Effectiveness of a Specific Physical Rehabilitation Program to Restore Some Physical Attributes of Achilles tendon Injuries for Some Young Athletes

Transcription

1 Effectiveness of a Specific Physical Rehabilitation Program to Restore Some Physical Attributes of Achilles tendon Injuries for Some Young Athletes 1-Prof. Dr. / Mohammed kadry Bakry *Professor of sports injury, Department of Sport Health Sciences, Faculty of Physical Education for Boys, Helwan University. 2-Dr/ Walid Mohammad El-Demerdash *Lecturer at Faculty of Physical Education for Boys, Al Azhar University 3-Researcher/ Mohammad Mahmoud Sheta *Researcher at Department of Sport Health Sciences, Faculty of Physical Education for Boys, Helwan University.

2 Abstract The research objective is designing a program of varied therapeutic rehabilitation exercises to identify range of motion (ROM) and balance of the ankle joint to the research sample and the injured of Achilles tendon rupture from the first class. Methodology and Procedures The researchers used experimental method for one group of injured young' athletes. They are 5 injured athletes who represented the research community. The results has been compared between before and after measurements to both injured and healthy foot for each injured one. The most important results was as follows:- The statistical processing have proven the feasibility of the implemented program that made an improvement in fixed-rate balance to restore the ROM to the feet injured with Achilles tendon tear from the first class. 1. Introduction and research problem Practicing sport has become a science that has its origins, objectives, rules and philosophy, therefore the care of the players' health and safety becomes an interest to scientists.(1:20) Both of Boneva (1988) and Mohammed kadry Bakry (2000) agreed on the treatment of a designed and rated movement that is one of the basic natural means in the integrated treatment of injuries. Also, the treatment is has a special importance in the field of rehabilitation, especially in its final stages when implementing it to prepare the injured person back to practice his special activity after restore the basic functions of the body.

3 Where there are treatment and rehabilitation to make exercises of different types. (13:88) Achilles tendon is a fibrous tissue, it is the largest and the most powerful tendon in the human body. The collagen fibers are its basic structure. It consists of the unity of two tendons with two muscles which are; calf muscle of the leg (Gastrocnemius muscle) and soleus muscle. The distance between the two muscles is 15 cm, where it is the length of the tendon from the point of connection of the ankle bone with the existence of a membranous sac that contains a fluid between the two tendons, where this bone to reduce the friction between the tendons during movement. (16:62) Achilles tendon rupture is considered the most common injuries of the muscular system, because it is weak in the bloody supply, also being exposed to a great effort and pressure during practice various sport activities. In spite of the prevalence of the injury and frequent occurrence but there is not a proper and accurate diagnosis for about 25 % of cases. Also the injury may occur gradually over a period of time, also may occur suddenly and rapidly. The injury is most likely to occur among young athletes because of their exerted effort during practice sport. Whatever the cause of the injury, the treatment of Achilles tendon mostly takes a long time and requires a therapeutic means and techniques, and rehabilitative methods based on a scientific basis to ensure a full improvement of the tendon and return to practice physical activities normally. (14:92) Ali Galal (2007) emphasizes that the injury of Achilles tendon occupies an advanced position among overall injuries that faced young players,

4 and it has been discovered first time in France by the electronic microscope. (10:217) Achilles tendon rupture usually occurs when there is an increase in the physical load and the pressure on the Gastrocnemius muscle which exposed to fatigue and excessive effort, where it shrinks and diminish and this leads to pressure on the tendon and rupture. Also, increased strength and pressure on the tendon more than its length, for instance, the foot may twisted as it moves forward or bending up suddenly with a muscle contraction which leads to the rupture.(4:527) Also some previous studies, whether Arabic or foreign, proved the effective role of rehabilitative exercises and its effect on the Achilles tendon. This studies include the following; Walid Mohammed Eldemerdash Abdul Rahim (2010), Mostafa El-Sayed Ismail Taher study (2006), Daniel U.Skaoch, M.D (1979), and Kundu, S Sangwan ( ) (5) (31) (32). Thus, the researchers faced the problem that many young athletes suffered and know how to treat it. This gives a scientific description in how to treat by knowing to what extent the rehabilitative exercises have effects on the body. This will be through access to studies and previous scientific researches. Through the researchers' work there found a lack of scientific research by study and analysis that dealt with the problem of Achilles tendon rupture for some young athletes. From here, there is a need to develop a varied program to face this problem that concerns both the player and the trainer. This will be one of the scientific attempts to rehabilitate Achilles tendon and the joint of the ankle connected to it.

