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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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Наш Мефедрон в Киеве- просто перчик? Про такой Мефедрон в Киеве даже соченили уже репчик? Какие молодцы люди, которые понимают в качестве и основных ингредиентах приготовления такого Мефедрон в Киеве?
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Struggling with regard to Justice with Martinicchio Criminal Security Party

(WarrenPlurl, 21. 11. 2023 0:04)

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Allow myself understand when a person would similar to me in order to expand or perhaps add any particulars on specific areas.

Struggling for Justice together with Martinicchio Offender Protection Group

(WarrenPlurl, 20. 11. 2023 23:04)

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-Started through Frederick Third. Martinicchio, the past Middlesex State Helper Lawyer or attorney
-Many years of combined knowledge successfully shielding consumers
-Team of educated lawyers dedicated in order to personal security
-Committed to be able to protecting legal rights and obtaining ideal outcomes
https://localservicesnearme.blob.core.windows.net/martinicchio-criminal-defense-group/dui-lawyer-media-pa/index.html
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-Young crime representation
-Domestic violence as well as restraining buy cases
-Sex offensive allegations
-Homicide, attack, as well as chaotic crimes
-White shirt and financial offenses
-Website traffic transgressions as well as driver's permit protection

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-Focus in consumer conversation and education
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-Any history of ignoring fees as well as keeping clients out there of imprisonment

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-Experience discussing beneficial plea discounts
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-Affordable lawful protection services

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Permit myself know if an individual would certainly similar to me to broaden or even include just about any details on certain parts.

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(WarrenPlurl, 20. 11. 2023 15:39)

When encountering offender charges, a person want an promoter in your part. Martinicchio Criminal Protection Group provides the particular know-how in order to end up being that intense champion. Why don't we check out exactly how this particular organization provides best-tier legal statement with regard to clients in Fresh Jersey.

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-Founded by Joseph Third. Martinicchio, any former Middlesex county State Associate Prosecutor
-Decades of put together knowledge successfully defending consumers
-Group of well-informed law firm devoted to be able to personal protection
-Committed to be able to defending rights and achieving optimal outcomes
https://localservicesnearme.blob.core.windows.net/martinicchio-criminal-defense-group/dui-lawyer-media-pa/index.html
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-Young crime rendering
-Domestic abuse and restrictive purchase cases
-Lovemaking offense costs
-Hardship, attack, as well as chaotic criminal acts
-Bright white shirt along with monetary offenses
-Traffic transgressions along with motorist's license security

Customer-Centered Approach:
-Customized defense technique structured on the distinctive situation
-Stress on customer communication and schooling
-Compassionate assistance through the challenging method
-The record of dismissing fees as well as retaining clients away of imprisonment

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-Knowledge of Nj courts as well as offender the law program

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-Affordable legal security services

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Allow me understand if you might such as me to increase or perhaps include virtually any particulars on specific parts.

Battling regarding Justice together with Martinicchio Legal Protection Party

(WarrenPlurl, 20. 11. 2023 14:33)

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Regarding Martinicchio Offender Security Party:
-Launched simply by Joseph R. Martinicchio, a past Middlesex State Assistant Lawyer or attorney
-Decades of combined experience successfully defending customers
-Staff of educated attorneys dedicated to personal protection
-Committed to guarding legal rights and obtaining ideal final results
https://localservicesnearme.blob.core.windows.net/martinicchio-criminal-defense-group/dui-lawyer-media-pa/index.html
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-Juvenile offense representation
-Home-based violence along with constraining buy instances
-Lovemaking offensive allegations
-Homicide, strike, as well as fierce criminal acts
-Bright white collar along with fiscal offenses
-Website traffic violations and car owner's licence protection

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-Customized protection tactic structured in the actual distinctive situation
-Stress upon consumer communication and training
-Caring counsel through the hard procedure
-Any record of overlooking charges as well as retaining consumers out there of prison

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-Experienced demo attorneys adept in creating a robust defense
-Encounter discussing good request deals
-Skilled at consequence proposta in order to reduce charges
-Understanding of Nj-new jersey process of law as well as criminal the law method

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-Established final results in receiving dismissals, exculpations, along with fee reducing
-Popularity regarding aggressive and honorable rendering
-Personal attention along with value with regard to each consumer
-Inexpensive legal defense providers

Realization:
With the client-very first ideology along with the persistent approach, Martinicchio Offender Defense Party has a keep track of record of obtaining successful final results. Their own competence offers the actual robust security a person are entitled to.

Allow myself recognize in the event that you would similar to everyone to increase or add any information about particular areas.

Fighting for The law along with Martinicchio Legal Protection Team

(WarrenPlurl, 20. 11. 2023 11:04)

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-Launched by May well Third. Martinicchio, any previous Middlesex county County Assistant Prosecutor
-Decades of put together knowledge successfully protecting clients
-Staff of educated law firm focused in order to personalized defense
-Committed to be able to protecting privileges and accomplishing ideal outcomes
https://localservicesnearme.blob.core.windows.net/martinicchio-criminal-defense-group/dui-lawyer-media-pa/index.html
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-Young offense representation
-Household violence and constraining buy instances
-Sex offense accusations
-Hardship, assault, as well as chaotic offenses
-White colored shirt as well as monetary crimes
-Visitors violations along with driver's licence security

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-Customized defense technique dependent in the particular unique circumstance
-Focus in client discussing and schooling
-Sympathetic advice by means of the difficult process
-The history of dismissing fees as well as keeping consumers out of jail

Trial Capabilities:
-Skilled test attorneys adept in developing a strong protection
-Knowledge discussing favorable request bargains
-Experienced in consequence support to be able to minimize penalties
-Knowledge of NJ courts as well as offender proper rights system

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-Tested outcomes in obtaining terminations, acquittals, and demand reductions
-Status regarding intense as well as honorable rendering
-Personal attention and regard with regard to every customer
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Permit me recognize when an individual would such as myself in order to broaden or even include any details upon specific sections.

