Patela (čéška) – LÉČENÍ - II. část
Dr. Petr Juda pokračuje: ... léčení bolestí čéšky je složité. Vyžaduje v první řadě velkou trpělivost ze strany postiženého sportovce, jeho trenéra, okolí a nakonec i ošetřujícího lékaře. Bolesti se zmírňují i přes poměrně intenzivní léčbu jen velice pozvolna. Mnohdy hlavně kvůli netrpělivosti propadá sportovec zoufalství, že se nevyléčí, že bude mít bolesti stále. Nabývá podezření, že je špatně léčen, mění lékaře, vyhazuje čím dál více peněz za různé masti a léky, o kterých se dozví z lákavých reklam v mediích ...
Trenér, funkcionáři a nakonec i spoluhráči začnou mít podezření na sportovcovu agravaci (zveličování přítomných příznaků) nebo dokonce na simulaci (účelové vymýšlení si příznaků, které nejsou). Hodně sportovců nakonec v beznaději podstoupí mnohdy i zbytečnou operaci, aby po ní zjistili, že jsou v léčbě opět na počátku. Ze svých zkušeností bych shrnul hlavní zásady do několika oblastí:
1. POSILOVÁNÍ. Základním předpokladem prevence i léčení je mít pevný a dobře vycvičený extensorový aparát kolena. Hlavním extensorem i dynamickým stabilizátorem kolena je čtyřhlavý sval stehenní. A pro patellu má v tomto svalu vedoucí úlohu jeho vnitřní hlava (muscullus vastus medialis). Bříško svalu a jeho úpon na vnitřní stranu čéšky jsou hlavním stabilizátorem patelly v jejím pohybu ve žlábku kosti stehenní. Posilování a tonizace tohoto svalu jsou základem pro léčbu bolestí vzniklých poškozením chrupavky čéšky. Z kinesiologie je známo, že kontrakcí tohoto svalu vzniká pohyb z lehkého ohnutí kolena do plného natažení. Proto veškeré posilovací cviky musí končit plným natažením kolena !!. Jinak je cvičení neúčinné. Samozřejmě při bolesti musí sportovec omezit hlavně tu zátěž, při které se bolest vyvolává. Nemusí tudíž přerušit veškerou sportovní činnost.
2. CHLAZENÍ. Obecně platí, že při zátěži dochází v příslušné části (kloub, sval) k překrvení (hyperemii). Vzniká tak i malý otok. Zde může vzniknou i nevelký zánět, který se projevuje bolestí. Studené obklady nebo ještě lépe přímo led působí právě proti tvorbě otoku. Doporučuje se přikládání ledu na postižené oblasti (v našem případě na čéšku) do 10 -15 minut po zátěži (tréninku nebo utkání).
3. LÉKY. Jedná se o skupinu léků s protizánětlivým účinkem. Jsou běžně dostupné a hojně užívané. Určitě mají svůj význam, neboť potlačují zánět a jeho potlačením snižují bolest.
Léky s protizánětlivým účinkem rozdělujeme na dvě velké oblasti - nesteroidní a steroidní antiflogistika. Nesteroidní jsou ve formě s lokálním (masti, krémy, gely, emulgely..) nebo celkovým užitím (tablety,injekce). Jsou různého složení. Každému pomáhá něco jiného a sám si musí vyzkoušet, co zrovna je na něho účinné (např.diclofenak, ibuprofen, piroxikam, indomethacin, nimesulidum, ketoprofenum apod.). Steroidní protizánětlivé léky se rovněž mohou použít v omezené míře nejčastěji v injekční nitrokloubní formě. Zde je třeba dávat pozor, neboť patří mezi zakázané podpůrné prostředky a tím je jejich užití omezeno. (Podle antidopingové vyhlášky je jejich podávání zakázáno pouze v době konání mistrovských soutěží – ME, MS – viz případ diskvalifikované portorikánské volejbalistky na MS, která užila mast s kortikoidem na ekzém).
4. CHONDROPROTEKTIVA. Jsou to látky, které mají za úkol, zjednodušeně řečeno, chránit a částečně regenerovat kloubní chrupavku. Těmto látkám se přikládá až přemrštěný význam. Jejich účinky nejsou rozhodně takové, o jakých nás informuje reklama, kterou jsou nyní všechna media až přehlcena. Na druhé straně ovšem pomoci mohou. Podstatou těchto látek jsou následující složky - glukosamin, chondroitin a MSM (methylsulfonylmethan). Kombinace těchto tří látek spolu s vitaminem C je základní složka všech chondroprotektiv.