5 2. Research Objectives This research aims to identify: 1- The effect of the proposed rehabilitation exercises program to develop the muscular strength to the total muscles of the front and back sides of the injured limb of the experimental group. 2- The effect of the proposed rehabilitation exercises program to restore the extent movement to the ankle joint of the experimental group. 3- The effect of the proposed rehabilitation exercises program on the development of some physical attributes (flexibility- balance). 3. Research procedure The researchers have used the experimental approach by using measurement of (before/after) method because it suits the nature of the research The research sample: The research sample includes five injured young athletes. They were chosen intentionally after presenting them to a specialized doctor where the rehabilitative exercises have been implemented. Terms of the sample selection: - All the injured have been presented to a specialized doctor. - The injured cases complaining of Achilles tendon rupture not any other injury. - Not subject to any other treatment programs while carrying out the research. - To be from the young athletes. - Regularity in the proposed program.

6 - To be from volunteers to participate in the proposed program, and submitting a written undertaking to do so. Measuring instruments used in the research: 1. Measure the degree of pain: Use the degree of pain scale (VAS- Visual analogue scale). 2. Measure muscular strength by Isokinetic device ( Biodex Multi Joint System3) 3. Measure the range of movement by Goniometer device. 4. The balance measurement by the balance device ( Biodex Balance System). 4. The proposed rehabilitation program: The program have been applied on the young athletes injured with rupture in Achilles tendon from the first class and the visitors of different clubs like (Heliopolis club Arab contractors sporting club). They are chosen according to the diagnosis of the specialist doctor. And they are aged between (14-19) years. The researcher has applied the rehabilitation program in Pro Sport Center. Also choosing the sports medicine hospital at Nasr city to conduct the before and after measurements of the research sample. The program was prepared in three stages. Every stage takes three weeks and the period necessary for the implementation of the program is 9 weeks. Every stage includes specific therapeutic exercises that suit to the injured stage. Each stage include fixed exercises, free exercises, and exercises with different resistances, flexibility and stretching exercises. The program applied by three units weekly, where the unit is ranging between (30 to 40 min.) in using

7 Isokinetic therapeutic exercises. The session time stops and its period According to the nature of each stage. 5. Results and discussion Results Display Table No. (1) The arithmetic mean, standard deviation and skewness coefficient of the descriptive variables (No. =5) Variables A S SK Age Length Weight As shown in Table No.1 that Skewness coefficient is confined between (±3) descriptive variables under consideration which indicates moderation of the data. Table No. (2) The differences between the healthy and injured leg in the before measurement of the variables under consideration (No. =5) Statement variables Two legs Average grades Total grades U Significance Extend 30 Injured 3 15 ± degrees healthy 8 40 ±0.000

8 Flex 30 degrees Injured 3 15 ± healthy 8 40 ±0.000 Extend 60 Injured 3 15 ± degrees healthy 8 40 ±0.000 Flex 60 degrees Injured 3 15 ±0.000 healthy 8 40 ± Range of Extend Injured 3 15 ± movement (ROM) Flex healthy 8 40 ±0.000 Injured 3 15 ±0.000 Healthy 8 40 ± Back left Injured 8 40 ±0.000 healthy 3 15 ± Front left Injured 8 15 ±0.000 Healthy 3 40 ± Balance device Back right Front right Injured 8 8 ±0.000 Healthy 3 3 ±0.000 Injured 8 8 ±0.000 Healthy 3 3 ± Total balance degree Injured 8 8 ± Healthy 3 3 ±0.000 Significance < 0.05 There are statistically significant differences between the two legs of the before measurement in all the variables of the study.