Battling with regard to Justice along with Martinicchio Criminal Security Group

(WarrenPlurl, 20. 11. 2023 8:48)

When facing legal charges, a person require a good promoter throughout your place. Martinicchio Criminal Protection Party offers the particular competence to be able to be in which aggressive defender. Let's explore exactly how this particular company offers leading-rate authorized statement with regard to customers in New Jersey.

Regarding Martinicchio Offender Protection Party:
-Launched simply by Frederick Ur. Martinicchio, any former Middlesex Region Associate Lawyer or attorney
-Many years of mixed knowledge properly protecting consumers
-Team of educated attorneys devoted to be able to personalized protection
-Focused to be able to protecting rights and accomplishing ideal outcomes
https://localservicesnearme.blob.core.windows.net/martinicchio-criminal-defense-group/dui-lawyer-media-pa/index.html
Opportunity of Legal Defense Providers:
-Protection regarding all types of Nj-new jersey offender costs - Dwi, medicine violations, theft, and so forth.
-Juvenile offense statement
-Domestic assault along with restraining buy circumstances
-Sex offensive accusations
-Hardship, attack, and violent crimes
-White collar and fiscal criminal acts
-Visitors violations along with car owner's licence protection

Client-Focused Strategy:
-Custom made protection strategy based upon the special situation
-Focus in customer discussing as well as schooling
-Sympathetic advice by means of the difficult procedure
-The record of overlooking charges and maintaining customers away of jail

Trial Abilities:
-Skilled test law firm skilled at creating the powerful defense
-Encounter discussing good plea bargains
-Skilled at consequence support to reduce penalties
-Know-how of NJ courts as well as criminal proper rights system

Why Clients Have confidence in Martinicchio Offender Security Party:
-Proven final results in obtaining cancellations, acquittals, as well as charge reductions
-Popularity regarding intense as well as moral rendering
-Personal attention as well as respect for each customer
-Inexpensive authorized protection providers

Conclusion:
Along with a customer-first ideology as well as any unrelenting strategy, Martinicchio Criminal Defense Party provides any keep track of record of accomplishing effective effects. Their expertise offers the effective protection you deserve.

Let everyone understand when an individual might such as me in order to broaden or even include virtually any information about specific sections.

Fighting for The law with Martinicchio Legal Defense Team

(WarrenPlurl, 20. 11. 2023 6:25)

Any time facing criminal charges, an individual want a good recommend throughout the part. Martinicchio Criminal Security Party offers the particular know-how in order to become that intense defender. Let's check out just how this particular firm provides leading-tier legal representation regarding customers in Brand new Shirt.

About Martinicchio Criminal Protection Party:
-Launched simply by Joseph Ur. Martinicchio, any former Middlesex Region Helper Lawyer or attorney
-Many years of combined encounter successfully defending customers
-Group of knowledgeable attorneys dedicated in order to customized defense
-Focused to be able to guarding legal rights and accomplishing ideal outcomes
https://localservicesnearme.blob.core.windows.net/martinicchio-criminal-defense-group/dui-lawyer-media-pa/index.html
Scope of Offender Defense Expert services:
-Protection regarding just about all varieties of Nj-new jersey legal costs - DUI, drug offenses, theft, and so forth.
-Juvenile offense statement
-Home-based abuse as well as restrictive buy cases
-Intercourse crime allegations
-Hardship, assault, as well as chaotic offenses
-Bright white training collar and fiscal offenses
-Traffic infringements and car owner's permit defense

Customer-Focused Method:
-Custom made security technique dependent upon the actual distinctive situation
-Emphasis in consumer conversation along with training
-Sympathetic counsel via the hard process
-Any history of overlooking costs along with keeping clients away of prison

Courtroom Abilities:
-Experienced demo lawyers adept in creating the powerful defense
-Encounter discussing beneficial request bargains
-Experienced from consequence advocacy to minimize charges
-Knowledge of Nj-new jersey courts along with offender justice method

The reason why Customers Trust Martinicchio Legal Protection Group:
-Proven outcomes within obtaining dismissals, acquittals, and demand reductions
-Reputation with regard to hostile as well as moral statement
-Individual attention along with respect for each and every consumer
-Affordable lawful security services

Realization:
Along with any customer-initial considering and a unrelenting method, Martinicchio Criminal Defense Group offers a track report of obtaining successful outcomes. His or her expertise provides the powerful security a person deserve.

Let myself recognize if you would like myself to broaden or perhaps add virtually any particulars on particular sections.

Возьму чемодан сайт

(MartinIdotS, 20. 11. 2023 5:23)

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(Alfredonmub, 20. 11. 2023 3:25)

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Теги поисковых слов для запроса "Купить Мефедрон в Киеве"
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Если есть желание покупать Мефедрон в Киеве по самой демократичной и низкой цене по сравнению с качеством то Вам несомненно нужно посетить сайт на котором продают Мефедрон в Киеве?
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Челоек - Паук вместо паутины плетёт Мефедроновую нить, которую иногда можно перепутать с Мефедроном в Киеве по самой доступной цене на этом узкопрофильном рынке!
Каждая собака в Киеве знает где купить Мефедрон на розвес так сказать, разфасованный товар до милиграмма с точностью швейцарских часов Киевских Мефедроновых весов?
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Наш Мефедрон в Киеве- просто перчик? Про такой Мефедрон в Киеве даже соченили уже репчик? Какие молодцы люди, которые понимают в качестве и основных ингредиентах приготовления такого Мефедрон в Киеве?
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