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Anterior cruciate ligament injuries are more common in athletes who participate in active sports that require sudden changes of direction and a lot of running with stops, such as during soccer or tennis. possible.
Assess the risk.
Stand facing the mirror, the legs should be shoulder-width apart. Sit as much as possible by giving the pelvis back. At this time, the heel should not leave the floor and the waist should not be rotated.
Prevention.
In order to strengthen the muscle group related to the knee joint and to maintain its flexibility naturally, it is necessary to perform planned movements, and to develop deep perception (deep perception), balance and balance movements must be repeated constantly.
Complete or partial tears of the cruciate ligament take the main place among the traumas of various origins of the knee joint. There are 2 cruciate ligaments, front and back, and they are located crosswise between the thigh and cane bones. The anterior cruciate ligament fixes the joint and prevents the tibia from moving forward as a result of movements. Posterior cruciate ligament prevents pathological displacement of the knee backwards. Due to its anatomical characteristics, the anterior cruciate ligament is subjected to more loading, which is why it is more often damaged than the posterior cruciate ligament.
2 4 This pathology significantly reduces a person's quality of life:
- a complete or partial rupture of the cruciate ligaments occurs as a result of trauma, which interferes with the normal function of the knee joint;
- violation of the stability and stability of many elements of the joint;
- limitation of movement due to joint edema;
- strong pain syndrome and instability in the joint;
- the injured knee joint no longer performs the support function;
Disruption of the integrity of both cruciate ligaments leads to weakening of the blood supply to the joint (causing hemarthrosis), which makes it impossible to restore the ligaments without treatment.
A complete tear of one or both cruciate ligaments can be completely repaired through surgical reconstructive plastic surgery and post-operative rehabilitation. It is possible to treat patients with incomplete hernias conservatively. If the problem is not eliminated in time, it can lead to severe form of arthritis observed in these patients with locomotion disorders, or even complications that result in disability.
Causes:
Cruciate ligament ruptures in the knee joint are mainly found in people engaged in processional sports (football players, basketball players, skiers) or people who are likely to be exposed to physical stress and trauma to the knee joint in their professional activities. Sometimes even people who engage in active recreation can suffer such injuries.
-A blow to the knee joint from behind - causes damage to the anterior cruciate ligament.
-Frontal blow to the knee joint - causes damage to the posterior cruciate ligament.
- the anterior cruciate ligament is damaged as a result of a sudden rotation of the femur on the tibia while standing on a stable leg
- sharp rotation of the thigh without displacement of the knee and ankle joint in that direction.
- when performing high jump movements
According to the frequency of occurrence, cruciate ligament tears are more common in women than in men. There are various reasons for this:
-The fact that the thigh muscle (quadriceps muscle) is better developed and stronger in men than in women ensures the stability of the knee joint.
- The wider pelvis in women increases the angle of attachment of the thigh to the knee joint, which increases the risk of injury.
– Hormonal background. The amount of progesterone and estrogen hormones (female sex hormones) in the body affects the elasticity of the ligament apparatus, and the high amount leads to weak ligaments.
-Variation of the rate of contraction of thigh muscles. Compared to women, men's thigh muscles contract at a slower rate. Therefore, the amount of load on the anterior cruciate ligament is greater in women, which can cause a tear.
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Classification and symptoms
Cruciate ligament damage is divided into 3 degrees according to severity:
- First degree-microtear - Acute pain is observed, slight swelling of the knee is noted, while the stability of the knee joint is preserved, a slight restriction of movement is observed.
-Secondary- partial tear- Occurs due to repeated microtraumas, for example, when performing a simple turning movement of the leg. The symptoms are similar to the first degree.
-Third degree – complete tear- The ligament is divided into 2 parts. Considered a more severe form, it is observed with a sharp pain, significant edema in the knee joint, complete limitation of movement, instability of the joint and impaired support function.
The anterior cruciate ligament is injured by a sudden rotation of the femur on the tibia while standing on a stable leg. Patients say that there is a "sound" coming from their knees and after a few minutes there is swelling and limitation of movement in the knee. Due to severe pain, a football or basketball player cannot continue playing sports. In chronic cases, these patients feel as if they are "pressing on space". Depending on the severity of the trauma, anterior cruciate ligament injuries can be seen along with injuries to the outer meniscus and inner meniscus of the knee. In elderly people, the rupture of the ligament occurs more often from its trunk, and in children, from the place of attachment to the cane bone. The principles of treatment differ according to these characteristics.