9 Isokinetic Table No. (3) The differences between the healthy and injured leg in the after measurement of the variables under consideration (No. =5) Statement variables Two legs Average grades Total grades U Significance Extend 30 degrees Injured Flex 30 degrees Healthy Injured Healthy Extend 60 degrees Injured Flex 60 degrees Healthy Injured Healthy Range of movement (ROM) Balance device Extend Injured Healthy Flex Injured Healthy 6 30 Back left Injured Healthy Front left Injured Healthy Back right Injured

10 Isokinetic Healthy 6 30 Front right Injured Healthy Total balance degree Injured Healthy Table No. (4) Differences between the (before and after) measurement of the injured (No. =5) leg Statement variables Direction No. Average grades Total grades Z Significance % Extend 30 degrees = - * Flex 30 degrees * = - Extend 60 degrees = - * Flex 60 degrees = - * Range of movement (ROM) Extend * = - Flex *

11 = Degree of Pain * = Back left * = Front left * = - Balance device Back right = - * Front right * = - Total balance degree Significance < = - * There are statistically significant differences between the two legs of the before and after measurements in all the variables of the study.

12 Table No. (5) Improvement rate of the injured and healthy leg of before/ after (No. =5) Statement Isokinetic Range of Movement Balance device measurement Variables Injured Leg Healthy Leg Before/ After Before/ After Extend 30 degrees Flex 30 degrees Extend 60 degrees Flex 60 degrees Extend Flex Back Left Front Left Back Right Front Right Discuss the results of the research variables: In light of the outcome of the statistical results and according to the objectives and hypotheses of the research, the researcher interprets and discuss the results of the objectives and hypotheses of the research. 1. Discuss the results of the first hypothesis, which states that "there are statistical differences between the before and after measurements in the development of muscular strength of front and back muscles group of the injured leg in favor of the after measurement of the research sample." Table (4) shows that there are differences with a statistical significance between the before and after measurement in the variable of muscles strength of the injured leg for before and after measurements in favor of the after measurement. This resulted an improvement rate in table (5) which indicates the improvement

13 rate of the after measurement in legs strength variable of the injured leg. Where the improvement of the injured leg was in the extend strength of the injured leg at angle 30 degree/s with rate 70%, whereas the improvement of the flex strength was at angle 30 degree/s with rate 104.8%. The improvement rate of the extend strength of the injured leg was at angle 60 degree/s with rate %.Whereas the improvement rate of the flex strength at angle 60 degree/s with rate 102%. As shown in table (3) there is no difference with statistical significance in muscle strength variable of both legs, the injured and healthy leg in the after measurement which indicates restoration of the muscular strength to the injured leg and return it to its natural case as in the healthy leg. The researchers attributed the difference between the levels of improvement in muscular strength to the legs' muscles of the injured leg in the after and before measurement in favor of the after measurement because of the rehabilitation exercises program based on physiological basis in terms of relevance to the nature of the muscular work and the muscles working on the ankle joint starting from the static flexion then dynamic flexion by fixed and moving devices and tools with gradient weights in an attempt to return the injured foot joint to its natural state before the injury through physical rehabilitation program based on scientific basis. Where rehabilitative and therapeutic exercises works on strengthen the muscles of the injured area and the surrounded

14 muscles, which has an effective impact on the limitation of muscle pain, and raise its level of efficiency and muscular work. Hamelson (1991) and Yasser Saeed Shafie (1993) indicated that the gradient in the use of appropriate resistances in terms of severity and size helps to improve muscular strength and endurance. (25:104) (21:177) And the previous view agreed with what Gardiner (1985) indicated, that using exercises of fixed strength in the first phase to the gradient in using weights, elastic resistance band, and various resistances in all directions that will be in the second phase of the program. (24:144) This view also agrees with the study of Islam Amin Zaki Abdul Wakil (2008) and Reda Rashad Abdul Rahman (2007) which is the improvement they reached and increase in muscular strength after undergoing rehabilitation programs in the rupture injured limb of Achilles tendon.and the emphasis on the positive effect of the therapeutic physical programs on the limb injured with Achilles tendon rupture an limit the aggravation of the injury. (5) (7) 2. Discuss the results of the second hypothesis, which states that " there are statistical differences between the before and after to restore the range of movement of the foot joint" of the experimental group. As shown in Table (2), (3) and (4) that there are differences with statistical significance between the before and after measurement in the range of movement variable of the injured leg in favor of the after measurement and this is what resulted from the improvement percentages in the table (5), which

