1 Effectiveness of Qualitative Therapeutic Exercises on Junior Handball Injured by Achilles tendon Tear (First) Prof. Dr. Mohammed kadry Bakry 1 Dr. Ashraf Abdulsalam Alabasy 2 Introduction The rupture of the Achilles tendon is probably the most severe muscular problem in the lower leg. It is more commonly seen in individuals 30 to 50 years old (1214) (Figure1) (12). The usual mechanism is a pushoff of the forefoot while the knee is extending. A common move in many propulsive activities. Tendinous ruptures usually occur 1 to 2 inches proximal to the distal attachment of the tendon on the calcaneus. The individual Figure (1) Ruptured Achilles tendon bears and feels a characteristic "pop" sensation in the tendon area. Clinical signs and symptoms include a visible defect in the tendon inability to stand on tiptoes or even balance on the affected leg, swelling and bruising around the malleoli, excessive passive dorsiflexion, and a positive Thompson s test ( Failure of Planter Flexion to occur with passive compression of the gastrocnemius on the affected side) (2115,6 216,8219). Jumping and running can cause repetitive overextension and overload of the Achilles tendon. Commonly seen in joggers, runners, (1( Department of Sport Health Science, Faculty of Physical Education. Helwan University. KadryBakry@yahoo.com. 01001684085. (2( Department of Sport Health Science, Faculty of Physical Education. BeniSuef University. ma113@fayoum.edu.eg. 01005101875.
2 ballet dancers, skaters, and handball, basketball players. Achilles tendinitis is one of the most common overuse problems in sport activity. Risk factors include tight heel cord, foot malalignment deformities a recent change in shoes or running surface, a sudden increase in distance or intensity during a workout session, or excessive hill climbing (399,7 78). Treatment involves ice therapy, NSAIDs, and activity modification in mild cases. In moderate to severe cases, complete restriction of activity may be necessary for 3 weeks active stretching of the Achilles tendon before and after activity along with a full strengthening program for the Achilles tendon including eccentric loading is initiated immediately after acute pain has subsided. (4314, 438, 9215, 1011). In light of the above, the researchers have seen the necessity to face this problem through the junior handball players by designing a qualitative therapeutic exercises program to try treating them in shorter time than usual. Purpose Restoring the ankle's range of motion, the strength of the lower limb muscles, body balance and relieve pain. Method Experimental Protocol: The researchers have used the experimental approach, by using the pre and post measurements, and implemented a qualitative therapeutic exercises program that designed by them, to restore the basic functions of the foot, which are the ankle range of motion, body balance, relieve the pain of the research sample.
3 Sample Used The therapeutic program has been implemented on "6" six junior handball volunteers from East Cairo clubs aged between 1517 years, who have a first partial tear in Achilles tendon, and participate with a written approval. Scope study Some of the East Cairo Clubs from January 2016 to May 2016, and the comparisons are done according to the pre and post measurements between the injured limb as an experimental group and the healthy limb as a control group, where each one attended the therapeutic program according their case for "8" weeks, 4 sessions a week, each session takes from 3060 minutes.