Diagnostics
The diagnosis is determined based on the results of clinical and instrumental examinations. It is important to determine whether this ligament is completely or partially torn. The application of special clinical examination methods that show the violation of the integrity of this ligament helps to determine the nature of the tear in 90%. In very rare cases, the clinical examination does not provide detailed information (if the knee is very swollen and the pain is severe). In this case, the diagnosis is confirmed by a repeat examination after 1 week. Then the objective examination is completed by MRI.
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Treatment
Grade 1-2 tears of the cruciate ligaments of the knee joint are treated conservatively, while grade 3 tears are indicated for surgical operation.
Conservative treatment
1. The initial stage of conservative treatment is aimed at reducing edema and pain syndrome.
- Ice is applied to the injured joint
- If blood accumulates in the joint, a puncture is performed
- It is recommended to wear a plaster or orthopedic bandage on the injured knee joint for the purpose of immobilization for one month.
- For the purpose of treatment, non-steroidal anti-inflammatory drugs and painkillers are used.
2. The second stage of treatment - (3-4 weeks after the trauma) At this stage, the plaster placed on the knee joint or other orthopedic devices used for the purpose of immobilization are removed, the tone of the muscles and the movement function of the knee joint are restored. It is during this period that physiotherapeutic, rehabilitation and therapeutic sports methods give a high effect. Cryotherapy, magnetotherapy, ultrasound therapy, and short wave therapy are applied to patients. At the same time, high-frequency laser therapy and shock wave therapy are recommended in order to reduce edema and pain and increase blood circulation.
3. The third stage of treatment - after 1.5 months, continuous therapeutic sports and rehabilitation measures are re-evaluated by the doctor. The effectiveness of the treatment is determined by the disappearance of the signs of instability of the knee joint.
Rehabilitation is divided into 3 periods:
-Acute period (0-3 weeks)
-Subacute period (3-6 weeks)
-Chronic period (6-12 weeks)
The main goal of physiotherapeutic and rehabilitation therapy is to restore joint mobility and function, increase muscle strength, weight bearing and comfortable walking, restore strength and stability, joint stability, and eliminate pain and lameness.
Basics of anterior cruciate ligament rehabilitation
Before surgery
1-2 weeks
Target: initiate weight bearing, EHA 0-75 degrees, full extension, soft tissue mobilization
Exercises: Use of orthotics and braces, straight leg raises, isometric movements of the vastus medialis, EHA and mobilization exercises
2-4 weeks
Target: EHA 0-110 degrees, pain control, soft tissue mobilization, exclusion of varus/valgus moments
Exercises: EHA, ankle raises, passive stretching exercises, functional strengthening exercises
If there is a hamstring graft, it is necessary to completely exclude active hamstring exercises until the 2nd week, and stable kinetic hamstring exercises until the 4th week. At the same time, if there is a patellar tendon graft, it is necessary to exclude sustained leg extension.
4-6 weeks
Target: EHA 0-115 degrees, soft tissue mobilization, hamstring strengthening
Exercises: Single leg exercises, aerobic exercises, proprioception / balance exercises
6-8 weeks
Target: proper strength and balance
Exercises: Lateral exercises, eccentric control
12-14 weeks
Objective: Functional assessment
Exercises: Correct walking
14+ weeks
Target: Correct balance/coordination/thigh muscle strengthening, stability
Exercises: specific exercises
Rehabilitation after surgery
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Phase 1
Maintain graft fixation
Control of inflammation
Lowering the immobilization threshold
CPM should not be used
Full extension and 90 degree knee flexion
Using a drop-lock brace in extension
2 Weight bearing as tolerated using crutches (crutches can be waived in patients with positive quadriceps control after 7 days)
Therapeutic exercises:
Isometric movements of hamstrings and quadriceps (electrical stimulation if necessary)
Patellar mobilization
Hamstring and gastrosoleus stretches without weight
Flexion hanging exercises in a sitting position
Squats (extension)
In full extension with the brace, without the brace if the strength of the quadriceps muscle is sufficient
Functional exercises for Phase 1
Suitable cycling exercises
Balance exercises
Active-passive joint movements
Movements with eyes open and closed on a stable platform
Stretching and catching the ball while sitting on a chair
Phase 2 (2-4 weeks)
Quadriceps strengthening, DBK (without brace)
90 degree knee flexion
Full extension
Full ROM
Maintain graft fixation
Improve strength, stability and proprioception to be able to perform functional activity
In patellar tendon grafts, a locked brace should be used during movement, and the brace can be unlocked in sitting and supine situations. The brace should be removed during ROM movements.