Já osobně doporučuji postupovat takto - vyzkoušet osvědčené chondroprotektivum v tříměsíční kúře eventuelně spolu s nějakým nesteroidním antiflogistikem. Mělo by to být chondroprotektivum, které vyrábí farmaceutická firma a ne potravinářská zabývající se doplňkovou výživou. Tuto kúru je vhodné podstoupit pouze pokud jsou bolesti. Jestliže bude úleva a ústup potíží (nemusí být zcela vymizení bolesti), potom tento postup opakovat 2x do roka. Pokud se nic nezmění a bolesti jsou stejné, potom je možné ještě jednou změnit druh chondroprotektiva. A pokud ani potom nedojde k úlevě, již další neužívat a tuto léčbu již neprovádět. Pokračování je spíš jen vyhazování poměrně velkých prostředků za neúčinnou léčbu. Buď jsou změny již takové, že tyto látky ani nemohou být účinné, nebo zkrátka na daného sportovce nepůsobí.
5. FYZIKÁLNÍ LÉČBA. Jako doplňková léčba může mít výborný efekt. Zkušenosti jsou hlavně s ultrazvukem, laserem, elektrostimulací m. vastus medialis (vnitřní hlavy čtyřhlavého svalu). Opět jednotný recept neexistuje a je třeba vyzkoušet, co a jak na daného volejbalistu působí.
6. OPERACE. Operace by měla být až po neúspěchu konzervativní léčby („po dobrém“). Druhů operací je hodně k různým typům poruch a pokud by mělo k ní dojít, měl by sportovec být o všem dobře informován a měl by mít alespoň základní znalosti v problematice léčení postižené patelární chrupavky. Jinak může být efektem operace zklamán, protože očekává něco, co mnohdy zajistit ani v nejlepším nejde.
Závěrem. Snažil jsem se nastínit alespoň základní principy léčby potíží z poškození chrupavky kloubu mezi čéškou a stehenní kosti. Léčba tzv.skokanského kolena (postižení jednotlivých vláken vlastního vazu čéšky) má některé odlišnosti od léčby chrupavky. O tom zase příště.
Petr Juda
- převzato z webu Zdeňka Haníka (www.hanikvoleyball.cz) -
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Accessories like the Hermès Birkin, Kelly, and the CHANEL Iconic Flap remain notable objects that duplicates copy through remarkable accuracy.
Components as well as Workmanship
High-quality replicas feature superior resources such as high-grade material as well as meticulous needlework. These factors enhance toward these items' authenticity, helping luxury-inspired pieces in capturing the spirit for high-end designs.
Focus for Details
Precision is paramount within the sphere of high-quality replicas. Beginning with exact metal hardware etchings right down to that accurate shade for shade, high-end replicas replicate small elements to closely replicate real designer pieces.
Your Ultimate Overview to Superfake Handbags designed for Luxury Fans
(Bobbysat, 3. 11. 2024 16:49)
Overview on a Realm regarding Luxury-Inspired Items
Exactly What Are Considered High-End Replicas?
In a world regarding high-quality mimics, "top-quality replicas" are recognized as a result of its astonishing approximation with real designer pieces. In contrast to typical fake products, superfakes get created with high-quality materials along with precise concentration to quality.
These products replicate an surface attraction and quality associated with real high-end goods, offering an closely matched experience for just a fraction of their expense.
Popularity in relation to Designer Imitations
Why is top-grade replicas increasing in popularity between luxury aficionados? A primary reason can be attributed to accessibility and trend look. Luxury-inspired items allow luxury fans the ability to enjoy high-end designs bypassing such hefty outlay, allowing high-end within reach.
In-Demand Luxury Replica Replica Names
Hérmes alongside Channel
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Accessories like an Hermes Birken, Kelly, & the Chanelle Iconic Flap stand as timeless objects such that duplicates replicate with incredible precision.
Substances and Workmanship
Superfakes feature superior components like top-quality hide alongside meticulous embroidery. Such materials enhance regarding such realism, helping top-grade replicas to mimic the spirit of premium brands.
Attention for Specifics
Detail exists as paramount for the realm with imitation luxury. Starting from detailed components engravings to a perfect color for tint, top-grade imitations mimic small aspects for an authentic mimic original premium goods.
The Definitive Overview to Near-Authentic Bags intended for Superfake Enthusiasts
(WilliamPet, 3. 11. 2024 4:49)
Introduction Section on this Realm on Replicas
What Is Meant By Superfakes?
Inside that sphere of high-quality imitations, "superfakes" stand out for the remarkable resemblance with real high-end products. Distinct from ordinary counterfeit items, superfakes are made using premium substances and precise emphasis on quality.
Such replicas imitate the external look together with feel of original luxury goods, delivering a highly accurate result for a small percentage compared to such expense.
Increasing Demand regarding Luxury-Inspired Replicas
What’s the reason do luxury-inspired replicas increasing in appeal among luxury devotees? This is found in accessibility paired with aesthetic attraction. Luxury-inspired items enable style enthusiasts the chance to have luxury designs without a hefty price tag, creating premium more accessible.
Popular Luxury Replica Copy Makes
Hermès as well as Chanelle
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Purses including a Hermès Birkin, Kelley, alongside an Channel Classic Front remain notable pieces that imitations imitate using stunning accuracy.