15 indicates that the improvement rate of the after measurement variable in the injured leg. And the improvement rate of the injured leg of extend was 23.4%, whereas the improvement rate of the range of movement in the injured leg of flex was 80%. As shows in table (3) that there are no differences with statistical significance in range of movement variable between the injured and healthy leg in the after measurement which shows the restoration of the range of movement in the injured leg and reach the natural state as in the healthy leg. The researchers attributed the difference between the level of improvement in the range of movement variables of the injured leg and before/ after measurement in favor of the after measurement as a result of the rehabilitation program oriented to increase the muscular strength, stretching exercises and flexibility with the use of Stationary Bicycle( Argometer), Treadmill, in addition to walk and running exercises in the swimming pool and its effectiveness on increasing the range of movement for healthy and injured limbs. Also the researchers attributed the improvement of the range of movement to the second phase of the physical rehabilitation exercises program. This program like a functional rehabilitation which seeks to raise the player's physical efficiency with the organic adaptation of the lower limbs connected to the ankle joint. Also, Talha Hosam Al-Dean, Wafaa Salah Al-Dean and Saeed Abdul-Rashid (1997), agreed that flexibility exercises

16 works on the development of the muscular stretching and increasing Both Talha Hossam El-Din was also agreed, in fulfillment of Salah al-din, Saeed Abdul Rashid (1997), the flexibility exercises that work on lengthening the muscle and increase rubber feature of the muscles and ligaments which lead to the increasing of the joint's ROM. (9:246) (9: 72) Ahmed Imran (1998) also agrees that the improvement in the joint's ROM due to the positive role of stretching and flexibility rated exercises. This improvement coincided with decrease of the pain degree and the improvement of the muscular strength. (2:125) Also, the results of this study agreed with the results of Walid Mohamed Eldemerdash Abdel-Rahim (2010) study which indicates that practicing the appropriate and guided rehabilitation exercises with its different forms works on the improvement and restoration of the natural ROM for the people injured with rupture Achilles tendon. (20) And the previous view confirmed by the results of Mustafa El Sayed Ismail Taher (2006) study, that practicing the rehabilitation exercises with its different forms leads to achieve positive results on the restoration of flexibility and increase the ROM of the injured people with rupture Achilles tendon. Also these exercises have the positive effect more than other treatment methods. (17)

17 3. Discuss the results of the third hypothesis, which states that " there are statistical differences between the before and after measurements on the development some of the physical attributes (flexibility- Balance) of the experimental group:- First: Flexibility The researchers attributed the difference between the improvement level in the flexibility variable of the ankle joint of the injured leg and the before /after measurement in favor of the after measurement. As a result of the rehabilitation exercises program prepared to this case that has applied on the sample research. Practicing the oriented rehabilitation exercises are implemented towards increasing the rubber of the ligaments surrounding the ankle joint beside stretching and flexibility exercises with the use of TREDMILL device, in addition to the walking exercises with a regular step and running in the swimming pool and its effectiveness in increasing the flexibility of the ankle joint. Where the use of water [Swimming Pool] have a positive and effective role in the improvement noted on the ankle joint flexibility ankle for the injured and healthy limb. The researchers also attributed the improvement and development of the flexibility of the ankle joint to the third phase of the rehabilitation exercises program. It is as a functional rehabilitation to raise the efficiency of the player from

18 the physical and psychological aspects and also organic Adaptation to the muscles of the injured limb connected with the ankle joint. Both of Nariman Al-Khatib and Abdul-Aziz Al-nemr (1997) also agreed that the flexibility exercises are working on the development of stretching muscle and increase stretchiness attribute to muscles and ligaments together which lead to increasing the flexibility of the ankle joint. (11:246) (11:72) The results of this study agreed also with Ashraf Shaalan (1992) which noted that the rehabilitation program includes stretching and flexibility exercises in addition to the positive effect of the development of the muscular strength that leads to increasing the flexibility of ankle joint, where there is a direct correlation between the flexibility of ankle joint and increasing the strength of the muscular groups leading to the ankle joint movements. (77: 6) Second: Balance As shown in table (2) that there are differences with a statistical significance between the before and after measurement in the balance variable of the injured leg in favor of the after measurement. This is what resulted from the percentages of improvement in Table (5) that indicated that the improvement percentage of the after measurement in the balance variable of the injured leg, where the improvement percentage of the balance in the back left injured leg 21.2%. Whereas the improvement percentage of the in the front left

