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Patela (čéška) – LÉČENÍ - II. část

16. 10. 2007

 

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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Отказы

(aamuzzy, 18. 12. 2023 14:27)

Приветствую! Вы, наверняка, замечали подозрительные отказы с ipv6 адресов на своем сайте. Иногда они маскируются под реферер https://api.yandex-baza.website. Эти мошенники занимаются накруткой поведенческих факторов, определяя долгосрочные интересы сайтов через API Яндекс Вебмастера например доставка еды, недвижимость, подарки, туризм и т.д.
Они классифицируют все известные публичные сайты по их долгосрочным интересам.


Как выглядит схема.

Шаг 1: Когда требуется "прокачать" свой сайт, они выбирают базу сайтов соответствующую долгосрочным интересам(Д.И.) прокачиваемого сайта.

Шаг 2: Последовательно вбивают в выдаче ключевые слова относящиеся к этим Д.И.(долгосрочным интересам) и если в базе есть сайт с таким Д.И. то заходят на него из поиска и совершают отказы. Могут и по несколько раз. Каждый раз совершая такие отказные визиты они "прокачивают профиль" то есть грубоговоря нагуливают этим профилям cookies.

Шаг 3: Затем, используя эти cookie, они выполняют поисковый запрос по тем же ключевым словам. Но на этот раз они заходят не на ваш сайт для отказа, а на свой, который прокачивают, повышая поведенческий фактор. Это приводит к тому, что поисковая система Яндекса снижает рейтинг ваших сайтов, в то время как сайты накрутчиков поднимаются в выдаче.

Не смотря на мои жалобы и обращения в Яндекс, проблема так и осталась. Получал от них ответы вроде "мы в курсе", "мы рассмотрим", "этим занимается другой отдел", "мы сделали реплику искуственного интеллекта и теперь он рулит нашими алгоритмами". Очевидно что это полнейший бред.

Как говорится, "если хочешь что-то сделать, сделай это сам". Я разработал решение для блокировки подобных накрутчиков, и для его реализации не требуется установка каких-либо скриптов или других сложных действий. Стоимость данной услуги - 2000 рублей единоразово.
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(Michaelfaind, 18. 12. 2023 1:43)

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(Michaelfaind, 18. 12. 2023 0:32)

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(Michaelfaind, 17. 12. 2023 23:15)

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(Michaelfaind, 17. 12. 2023 19:13)

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Setting out on the legal odyssey necessitates competence, and our seasoned team specializes in securing your entitlements featuring unwavering allegiance. Through small infractions to complex criminal charges, these counsels carry a breadth in competency to the discussion.

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(Michaelfaind, 17. 12. 2023 17:59)

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Embarking on the jurisprudential odyssey necessitates mastery, plus our veteran crew deals regarding safeguarding one's entitlements with unwavering commitment. Through small infractions to complex criminal allegations, these counsels convey a wealth of experience toward the proceeding.

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(Marioboype, 17. 12. 2023 16:00)

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Understanding that not a single pair of cases manifest as alike, these jurisprudential experts assemble bespoke tactics. We delve deep within the particulars entailed by one's situation, ensuring a advocacy approach which resonates fluidly to one's distinct conditions.

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Legal complexities can manifest as overwhelming. We showcase clear discourse, keeping the client apprised at each step. Our devotion to clarity affirms you comprehend those nuances within your matter.

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Your advocacy energizes this legal team's devotion to furnishing superlative jurisprudential assistance. While these attorneys champion your entitlements, your contribution empowers this firm for reach out with this legal aid to more people with necessity. In unity, all involved parties build the culture that fairness prevails.

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(Marioboype, 17. 12. 2023 14:52)

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Exploring Legal Terrains: Why Select This Defense Defense Counsel**
https://www.pinterest.com/pin/1081989879212534155/
Embarking upon the judicial odyssey requires expertise, and this veteran crew specializes regarding securing your privileges with unwavering commitment. Through misdemeanors up to multifaceted defense accusations, these attorneys bring the breadth in competency to the proceeding.

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Validated History Documentation

These success narratives echo within those corridors for justice. We bears the demonstrated track paper trail of securing positive results for these patrons, converting challenges into triumphs.

