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Title:Učinkovitost fizioterapevtske obravnave tendinopatij spodnjih okončin
Authors:ID Wolf, Vesna (Author)
ID Omejec, Gregor (Mentor) More about this mentor... New window
Files:.pdf 1358$$wolf_diploma.pdf (1,01 MB)
MD5: E6C8A53C9B9895C353131A7F82CD45B4
 
Language:Slovenian
Work type:Bachelor thesis/paper
Typology:2.11 - Undergraduate Thesis
Organization:FIZIOTERAPEVTIKA - PHYSIOTHERAPEUTICA
Abstract:Tendinopatije predstavljajo velik delež športnih poškodb, vzrok za njihov nastanek pa se skriva v čezmernih ponavljajočih se obremenitvah. Simptomi tendinopatij zavzemajo bolečino, občutljivost na dotik, omejeno funkcijo in morebitno otekanje tetive. Med najpogostejše tendinopatije spodnjih udov se uvrščajo tedinopatija patelarnega ligamenta, ahilove tetive in glutealnih mišic. Zdravljenje tendinopatij je v prvi vrsti konzervativno, v primeru njegove neuspešnosti pa sledi operativni poseg. Konzervativna obravnava tendinopatij je sestavljena iz različnih fizioterapevtskih modalitet, med katerimi se v največji meri uporablja kinezioterapevtske pristope. V diplomskem delu smo želeli preveriti ter med seboj primerjati učinkovitost različnih fizioterapevtskih metod in tehnik pri obravnavi tendinopatij spodnjih okončin. Namen je bil tudi preveriti uporabnosti biomarkerjev za sledenje napredku zdravljenja ter na podlagi rezultatov podati smernice za rehabilitacijo tendinopatij. Na podlagi pregleda literature smo ugotovili, da je kinezioterapija učinkovita pri zmanjševanju bolečine in izboljšanju funkcije, pri čemer EKS vadba po Alfredsonovem protokolu ni učinkovitejša od EKC-KON vadbenih protokolov (Silbernagelov, Stanish in Curwinov ter HSR) kot je veljalo prepričanje v preteklosti. Metode fizikalne terapije (NL in UGV) naj se uporabljajo kot dodatno sredstvo za zmanjševanje bolečine, poglavitni del zdravljenja pa naj predstavlja kinezioterapija. Glede na smernice naj se vadba začne z IZOM vadbo, nadaljuje z IZOT vadbo ter zaključi z vadbo pliometrije ter športno specifičnimi gibanji. Vadbeni programi naj upoštevajo načela postopnega stopnjevanja obremenitve in naj bodo individualno prilagojeni značilnostim pacienta. Biološki biomarkerji, opazovani z UZ in MRI, so učinkoviti pri zaznavanju sprememb v strukturni zgradbi tetiv ter razlikovanju med asimptomatsko in simptomatsko stranjo. Kljub temu postavitev diagnoze tendinopatije v osnovi ostaja klinične narave, slikovna diagnostika pa naj se uporabi kot dodatno diagnostično sredstvo. Študije si niso enotne v trditvi, da so biološki biomarkerji učinkoviti pri spremljanju napredka zdravljenja. Zaključujemo, da so trenutno najbolj učinkoviti parametri za spremljanje napredkov v zdravljenju klinični kazalniki, in sicer spremembe v bolečini, funkciji, moči in gibljivosti prizadetega telesnega predela. Menimo, da so v prihodnosti potrebne nadaljnje raziskave, ki bi med seboj primerjale učinkovitost kinezioterapije ter fizikalne terapije dolgoročno (> 12 tednov), treba pa bi bilo tudi postaviti nove smernice obravnave za vsako tendinopatijo spodnjih okončin posebej.
Keywords:tendinopatija, kinezioterapija, biomarkerji
Year of publishing:2022
PID:20.500.12556/ReVIS-9011 New window
COBISS.SI-ID:116732163 New window
Publication date in ReVIS:28.07.2022
Views:1189
Downloads:92
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Secondary language

Language:English
Title:Efficiency of physiotherapeutic interventions on lower extremities tendinopathies
Abstract:Tendinopathies are one of the most common sports injuries. The main cause for their clinical presentation is excessive repeated tendon overload of tendons. The symptoms of tendinopathy include pain, tenderness to palpation, impaired function and possible swelling of the tendon. The most common tendinopathies of the lower extremities are patellar tendinopathy, Achilles tendinopathy and gluteal tendinopathy. The treatment of tendinopathy is mainly conservative, consisting of various physiotherapy modalities, with kinesiotherapy approaches being the most used. The aim of this thesis is to compare the effectiveness of different physiotherapy methods for the treatment of the tendinopathy of the lower extremities, to propose the biomarkers for both diagnosis and progress tracking, and to offer treatment recommendation. Based on a systematic review, the results indicate that kinesiotherapy is the most efficient in improving function and reducing pain. Eccentric training (based on Alfredson protocol) is not more efficient in comparison to eccentric–concentric training (based of Silbernagel, Stanish and Curwin and HSR protocol). Other conservative treatment modalities such as Extracorporeal Shockwave Therapy and Low-Level Laser Therapy should be used as an adjunct therapy to kinesiotherapy methods. Kinesiotherapy protocols should start with isometric training, continuing with isotonic training and finally progressing to plyometric training and sport-specific training. Exercise programmes should be based on the principles of progressive overload and should be adapted to patient's individual characteristics. Biomarkers observed by ultrasound and MRI are effective in detecting changes in tendon structure and distinguishing between asymptomatic and symptomatic side. The diagnosis of tendinopathy is primarily clinical, with ultrasound and MRI being useful additional diagnostics tools. There is conflicting evidence about biomarkers being efficient tools for tracking rehabilitation progress. Currently, the most reliable parameters for monitoring treatment progress are clinical parameters, such as changes in pain, function, strength, and flexibility of the affected area. We believe that further research is needed to compare the effectiveness of kinesiotherapy and physical therapy in the long term (> 12 weeks). New treatment guidelines for each of the lower extremity tendinopathy should be set out.
Keywords:tendinopathy, kinesiotherapy, biomarkers


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