19 41.6%. And the improvement percentage of the injured leg back right 83.3%. While the improvement percentage of the injured leg front right 41.5%. Finally the total improvement of balance in the injured leg 69 %. As shown in table (3) that there are no differences with statistical significance in the balance degree variable between the injured and the healthy leg in the after measurement which indicates the increasing of balance degree in the injured leg and reach the natural state as in the healthy leg. The researchers attributed the difference between the level of improvement in the balance variables and the after and before measurement of the injured leg in favor of the after measurement as a result of practicing the balance exercises through the rehabilitation program that has applied on the research sample which includes balance exercises which has applied positively on the research sample without help in doing it. This exercises have a great effective impact on balance and increase stretching of tendons and muscles. The previous views also agreed with Jean (2004) who mentioned that there are mechanical sensory receptors (Mechanoreceptors) in the muscles and tendons surrounding joint, and these receptors are activated or provoke by stimuli that the joint is exposed to it like the power or the mechanical pressures ( detailed such powers or mechanical pressure (contraction, relaxation, vibration, stretching, pressure ) and thus send information to the brain about such stimuli so that he can handle it. And the injury of those receptors leads to

20 disability in the self-reception after the injury, which leads to poor balance. (1:27) Also agreed with Carrie (1998) who said that the muscular strength exercises did not lead to the improvement of the balance where it works on the development of self-reception of the ankle joint in the flex of the ankle inside and outside as well as in the dorsi and plantar flexion of the joint. (23: ) And Ahmed Omran (1998) indicated that the balance exercises contribute to end the state of muscular imbalance located between the surrounding muscle of the injured joint by increasing the efficiency of the work of sensory receptors and this reflected on the nervous system which leads to increase the joint balance. (2:125) The results of the study also agreed with the study of Islam Amin Zaki Abdul-Wakil (2008) and Reda Rashad Abdul- Rahman (2007), which obviously showed that practicing the balance in terms of the direction of the muscle movement and intensity in the rehabilitation units and break periods have a positive impact on the balance development of the injured limb through the difference of the improvement rate compared to the healthy limb. (5) (7) Also the results of this study are consistent with the results of Walid Mohammed Abdel-Rahim Eldemerdash study (2010), which indicates that practicing the appropriate balance exercises with its various forms works on improving the

21 balance degree of people injured with rupture Achilles tendon. (20) From the previous results, it's clear that the proposed rehabilitation Program and by practicing the rehabilitation exercises that have a positive impact on improving the degree of pain, increase muscular strength, the ROM and the balance degree. The researchers have achieved the best results for all variables under consideration and the research hypotheses. 6. Conclusions 1- The physical specific rehabilitation Program that was implemented has a positive effects to restore and improve the strength of the muscles surrounding Achilles tendon. 2- The program has a positive impact on restoring and improving the ROM of the injured ankle joint of the young athletes injured with rupture Achilles tendon from the first class. 7. Recommendations 1-In the light of the above mentioned the researchers recommended the application of the proposed rehabilitation program of the young athletes injured with rupture Achilles tendon from the first class aged between (14-19) years old. 2- To conduct more researches that include other categories from players injures with rupture Achilles tendon.

22 References First: Arabic References 1-Ahmed Amin Fawzi (2004): Basketball of Young Athletes, Faculty of Physical Education, University of Alexandria, the Egyptian library. 2- Ahmed Abdel-Fattah Imran (1998): Effect of Rehabilitation Program on the Posture Mechanism of the People Injured with Lumber Disc Prolapse Treated Surgically, unpublished Master Thesis, Faculty of Physical Education for Boys, Alexandria University. 3- Abuel- Ela Abdel Fattah, Ahmed Nasr El-din (1993): Physiology of Fitness, Dar al-fikr al' Arabi, Cairo. 4. Abu Ela Abdul-Fattah (1985): Biology of Sport, Ed. 2, Dar al-fikr al' Arabi, Cairo. 5-Abdul Aziz Al-Nemr, Nariman Al-Khatib (1996): Weightlifting Training: Designing Strength Programs and Planning the Training Season, First Edition, Book publishing Center, Cairo. 6-Ali Gala Al-Dean (2007): Addendum in Sports Injuries, Third Edition