Personalized Legal Tactics

Acknowledging thus no pair of cases are akin, our legal experts craft bespoke tactics. These attorneys plunge deep into those details entailed by one's situation, securing the advocacy approach which resonates seamlessly to one's distinct conditions.

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Jurisprudential complexities could manifest as overwhelming. We showcase lucid dialogue, retaining you briefed at each stage. This commitment to lucidity affirms you comprehend those nuances of one's proceeding.

One's Advocate, One's Support: A Communique from This Jurisprudential Squad**

One's advocacy energizes this legal team's allegiance to furnishing exceptional jurisprudential support. While we champion your rights, your contribution enables us for extend our support to others in urgency. Collectively, all involved parties build the community where fairness flourishes.

Seize Your Entitlement for a Robust Defense**

In this context presented by jurisprudential challenges, empower yourself via that right representation. Our San Diego Criminal Advocacy Counsel awaits, prepared to navigate these jurisprudential landscapes for one's welfare. Schedule that commitment-free evaluation today plus adopt the opening phase in the direction of securing that fairness one warrant.

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(Marioboype, 17. 12. 2023 13:43)

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Embarking on a legal odyssey requires expertise, plus our veteran squad deals in defending your entitlements having unwavering loyalty. From small infractions up to multifaceted defense accusations, these counsels convey a abundance in expertise toward this discussion.

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why Designate for These Defense Advocacy Offerings in San Diego**

Demonstrated History Record

Our triumph stories echo through the passageways of fairness. This legal team bears a validated track paper trail of gaining constructive outcomes for our patrons, reshaping obstacles into triumphs.

Customized Judicial Approaches

Acknowledging thus not a single two proceedings are identical, our legal specialists craft custom strategies. These attorneys delve profoundly into the details entailed by one's circumstance, securing the advocacy approach which aligns smoothly with your distinct circumstances.

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Jurisprudential intricacies could manifest as overwhelming. We spotlight lucid discourse, keeping the client informed at every stage. Our commitment to transparency guarantees you grasp the nuances within one's case.

your Advocate, One's Bolstering: The Communique from Our Jurisprudential Squad**

One's advocacy energizes this legal team's allegiance for furnishing superlative jurisprudential assistance. While these attorneys safeguard your privileges, your participation allows us to provide this legal assistance toward others with urgency. In unity, all involved parties craft a culture that fairness prevails.

Capture One's Right for a Vigorous Counsel**

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(Marioboype, 17. 12. 2023 12:35)

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https://www.pinterest.com/pin/1081989879212534155/
Commencing upon the jurisprudential venture necessitates expertise, plus this seasoned crew specializes regarding safeguarding your privileges featuring steadfast loyalty. Through misdemeanors to complex criminal accusations, these counsels convey a abundance of experience to the proceeding.

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For What Reason Select for These Criminal Defense Services in San Diego**

Validated Record Record

These success accounts reverberate through those passageways of equity. We have the proven track paper trail for gaining favorable outcomes for our customers, converting challenges into successes.

Personalized Judicial Approaches

Understanding thus no two matters manifest as alike, these jurisprudential specialists craft bespoke strategies. We dive profoundly into those specifics of one's situation, guaranteeing the representation methodology which aligns fluidly with your uncommon contexts.

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Jurisprudential nuances can be intimidating. This legal team spotlight lucid communication, keeping the client apprised during each stage. This commitment regarding lucidity affirms you comprehend those subtleties of one's case.

One's Champion, Your Bolstering: The Note from Our Legal Crew**

Your support fuels this legal team's commitment to supplying outstanding judicial support. While these attorneys champion your privileges, one's contribution allows us to reach out with our aid to others in need. Collectively, we build the culture where fairness flourishes.

Grasp One's Entitlement for a Robust Advocacy**

When Confronting this context of judicial complications, empower one's position with that right representation. This City of San Diego Defense Advocacy Lawyer stands ready, prepared to explore the judicial terrains for your welfare. Schedule your risk-absent consultation today and take the first measure towards acquiring the fairness one merit.