4 Statistical Analysis Table (1) The difference between the (injured/ healthy) lower limb in the premeasurements of the research variables N0. 6 Statement Pain Range of motion Measure Strength by Isokinetic Balance Variables Right Foot Left Foot Extension Flexion Extend at 3 Flex at 30 Extend at 60 Flex at 60 Left back front left Right back Front right Total balance Injured/healthy lower limb Average Grade Total Grade Injured 8.0 40.0 0.00 Healthy 3.0 15.0 0.00 Injured 8.0 15.0 0.00 Healthy 3.0 40.0 0.00 Injured 8.0 40.0 0.00 Healthy 3.0 15.0 0.00 Injured 8.0 15.0 0.00 Healthy 3.0 40.0 0.00 Injured 8.0 40.0 0.00 Healthy 3.0 15.0 0.00 U Significance 0.005 0.005 0.007 0.005 0.005 0.005
5 Significance > 0.05 Table No (1) shows that there are statistical significant differences between the injured and the healthy lower limb in all the research variables Table (2) The difference between (injured/ healthy) lower Limb in the post measurements of the research variables Statement Variables Both legs Average grade Total grade U Significance Pain Right Limb Left Limb Injured 6.20 22.0 0.0 Healthy 6.80 25.0 0.0 Injured 6.20 22.0 0.0 Healthy 6.80 25.0 0.0 0.507 0.347 Range of motion Extension Flexion Injured 6.20 31.0 9.0 Healthy 4.80 24.0 Injured 5.0 25.0 10.0 Healthy 6.0 30.0 0.459 0.597 Extend at 30 Injured 5.40 27.0 12.0 Healthy 5.60 28.0 0.0916 Measure Strength by Isokinetic Flex at 30 Extend at 60 Injured 5.40 27.0 12.0 Healthy 5.60 28.0 Injured 4.60 23.0 8.0 Healthy 6.40 32.0 0.0916 0.341 Flex at 60 Injured 4.20 21.0 Healthy 6.80 34.0 6.0 0.169 Balance Back Left Injured 6.40 32.0 8.0 0.180
6 Front Right Right back Front Right Total Balance Healthy 4.60 23.0 Injured 6.10 30.50 9.50 Healthy 4.90 24.5 Injured 5.0 25.0 10.0 Healthy 6.0 30.0 Injured 5.50 27.50 12.5 Healthy 5.50 27.50 Injured 6.90 34.5 5.5 Healthy 4.10 20.5 0.502 0.548 1.0 0.118 Significance <0.05 Table No. (2) Shows that there are statistically significant differences between the injured and healthy lower limbs in the post measurements in all research variables. Table (3) Differences between pre and post measurements in the injured limb Statement variables Direction Number Pain Range of motion Measure strength Pain Extension Flexion Extend 30 Average Grade Total grades + 6 3.5 15.0 + 6 3.5 15 Z Significance % 2.04 0.041 96.5 2.04 0.041 23.4 2.07 0.038 8 2.04 0.041 70
7 by Isokinetic Balance Flex 30 Extend 60 Flex 60 Back Left Front Left Right back Front Right Total balance + 6 2 15 2.04 0.041 104.8 2.04 0.041 106.2 2.04 0.041 102 2.07 0.038 21.2 3.07 0.038 41.6 2.04 0.041 83.03 2.07 0.038 41.5 2.07 0.038 69 Table (3) shows that there are a statistically significant differences between pre and post measurements of the injured lower limb in favor of the post measurements in all research variable. Table (4) The improvement percentage for both injured and healthy lower limb of pre and post measurements Injured Limb Healthy Limb Statement Variables Pre/Post Pre/Post Pain Degree Right limb 80.2 53.9
8 Range of motion Isokinetic Balance Left Limb 79.7 51.8 Extension 23.4 2.85 Flexion 7.9 2.85 Extend 30 69.9 5.7 Flex 30 104.8 0.9 Extend 60 106.2 5.2 Flex 60 102.07 0.05 Left back 21.2 41.1 Front left 41.6 116.6 Right back 83.3 25.8 Front right 41.5 3.8 Significance Table (4) shows that there are differences with statistical significance between the pre and post measurements in the improvement percentage between the two limbs in favor of the injured limb in all research variables. A sample for a qualitative therapeutic exercises fourth week after warmup preparation for 10 minutes No Exercises and used devices Exercise intensity % Repetition Intrarest Groups 1 Sitting on a seat and exchange raising up the instep and the heel. 8090% 810 15 s 3 2 3 4 5 6 7 8 (Standing with a waist constancy) stand on the instep. (Standing) walking to the front and both sides on the insteps in a sand bit. (Standing) running to the front of in the sand bit. (Standing) running to the both sides in the sand bit. Standing hold a handball and run in a sand bit then jump up and shooting. Standing and hold a handball then high jump up and to the front with approaching 3 steps. Participate actively with colleagues in match as a practical training. 8090% 710 15 s 4 8090% 710 20 s 4 7080% 68 30 s 4 7080% 68 30 s 4 8090% 710 30 s 4 8090% 710 30 s 4 95% Graded time from 10 20 min.