23 7-Ashraf Al-Dessouky Shaalan (1992): The Effect of a Proposed Exercises Program to Rehabilitate the Knee Joint and the Muscles Working on it After Repair the Anterior Cruciate Ligament, unpublished PhD Thesis, Faculty of Physical Education for Boys, Minia University. 8-Islam Amin Zaki Abdul-Wakil (2008): A Study entitled "Evaluate a Proposed Exercises Program for the Rehabilitation of Achilles Tendon after Surgery" The study aims to evaluate the rehabilitation program of the lower limb after repairing Achilles tendon surgically. 9- Mohammed kadry Bakry, Seham El-Sayed El Ghamry (2005): Sports Injuries and Physical Rehabilitation, First Edition, Dar El Manar Publishing House, Cairo. 10- Mohammed kadry Bakry, Thoraya Nafea (1999): Your Guide to Sports Medicine written by Jab Mercth, First Edition, Book Publishing Center. 11- Mohammad Hassan Allawi (1998): Psychology of Sports Injuries, Book Publishing Center, Cairo. 12- Mahmoud Fathi Hindi (1991): Sports Injury and Modern Rehabilitation, Book Publishing Center,Cairo. 13- Mahmoud Yehia Saad, Ibrahim Saad Zaghloul (2004): Sports Injuries and its Applications, Ed.1 Dar al-fikr al' Arabi, Cairo. 14- Mustafa El-sayed Taher (2006): Evaluation of Lower Limb Results after Repairing Achilles Tendon Surgically, Published Research, Theories and Applications Journal, No.58, Faculty of Physical Education for Boys, Alexandria.

24 15-Maha Hanafi Kotb, Rehab Hassan Ezzat, Dalia Ali Mansour (2009): Sports Injuries and Kinetic Therapy, Dar Al Isra for printing, Cairo. 16-Nazmy Darwish, Yasser Saeed Shafi (2005): Sports Injuries and First Aid. 17- Reda Rashad Abdel-Rahman (2007): The Effect of Merging between Rehabilitation with Electrical and Self-Stimulation on some of the Physical and Physiological Variables associated with Pain of Achilles Tendon Embodiment of the First Class, No. 52, the scientific journal of Physical Education and Sports, Helwan University, Faculty of Physical Education for Boys, Al-Haram. 18-Soheir Salem Hafez (1986): The Starting Foot Injuries and its Relation with the High Starting Competitions, Faculty of Physical Education for Girls, Alexandria University. 19 -Talha Hossam El-Din, Wafaa Salah al-din, Saeed Abdul- Rashid (1997): Scientific Encyclopedia in Training (Strength- Ability- Endurance- Flexibility), Part 1, Book publishing Center, Cairo. 20-Waleed Mohammed Eldemerdash (2010): Effectiveness of Rehabilitation Treatment Program on Basketball Young Players Injured with Achilles Tendon Rupture, Unpublished PhD Thesis, and Faculty of Physical Education for Boys, Helwan University. 21- Yasser Saeed Shafi (1993): Rehabilitation of Knee Joint after a Surgical Repair to the front Cruciate Ligament, Unpublished PhD Thesis, Faculty of Physical Education for Boys, Helwan University. Second: Foreign References

25 22- Boneva I (1988): Rokovodstvo bo Kenezeterapeer Medetsena Fezkoltora, Sofey. 23- Carrie L.Docherty (1998): Effects of Strength Training On Strength Development and Joint Position Sense in Functionally Unstable Ankles, J Athl Train. 24- Gardiner, M. D. (1985): The principles of Exercises therapy, C. B.S. Publishers, Delhi. 25- Hamelson,GL (1991):Physical Rehabilitation of the Physiologic Factors or Rehabilitation W.B. Sawhders Go, Philadelphia. 26- Harry B. SKINER (2005): Current diagnosis and treatment of orthopedics, Fourth Edition. 27-Jean M. Eelma., (2004): Ankle Sprain and Instability. 28- Robert w. Bucholz james d. heckman Charles court (2001): Brown Rockwood and Green S. Fractures In Adults Volume. 29- Steven J. BAGET, John F. BECY and others (2006): Orthopedic Guide, port (5), American Colleague. 30- Sameh Dos (ph.d) (2006): Anatomy Hand - Out, lower Limb Faculty of Medicine, Cairo University. Third: World Wide Network References 31- Http;//Ajs.Sagepub.com/Content/9/1/20.Abstract. 32-

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