Therapeutic exercises:
mini squat (0-30 degrees)
Bicycle ( high seat )
Closed chain extension (leg press 0-30 degrees)
Continue to stretch the hamstring
Stretch the gastrosoleus by applying weight
Continue to hang the calf over (putting increasing weight on the ankle to achieve full extension)
Functional Exercises:
Pylometric eccentric exercises of my thigh muscle
Stair climbing (up down, back and forth)
Don't walk in the pool
Running in a deep pool
Balance movements
Movements with eyes open and closed on an unstable platform
Reach and catch the ball while standing
Phase 3 (6 weeks-4 months)
Normal walking
Full ROM
Graft stability in the Lachman test
Sufficient strength and proprioception during functional active movements
Therapeutic exercises:
Continuing to reinforce the closed kinetic chain
Stepping on the stairs
Continue comfortable exercises as appropriate for the patient
Continuing cycling and upper extremity ergonomics
Running and swimming in the pool
Pylometric movements
Sharp step on the stairs
Jumping from a height of 15-20 cm
Jogging (walking or jogging in a large circle, gradually increasing the distance)
Mini tramp jumping
Reaching and catching the ball on an unstable ground
Jumping from a height of 30-60 cm
Phase 4 (4 months)
Stable graft in Lachman test
Painless full ROM
Initiate restricted actions
Therapeutic exercises:
Continue flexibility and strengthening movements
Functional exercises:
Running in the pool, swimming
Stepping on the stairs
Cutting drills
Carioca crossover
Specific sports exercises
High jump
Do not run on the stairs
Phase 5
Absence of patellofemoral joint or soft tissue complaints
To meet all the criteria for a return to sports life
Doctor's decision for full active implementation
For the purpose of psychological confidence, a functional brace can be used 1-2 years after surgery in the period of sports activity after consultation with a rehabilitation doctor.
A step-by-step return to sports life
Following a strength and endurance maintenance program
Rehabilitation after anterior cruciate ligament surgery is an indispensable part of treatment. At this time, rehabilitation is carried out in three periods.
Acute period after anterior cruciate ligament surgery (0-4 weeks) Goal of rehabilitation
- prevention of pain and inflammation,
-gaining full opening and at least 100 degree flexion range of motion,
- prevention of quadriceps muscle reflex inhibition,
- ensuring patellar mobility.
Subacute period (4-8 weeks) after anterior cruciate ligament surgery
Goal in rehabilitation
- ensuring normal movement of the knee,
- Ensuring proportion and balance,
-strengthen the muscles around the hips,
-problem-free self-care of the patient.
Chronic period after anterior cruciate ligament surgery (8-12 weeks) Goal of rehabilitation
-providing full movement in the opening and bending direction,
- ensuring a high level of proportion and balance,
- high level of muscle strengthening.
Shin Splint is also known as runner's foot or medial tibial stress syndrome. Exercising on unsuitable and excessively hard surfaces is caused by wrong choice of shoes, wrong applications in running technique and anatomical disorders in the foot. This disease is characterized by an inflammatory reaction of the bone membrane. It is known as runner's foot because it is more common in individuals who exercise and repeat the running motion quickly.
Patients complain of a pain that occurs in the inner-front part of the leg, and this pain is aggravated when the toes or the ankle are bent down.
In the leg, in front of the tibia bone, the tibialis anterior muscle is involved in pulling the ankle up. This muscle attaches to the outer surface of the tibia bone. During this disease, there are separations between the muscle and the bone and inflammation occurs in the area. As a result of the resulting inflammation, patients feel pain in front of their knees. Pain in shin splints is felt along the tibia and is aggravated by forceful movements such as running and relieved by rest.