9 Results and its discussion: The statistical analysis confirmed the feasibility of the therapeutic program, where table (3) indicated that that there are statistically significant differences between pre and post measurements for the pain variable in favor of the post measurement, and this is obvious in the improvement percentage in table (4) that reached 80.2, and this result agrees with the conclusion that the therapeutic exercises not only help to strengthen the working muscles around the place of injury, but also help to relieve the acute pain (411, 4211). In addition, tables (1) and (2) show that there are statistical significance differences between the pre and post measurements in the range of motion variable of the injured limb in favor of the post measurements, and this is shown in the improvement percentage in table (4), where table (2) shows that there is no statistical significance differences in the range of motion in the post measurements between the injured and healthy limb, which indicates the restoration of the range of motion; this is the result of the therapeutic exercises which started since the first week, which aimed to restore the range of motion gradually, and to emphasize on that matter in the last period through the functional exercises, which help to increase the stretching of muscles and ligaments (3158). Also, Table (2) shows that there are statistically significant differences between the pre and post measurements in changing the muscle strength of the front and back limb in favor of the post measurements, and this shows in the improvement percentage in table (4). Also, table (2) shows that there is no statistically significant differences in the strength variable in the post measurement between the
10 injured and healthy limb; this is due to the use of the therapeutic quantitative exercises, which are based on physiological bases that suits the nature of the muscles' movement to perform handball in terms of bounce, sudden change of direction, jump up and forward, sudden change of direction and using resistors during static and dynamic exercises help to develop the strength gradually, where Terese & Reed (2012) indicated that the gradient in the use of resistors in terms of intensity and size helps to improve restore muscle strength (9218). And, table (2) shows that there are a statistically significant differences between the pre and post measurements in the balance variable of the injured limb in favor of the post measurements which is shown in table (4) of the improvement percentages. Also, table (5) shows that there is no statistically significant differences in the balance variable between the injured and healthy limb in the post measurements, which indicates a further improvement in the balance of the injured limb reaches to its natural state as in the healthy limb, and this is due to the exercises' nature that aimed to develop the balance for the two lower limbs together. And the response to these exercises are due to the Mechanoreceptors in tendons and muscles surrounding the joint (4311). This is consistent with what Gray (2012) ended up to that the role of strength exercises is not only improve and increase the strength, but also improve balance where it works on the development of selfreceiving of the ankle movements in all its movements and directions.(2) From the above, it is clear that the used qualitative therapeutic program has led to positive results to restore the basic functions of the lower limb injured by first Achilles tendon tear. Conclusion
11 The research procedures and its results showed that the feasibility of the therapeutic exercises that targeted the injured junior handball by first Achilles tendon tear, where it is possible to restore the basic functions of the injured lower limb, which marked by the ankle's range of motion, muscles strength of the back and front leg, balance, relieve the of pain, in just 8 weeks. Recommendations: Oriented toward and pay interest to the qualitative therapeutic exercises, which based on the nature skillful performance of the injured junior handball by first Achilles tendon tear. Conduct similar researches for group and individual activities that expected the occurrence of such injury, to be able to make specialized qualitative therapeutic programs for each sports activity and for both sexes.
12 References 1Barry Daler, Gary Lr; Principles of Rehabilitation, New York, 2013. 2Gary L. Harrelson, Elizabeth swann: Measurement in Rehabilitation 2012. (101) 3Irvine. WO. Feet under Forcer Treating sprains and strains, Phys sportsmen.2003.137. 4James R. Andrews, Gary L. Harrelson, Kevin E.Wilk: Physical Rehabilitation of the injured Athletics, Third Edition, Saunders, H5. 5Julie Frits: Low Back Rehabilitation, London, 2014.233. 6 Marcia K. Anderson, Susan J. Hall: Sports Injury Management: Williams & Wilkins, Philadelphia, PA, 2008. (204) 7 Reid. DC, Sports Injury Assessment and Rehabilitation. New York, (2011) 293. 8 Rubin. CT, Skeletal strain and the functional significance of bone architecture Calcif Tissue Int.11. 9 Terese C. Reed F: Rehabilitation Considerations for Female, New York.2015. 10 Http://www. Achilles Tendon.com. 11 HTTP://en:Wikipedia.Org/Wiki/achilles tendon. 12Http://www.footheaven.com/commonfootconditions/achillestendonrupture.
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