Components and Craftsmanship
Luxury-inspired items include superior components including superior fabric and meticulous sewing. Such elements contribute for these items' realism, letting superfakes to reproduce a true likeness of luxury designs.
Commitment to Craftsmanship
Precision exists as essential within the realm in luxury-inspired replicas. Starting from detailed hardware etchings and the accurate tone concerning shade, superfakes mirror even the most minor features to closely mimic authentic designer items.
One Ultimate Introduction about Luxury-Inspired Bags aimed at Superfake Lovers
(TommySex, 2. 11. 2024 22:41)
Beginning regarding an Domain of Replicas
What Are Considered Superfakes?
Across this sphere regarding exclusive items, "luxury-inspired items" are recognized as a result of its astonishing approximation toward original exclusive items. Dissimilar from standard counterfeit items, superfakes are crafted with premium substances and careful attention concerning specifics.
They mimic the visible appearance together with texture regarding real designer items, delivering a almost indistinguishable look at a portion of their cost.
Growing Popularity for High-Quality Replicas
How come can superfakes increasing in popularity among designer lovers? The answer is found in affordability combined with trend charm. Luxury-inspired items grant luxury fans to access designer designs bypassing a hefty cost, allowing designer more accessible.
Top Replica Imitation Labels
Hérmes as well as Channel
https://www.pinterest.com/pin/1147292073865364781
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Handbags including the Hermes Birkyn, Kelly, & an CHANEL Signature Closure remain timeless items which replicas copy through remarkable detail.
Components and Workmanship
Premium replicas include high-end substances including premium hide and careful embroidery. These components contribute toward their realism, allowing superfakes to mimic an authentic feel regarding premium brands.
Attention to Details
Detail is essential for the world in high-quality replicas. From exact components markings toward the ideal hue regarding shade, high-end replicas replicate subtle details to accurately copy genuine premium products.
A Definitive Manual to Superfake Bags aimed at Superfake Collectors
(Richardjem, 2. 11. 2024 10:39)
Introduction Section regarding this World regarding Luxury-Inspired Items
Defining the Term Characterizes Top-Quality Replicas?
Across the sphere in luxury replicas, "luxury-inspired items" stand out based on their incredible likeness to real luxury goods. Distinct from standard knockoff replicas, superfakes are made by means of high-quality elements combined with detailed focus on craftsmanship.
Such replicas resemble the external attraction and sensation of real luxury goods, delivering a almost indistinguishable feel for just a reduced amount regarding an price.
Growing Popularity of Luxury-Inspired Replicas
Why can luxury-inspired replicas gaining favor between premium devotees? A primary reason lies in cost-effectiveness along with fashion charm. Luxury-inspired items provide fashion lovers with access to high-end styles minus those steep cost, creating luxury more accessible.
Popular High-Quality Copy Makes
Hérmes alongside Channel
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Bags such as the Hermès Birken, Kelly, and their Chanel Timeless Flap are notable goods which replicas mimic utilizing exceptional attention.
Substances as well as Workmanship
Superfakes feature premium resources such as high-grade leather as well as meticulous sewing. Such materials contribute to these items' authenticity, helping luxury-inspired pieces to capture an authentic feel related to designer brands.
Emphasis regarding Precision
Detail exists as key regarding the realm for superfakes. Beginning with exact components markings and each exact tone regarding color, quality replicas mimic even the most minor aspects for an authentic copy original premium pieces.
Your Ultimate Overview regarding Luxury-Inspired Items aimed at Replica Fans
(Wileydag, 2. 11. 2024 4:32)
Overview regarding the Universe on Replicas
Defining the Term Are Considered High-End Replicas?
Inside a realm for high-quality imitations, "high-end replicas" shine based on these items' impressive approximation regarding real designer products. Unlike conventional counterfeit goods, these items are made by means of high-quality substances in addition to meticulous concentration concerning craftsmanship.
Such replicas imitate an surface appeal along with feel of real high-end items, delivering a almost indistinguishable look for just a portion of an value.
Growing Popularity of High-Quality Replicas
In what way do top-grade replicas rising in popularity between luxury enthusiasts? One reason stems from cost-effectiveness along with aesthetic attraction. Top-grade imitations enable style lovers the chance to have luxury designs bypassing such significant price tag, creating high-end easier to obtain.
Well-Known Replica Replica Brands
Hermès as well as CHANEL
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Purses such as the Hermès Birkyn, Kelly, as well as an Chanelle Classic Flap remain notable objects which duplicates imitate with exceptional detail.
Elements and Artistry
Superfakes feature high-end substances including superior leather with precise sewing. These factors enhance for such realistic appearance, helping luxury-inspired pieces to mimic an authentic feel for high-end labels.
Emphasis on Specifics
Exactness stands as paramount within the realm for imitation luxury. From accurate metalwork markings right down to the perfect shade of hue, top-grade imitations imitate the tiniest features for an authentic mimic authentic designer items.
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(CurtisFumma, 7. 12. 2024 15:46)