Physical examination and patient history are usually enough to make a diagnosis. However, doctors may sometimes request an MRI scan. The first recommendation for a diagnosed illness is rest. An elastic lower shin corset is used for the shin splint and cold therapy is applied.
In stubborn cases, physical therapy methods are applied. A shin splint does not require surgical intervention.
The duration of treatment varies from 2 weeks to 2 months and a slow rehabilitation program is followed.
Tips.
-It should be used on soft slopes such as soil or grass instead of difficult and bumpy, uphill and downhill surfaces for running and walking.
- Adequate muscle warm-up should be ensured before training or competitions.
-Shoes that support the foot and ankle well should be worn during physical exercise.
The medical name for your tennis elbow is "lateral epicondylitis." The muscles that pull the wrist back have a common starting point on the outside of the elbow in an area called the lateral epicondyle. Tennis elbow occurs as a result of degeneration of the musculo-skeletal junction in this region associated with repetitive strain.
This disease is often found in athletes who play tennis. The disease can also occur in anyone who does repetitive and forced work with the wrist. Tennis elbow can be seen in all occupational groups that perform forced wrist movements for more than 2 hours per day. Tennis elbow is especially common among painters, plumbers, and even housewives who do heavy housework. It is mostly found in the 30-50 age group.
Symptoms of tennis elbow.
The most important symptom of tennis elbow is pain on the bony ridge on the outer edge of the elbow that radiates down the front of the arm. Pain is usually increased by raising the wrist backward against resistance. The most typical example of this is pain in the elbow that radiates to the wrist when lifting a heavy jug or kettle. Along with the pain, there may be weakness in the arm muscles. Pain can start after a single strenuous activity, or it can start 24-72 hours after prolonged strenuous activity. The pain is weak at first. If compulsive activities continue, it increases over the course of weeks and months. In advanced cases, even saying hello or turning a door handle can be very painful.
What are the risk factors for tennis elbow?
The fact that the handle of the racket is small for the length of the hand, playing with heavy and wet balls can lead to tennis elbow. Overly demanding training and competitive periods also increase the risk of injury. In some sources, smoking has been shown to increase the risk of developing tennis elbow. To protect yourself from tennis elbow, you must warm up well before exercise and do some softening exercises. Your arm muscles must be strong enough and you must apply ice after strenuous activities.
How is tennis elbow diagnosed?
Your doctor first evaluates the history of the disease, its appearance and sports habits, if any. Then, an X-ray image of the elbow is taken.
Treatment of tennis elbow.
Complaints are not very severe, but the disease can be calmed by methods such as rest, application of ice, taking a break from sports. Simple pain relievers such as paracetamol or drugs such as naproxen and diclofenac (Voltaren) are useful for short-term use. Appropriate exercise and relaxation programs recommended by your doctor may be helpful.
There are different tapes and braces to treat tennis elbow. Their common goal is to reduce the load on the injured area. These are worn when using your arm or during exercise, and should be removed during rest.
If the patient's complaints persist despite 4-6 weeks of treatment, the doctor will offer different treatment options. One method that has been used for many years is cortisone injection in that area. Unlike regular oral cortisone medications, regional cortisone injections have very few side effects. Cortisone injections are effective in reducing pain and swelling in that area. It can be repeated several times if necessary.
Despite the presence of numerous ligaments in our feet that allow us to walk, run, jump and balance, we often lose our balance. As a result, the simplest sprains appear. Sprains are not only related to sports or other occupations, but can happen to normal people as well. During a sprain, the most injuries occur in the external lateral ligament. In the ankle with a sprain; pain and swelling develop rapidly. At this time, if the vein is ruptured, swelling occurs very quickly and a violent reaction occurs when touched. Redness turns to blue over time.
In ankle injuries, after a detailed examination and examination, a plain X-ray film will easily show cracks and fractures in the bones. If soft tissue injury is suspected, MRI may be required.
Treatment of ankle ligament trauma.
In the acute period after the injury, a period of rest should be given, cold is applied to the leg area for 2-3 days. Painkillers and anti-edema drugs are used.
Except for mild sprains, a cast is usually required for 10 days to 3 weeks, immobilizing the ankle. If this is not done, the ankle ligaments do not fully heal and the sprain often recurs. Buda, in turn, causes calcification in the ankle.
