL:15.04.2021
Views:3102
Downloads:356
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Secondary language

Language:English
Title:Femoroacetabular impingement and kinesiotherapy management
Abstract:
Femoroacetabular impingment syndrome is a movement-related clinical disorder of the hip that represents symptomatic premature contact between the proximal femur and the acetabulum. Anterior hip pain is diagnosed with femoroacetabular impingment syndrome when present with symptoms (pain, clicking, weakness and stiffness in the hip), clinical signs (positive FADIR test, limited range of motion in the hip, dysfunctional movement patterns in the lumbopelvic and hip region) and imaging findings (»cam«, »pincer« or »mixed« type). Currently, approaches for treating the syndrome are focused primarily on surgical techniques. The main purpose of the monographic master's thesis was to design a structured kinesiotheraphy program for the treatment of femoroacetabular syndrome, which will help in the systematic and comprehensive rehabilitation of this syndrome. In the first part of the thesis, the aim was to provide basic information about the anatomy and biomechanical characteristics of the hip, identify more susceptible morphological features for the development of femoroacetabular impingement syndrome and mention the most common hip injuries. The aim of the second part of the thesis was to systematically review the literature by obtaining information on the etiology and epidemiology of the syndrome and to present a pathomechanical model of the occurrence of femoroacetabular impingement syndrome. The last part of this master's thesis consists of the instructions for the design of a movement-therapeutic program and the presentation of an example of such program. We found that a combination of the following factors is crucial for the development of the syndrome: altered bony morphology, risk population and risk activities, and altered kinematics of the hip-pelvic region. Altered bony morphology is »cam«, »pincer« or »mixed« type of morphology. Affected are mainly young, active individuals, whose activities include intense, cyclic movements in the direction of hip flexion or repetitive movements outside the physiological planes. In certain cases, however, the problems are a reflection of persistence in a static hip flexion position as a result of a predominant sedentary lifestyle. The following kinematic changes during movements where large amplitude of hip flexion is required have been consistently observed in patients: increased pelvic anteversion in the phase of maximum hip flexion, decreased pelvic retroversion in the eccentric phase of movement, reduced activity of the hip extensors, reduced total range of motion of the pelvis and often increased adduction and reduced internal hip rotation. The designed movement-therapeutic program is based on the adjustment of risky activities and the elimination of unfavorable movement patterns. The program includes content aimed at reducing pain, inflammation and capsular rigidity (multidisciplinary cooperation), development of lumbar-pelvic and hip kinesthesia, development of power, stabilization and strength of hip (emphasis on the posterior muscle chain) and trunk muscles, and in the last stages the development of coordination in sports-specific situations with an emphasis on hip flexion. The exercise program must be individually tailored and take into account the basic principles of movement therapy. Active involvement of the individual in the treatment process is also important. With effective interdisciplinary cooperation of health professionals, we can eliminate or at least slow down the progression of the syndrome and reduce the risk of developing further pathologies.

Keywords:femoroacetabular impingement, anterior hip pain, abnormal morphology, hip flexion, kinesiotherapy

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