Natasa Desnica Bakrac Cybex Rehabilitation Center, Zagreb, Croatia

Transcription

1 FolijeRi4-4 Isokinetic rehabilitation in treating knee injuries Natasa Desnica Bakrac Cybex Rehabilitation Center, Zagreb, Croatia MAIN PRINCIPLES OF THE ISOKINETICS Methods of uscle strengthening using resistance exercises: isoetric exercises: fixed speed ( /sec); fixed resistance isotonic exercises: accoodating speed (about 6 /sec), fixed resistance isokinetic exercises: adjustable constant speed (1-3 /sec dynaic speed), accoodating resistance ISOKINETICS - constant speed of otion is chosen on the basis of specific goals of rehabilitation, while the resistance is accoodating - isokinetic resistance enables exercising in the functional speed, to develop strength and endurance of the uscles, and to train the neurouscular syste to the speeds required for the dynaical functions of the extreities - coplete accoodation of the resistance, througout the whole range of otion; resistance adapts precisely to the capacity of strength, the pain,and fatigue of patient it s possible to rehabilitate even the ost recent injuries of joints and other locootor structures, as well as early postoperative rehabilitation. PRINCIPLES OF THE METHOD - actuator- hydraulic echanis, with oil, syste of ventils and speed regulator; the patient using the uscle force pushes the oil fro one chaber to the other; by controling the speed of oil oveent resistance is regulated autoatically - the patient uses its uscle strength- Orthotron produces the resistance; when the force stops, there is no resistance selecting the speed the patient is not in danger of further injury low speed - developent of uscle strength high speed - increase of uscle endurance - display instruents show the force produced, separately for both antagonistic uscle groups for each extreity positive feedback to the patient, and visual control for doctor - resistance in both directions develops balance of the antagonistic groups (e.g. quadriceps and hastrings)

2 ADVANTAGES OF THE ISOKINETIC REHABILITATION 1. efficency- the uscle is dynaicaly activated to its axial capacity, constantly, throughout the range of otion 2. uscle strengthening, without loading the joints 3. possibility of developing strength (low speed), or endurance of the uscles (high speed) 4. resistance is accoodating to the patients strength capacity throughout the whole range of otion rehabilitation of recent injuries, and early postoperative rehabilitation 5. resistance for each extreity separately - precise strengthening of the injured extreity solely 6c. resistance in both directions of otion- establishent of balance between antagonistic uscle groups in rehabilitation and prevention less injuries 7. very iportant in preoperative preparation (especially iportant for athletes) 8. rehabilitation of ACL rupture, using Johnson s antisheer device, which restricts anterior oveents of the tibia 9. rehabilitation is extreely fast, in average 3 weeks, for ost of the injuries, which enables the athletes to return to their sport activities in the fastest tie possible Isokinetic rehabilitation protects daaged joints during exercise, since the resistance adapts autoatically according to the uscle strength, pain, fatigue, etc. Thus, even heavily injured athletes, and early postoperative patients could be treated. We have developed a procedure of thigh uscles strengthening, based on the individually designed protocols. These protocols are being adjusted throughout the treatent, taking into account the progress fro one phase to the other, increase of easured uscle strength, subjective coplaints, efficiencies at different speeds, and other relevant factors. Extension and flexion exercises are being perfored on a daily basis. ISOKINETIC REHABILITATION for each patient we develop specific progras (individual protocols), constant odification of protocols during exercising, depending on - progress fro one phase to the other, - developent of uscle strength - efficiency in different speeds - pain - fatigue - specific goals of the rehabilitation, etc

3 RESULTS 44 ATHLETES (aged 16 35) diagnosed with: - chondroalacia patellae - 16 cases --11 ale, 5 feale - ACL rupture - non-reconstructed - 2 cases-14 ale, 6 feale - ACL rupture - reconstructed - 8 cases- 6 ale, 2 feale - underwent isokinetic rehabilitation on the Cybex Orthotron KT2 device - soe of these injuries were recent, soe of the very old and neglected - treatents were different - conservative, and operative - iobilisation was applied frequently - ost of these patients already underwent physical therapy treatent using classical ethods (electrical currents, kinesitherapy, ultrasound, electrostiulation, etc) without uch success the result of isokinetic rehabilitation was assessed through subjective and objective paraeters - subjective criterion: - pain - swelling - instability - personal feeling of uscle strength - objective easureents: a) progress of axial uscle strength (peak torque) of quadriceps and hastrings was onitored every day during the rehabilitation. b) prior to and after the rehabilitation, detailed dynaic status of the upper leg uscles was taken for both injured and healthy contralateral leg. This status included peak torque, work per repetition, range of otion and fatigue index.

4 strength (N) INCREASE IN STRENGTH - ACL reconstructed group Patient: Z.O. (age 31) Dg:. ACL rupture Sport: kickboxing Th: surgical reconstruction (swing bridge ethod) Rehabilitation progra: Nuber of treatents: 14 Strength at the beginning: 8 N Strength at the end: 21 N Cybex isokinetics KT days of treatent

5 strength (N) strength (N) INCREASE IN STRENGTH - ACL RECONSTRUCTED group (selected patients) I.K. - skiing days of treatent M.V. - soccer days of tretent

6 iproveent of strength (%) IMPROVEMENT OF STRENGTH in percents (daily average of all patients in the particular group) chondro ACL ACL-recon days of treatent

7 ACL (14M, 6 F, total 2) ACL group BIG IMPROVEMNT LITTLE IMPROVEMENT NO CHANGE IN SYMTOMS WORSENING OF THE SYMPTOMS NO SYMPTOMS IN THE BEGINNING PAIN SWELLING no pain left 4 % no swelling left little pain left 45 % 15 % little swelling left STABILITY 15 % big iproveent in stability 35 % little iproveent in stability 5 % FEELING OF MUSCLE STRENGTH 5% great increase % 45% 5 % RECON (6M, 1 F, total 7) RECON group BIG IMPROVEMNT LITTLE IMPROVEMENT NO CHANGE IN SYMTOMS WORSENING OF THE SYMPTOMS NO SYMPTOMS IN THE BEGINNING PAIN SWELLING STABILITY FEELING OF MUSCLE STRENGTH no pain left 42,9 % no swelling left 42,9 % big iproveen t in stability % great increase % little pain left 28,6 % 14,3 % 14,3 % little swelling left 42,9 % 14,3 % CHONDRO (11M, 5 F, total 16)

8 CHONDRO group PAIN BIG IMPROVEMEN T no pain left LITTLE IMPROVEMENT IN SYMPTOMS little pain left NO CHANGE IN SYMTOMS WORSENING OF THE SYMPTOMS NO SYMPTOMS IN THE BEGINNING SWELLING STABILITY 81,3 % no swelling left 31,3 % 12,5 % 6,3 % little swelling left 18,8% 6,3 % no swelling in the beginning 43,8 % stable in the beginning FEELING OF MUSCLE STRENGTH great increase % %

9 strength (N) strength (N) influenza strength (N) INCREASE IN STRENGTH - ACL RUPTURE group 4 typical progress S.D. - basketball 3 exceptional progress I.V. - basketball very good progress D.R. - soccer interuption in progress D.M. - karate T.L. - taekwondo f M.H. - handball f days days