For lighter sprains or frequent repeated sprains, special bandages are applied to the ankle. These are used for a long time. Similar bandages should be reused, especially in case of frequent ankle sprains in athletes.
Physiotherapy should be applied to the foot after an acute period of foot trauma. Cryotherapy, a magnetic field and a special application of cold, are physiotherapy methods that give very successful results in these traumatic foot problems.
ARS syndrome is a disease caused by damage to ligaments and tendons connected to the symphysis and pubic bone. Pathology is initially inflammatory, and later degenerative-dystrophic. ARS syndrome is associated with uniform loading and repeated microtraumas. It is found in athletes. It is manifested by pain localized in the lower abdomen and groin, which intensifies when the thigh is moved away. Diagnosis is based on the results of complaints, anamnesis, objective examination, X-ray, USM and MRI. Treatment consists of limitation of physical load, drugs, physiotherapy and surgical intervention.
ARS syndrome is a fairly common disease among athletes. ARS is an abbreviation for Adductor-Rectus-Symphysis, which is the Latin name for the affected structures: the adductor muscle of the thigh, the rectus abdominis, and the inguinal junction. The syndrome has been known since 1958; first described by the Bulgarian doctor M. Bankov. The pathology belongs to the group of myofascial pain syndromes localized in the pelvis. More football players are diagnosed. It can be found in people who are actively engaged in any type of sports that places intense load on the legs. It greatly limits the patient's capabilities; may lead to forced withdrawal from major sports.
The reasons
The main reason for the development of the disease is the inconsistency between the amount of physical load and the body's self-regeneration, especially against the background of the instability of the hard and soft tissue structures of the pelvis and lower limbs. The syndrome is promoted by the same asymmetric loading of the thighs, lower abdomen, and groin (eg, accelerated abduction of the lower limb when hitting the ball). The condition is aggravated by an improperly planned training regimen and premature return to sports after trauma.
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Pathogenesis
When tendons and ligaments are overloaded, microtears occur in areas that are more stressed. In response to injury, local edema and inflammation foci are formed. Tendon resistance to loading weakens, blood circulation in the damaged area deteriorates. These listed ones lead to more microtears, microscars and fat tissue formation. The inflammatory process is accompanied by degenerative-dystrophic changes. Enthesopathy, tendinitis and tendovaginitis of tendons of thigh and abdominal muscles; similar processes of the ligaments and tendons of the symphysis develop.
Symptoms
Pathology is detected in young people actively involved in sports, usually in professional athletes. Patients complain of pain that appears in the groin area and radiates along the course of the damaged muscle. The intensity of the pain syndrome can vary from weak and moderate pain to pain that significantly limits the patient's activity. The relationship between pain and certain physical load is noted. Palpation reveals local pain in the projection of the tendon. The pain syndrome intensifies when a functional test is performed (thigh adduction with resistance, thigh abduction, abdominal muscle tension).
Aggravations
When ARS syndrome lasts for a long time, the possibility of major traumas (partial and complete rupture) increases due to extensive degeneration of the tendon tissue. In some cases, long-term symptoms of the disease lead to forced limitation of motor activity, refusal of competitions and even sports career. Complications can also be related to the drug therapy of the pathology. Thus, when blockades with glucocorticosteroids are often performed, it is possible to deepen the degenerative processes in the injury area.
Diagnostics
In many cases, the initial diagnosis is made by a sports doctor. Orthopedic examination and instrumental examination are required for final diagnosis. Characteristic anamnesis (intense, same-shaped, asymmetric loads), pains in the groin that intensify during movement, and positive functional tests allow us to assume the pathology. To confirm the diagnosis, the following instrumental examinations are performed:
X-ray examination. In the continuous course of the disease, degenerative-dystrophic changes are revealed in the region of the joint of the pelvic bones in the X-ray images of the pelvis. Similar damage to the ileosacral joints is also possible.
USM of the inguinal junction. In sonography, the state of the bone and cartilage structure, the upper regions of the thigh muscles and the areas where their tendons join (enthesis) is evaluated. According to the results of the procedure, expansion of the symphysis, more noticeable degeneration of tendons and muscle fibers, especially in the zones close to the bones, is determined.
MRI of the pelvis. This examination method allows to determine inflammation and degeneration in entheses and nearby structures, including the symphysis area and ileosacral joints.
Dr. Parvin Akbarov
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