Exercises interventions for treatment and prevention of hip and knee related disorders. Arthroscopic Centre Amager, Copenhagen

Transcription

1 Exercises interventions for treatment and prevention of hip and knee related disorders

2 How do we best treat and protect the muscle-tendon-bone unit? 1. Careful monitoration of load and overload 2. Preparing athletes for specific and repetetive loading/overloading

3 Exercise as medication

4 What is in it? (Tyler et al., 2002)

5 What if I forget to take it? (Soligard et al., 2010)

6 How strong is it

7 How often do I need to take it?

8 Eccentric and isometric strength improvement (Mjølsnes et al., 2004)

9 Eccentric strength training as injury prevention (hamstring injury) (Petersen et al., 2011) All injuries New injuries Recurrent injuries Number of injuries * * * 10 0 Control * Intervention

10 Why is strength training effective for acute muscle injuries? (Nikolaou et al., 1987)

11 Is strength training effective for overuse-problems? Increased tendon CSA and tendon stiffness in asymptomatic tendons after strength training decrease tendon stress and strain Increased fibril density, through increased number of fibrils in healed tendons after strength training (Kongsgaard et al., 2007, 2010)

12 Is hip adduction strength training relevant for groin injury prevention and treatment?

13 Risk-factors for groin injury (Engebretsen et al., 2010) Arthroskopic Centre Amager,

14 Hip adductor strength reduction preceeding groin injury (Crow et al., 2010)

15 Arthroskopic Centre Amager, (Thorborg et al., 2011)

16 Isometric hip strength in soccer players (Thorborg et al., 2009)

17 Eccentric hip strength in soccer players (Thorborg et al., 2009)

18 Eccentric hip strength in soccer players (Thorborg et al., 2009)

19 Recent RCT-study 34 soccer players (17 controls) 1 exercise (using elastic bands) repetead for both sides (Concentric 3s/isometric 2s/eccentric 3s) exercise for hip adductors 3 times a week 15 RM ( 2 weeks)/ 10 RM ( 4 weeks)/ 8 RM ( 2 weeks) Supervised by a physiotherapist in the club Outcome: Eccentric hip adduction strength and Isometric hip adduction strength

20 Strength training for the hip adductors using an elastic band (Thorborg et al., 2011) Week External load Number of sets per training session for each (relative) leg Training sessions per week RM RM RM 3 3

21 DOMS Arthroskopic Centre Amager,

22 Perceived loading

23 Eccentric strength

24 Isometric strength Arthroskopic Centre Amager,

25 Eccentric hip abduction strength in patients with external snapping hip (Jacobsen J, Thorborg K et al., 2011, unpublished data)

26 Hip abduction strength training

27 Design Stratification and randomisation Assesor blinded to group allocation Pretesting 6 weeks HST (15 sessions) 6 weeks MST (15 sessions) Posttesting Supervised by two physiotherapists Thorborg et al., Scand J Med Sci Sports (2009) Thorborg et al., BJSM (2009)

28 Hip abduction strength training Compliance and DOMS Fifteen training sessions were planned for each participant during the six weeks of strength training. The total compliance for all the participants was 14.4±1 sessions. For the MST group, compliance was 14.3±1 sessions, and for HST group it was 14.4±1 sessions. Twenty-seven participants reported DOMS in the gluteus medius muscle at the first training session as a result of the pre-test, with no between-group difference in DOMS (HST, 2.6±0.8; MST, 2.1±1.5, p>0.05). After this, there were no further reports of DOMS.

29 Results

30 Results

31 Hip flexion strength training Arthroskopic Centre Amager,

32 Arthroskopic Centre Amager,

33

34 Other exercise evaluation studies A B C

35 Specific exercise evaluation FJU LU DJU FJ SJ Cand Scient, PhD Mette Kreutzfeldt Zebis Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark

36 Specific exercise evaluation SPL KS NH SuLC Cand Scient, PhD Mette Kreutzfeldt Zebis Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark

37 Specific exercise evaluation HE HEB RD SeLC PrLC Cand Scient, PhD Mette Kreutzfeldt Zebis Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark

38 Acknowledgements Collaborators: Per Hölmich Jesper Petersen Ewa Roos Peter Magnusson Christian Couppé Andreas Serner Thomas Møller Madsen Jesper Jensen Thomas Bandholm Mette Zebis Lars Andersen Maja Schick Robin Christensen Else-Marie Bartels Funding: Department of Orthopaedic Surgery, Amager Hospital The Association of Danish Physiotherapists Danish Sportsphysiotherapists Association Danish Regions Lundbeck Foundation Danish Rheumatism Association