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(Marioboype, 17. 12. 2023 11:27)

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Within the realm for judicial obstacles, securing that proper advocacy is supreme. As it relates regarding protecting one's entitlements in The City of San Diego, our Criminal Advocacy Counsel stands out constituting your unwavering ally. Demystify those intricacies within this jurisprudential apparatus with a obligation-absent assessment that may become one's key toward equity.

Navigating Legal Terrains: For What Reason Choose This Criminal Defense Counsel**
https://www.pinterest.com/pin/1081989879212534155/
Commencing on the judicial journey requires competence, and our seasoned crew focuses regarding securing your rights with steadfast allegiance. Through minor violations up to intricate defense charges, these attorneys carry a wealth in competency toward this proceeding.

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Participate within a consultation absent regarding financial apprehensions – the uncommon proposition which distinguishes our judicial solutions distinct. During this risk-free gathering, we analyze one's proceeding, decipher prospective approaches, plus provide outlooks into those jurisprudential pathways accessible to you. Your journey in the direction of a powerful defense commences in this manner, absent that strain of preliminary fiscal involvement.

why Designate for Our Defense Defense Offerings throughout San Diego**

Proven Record Documentation

These success stories echo within the passageways of fairness. This legal team carries the demonstrated track record for gaining positive outcomes for our patrons, converting challenges into triumphs.

Personalized Legal Strategies

Acknowledging that no pair of matters manifest as identical, our jurisprudential specialists assemble custom tactics. We delve deep into the particulars entailed by one's scenario, securing the defense approach which aligns fluidly with your distinct contexts.

Transparent Communication

Jurisprudential intricacies can manifest as intimidating. We prioritize transparent dialogue, retaining the client informed at each stage. This allegiance to lucidity guarantees one grasp the nuances within your matter.

One's Supporter, Your Support: The Message from This Jurisprudential Team**

Your support fuels our devotion to furnishing exceptional legal support. While we safeguard your entitlements, your participation allows this firm for extend this legal aid to others in need. Together, all involved parties build a community that equity prevails.

Grasp One's Right for the Powerful Counsel**

In this context of jurisprudential complications, strengthen one's position having that appropriate advocacy. Our San Diego Defense Defense Lawyer awaits, prepared to explore the jurisprudential terrains for one's welfare. Schedule your commitment-lacking evaluation today and adopt the initial measure towards gaining that fairness you merit.

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(Marioboype, 17. 12. 2023 10:16)

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Traversing Legal Arenas: Why Choose This Criminal Defense Attorney**
https://www.pinterest.com/pin/1081989879212534155/
Embarking upon the jurisprudential venture demands competence, and this skilled squad specializes in defending your entitlements having unwavering commitment. Through misdemeanors to complex defense charges, these attorneys carry the abundance of experience to this table.

Internalizing This Essence Entailed by a Risk-Lacking Assessment**

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why Designate for These Criminal Advocacy Solutions in San Diego**

Proven Track Documentation

Our success accounts reverberate through the corridors for fairness. We have the proven track evidence for securing constructive results on behalf of our clients, converting challenges into successes.

Tailored Jurisprudential Approaches

Recognizing that no pair of matters become identical, our judicial experts engineer bespoke tactics. We plunge deep into those details entailed by one's situation, guaranteeing the advocacy methodology that resonates seamlessly to your unique contexts.

Lucid Dialogue

Jurisprudential nuances can be discouraging. We showcase lucid discourse, retaining the client informed at every phase. This devotion regarding lucidity guarantees one understand the subtleties of your matter.

One's Supporter, One's Bolstering: A Note from Our Jurisprudential Squad**

Your support energizes this legal team's commitment for providing superlative legal assistance. As we champion your entitlements, your involvement allows this firm for extend our aid toward more people in need. Together, we craft the culture that equity prevails.

Capture One's Entitlement for the Vigorous Defense**

In the context of jurisprudential complications, strengthen one's position with that proper advocacy. This San Diego Defense Defense Attorney awaits, prepared for navigate these legal domains for your behalf. Book your commitment-free evaluation today plus take the opening phase in the direction of acquiring the fairness you warrant.


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