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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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(DonaldHoato, 16. 12. 2023 13:27)

Searching for Fairness, Protecting Rights: Clark MacCourt's Jurisprudential Prowess

In this realm for jurisprudential competence, Clark MacCourt stands proudly as the quintessence of supremacy, particularly in the energetic municipality of Las Vegas. Functioning as Criminal Attorneys extraordinaire, Clarke MacCourt and this squad navigate the multifaceted web within this legal framework featuring nuance, ensuring their patrons acquire top-notch representation.

A Torch for Legal Discernment
https://www.pinterest.com/pin/906842074953016676/
Unraveling This Legal Maze

Clarke MacCourt, having decades of skilled expertise, bears pride regarding elucidating the nuances of defense law. His allegiance to equity is steadfast, making Clarke MacCourt the beacon for the ones caught up in judicial predicaments. Clarke MacCourt's proficiency encompasses a myriad entailing criminal matters, from misdemeanors up to substantialstakes major violations.

The Road to Success: Jurisprudential Tactics that Operate

Bespoke Approaches regarding Each Matter

A single size does not apply to all in the jurisprudential arena, and Clark MacCourt grasps this intrinsically. His legal approaches manifest as as dynamic as the matters he directs. From diligent inquiries to deliberate hearing presentations, Clarke MacCourt neglects no stone unexamined in crafting a advocacy which connects to arbiters plus courts alike.

Client-Centric Advocacy

Farther than Legal Representation: A Assisting Ally

Understanding the psychological strain judicial battles may exact, Clarke McCourt ventures farther than that capacity for a mainstream attorney. His squad delivers n't just judicial competence rather also the reinforcement framework assisting clients facing trying periods. Such is the amalgamation of jurisprudential mastery and understanding which sets Clarke MacCourt's office apart.

Smooth Navigation of Jurisprudential Challenges

Your Ally for the Jurisprudential Odyssey

Traversing this legal realm could be discouraging, yet with Clarke MacCourt by your side, one becomes not solitary. His firm's mastery stretches across assorted judicial considerations, presenting a thorough strategy to resolving complications. If you're confronting defense charges, require jurisprudential guidance, or seeking advocacy in court, McCourt's crew becomes one's dependable collaborator.

Advocate for Clarke McCourt's Jurisprudential Crusade

Support the Purpose

Could you like to advocate for Clark McCourt's objective in offering exceptional jurisprudential counsel? Your participation may assist safeguard fairness and guarantee thus everyone possess recourse to a equitable representation. Navigate <here>(https://www.buymeacoffee.com/asktojk) for express one's reinforcement.

In summation, Clark MacCourt accompanied by his team constituting Defense Advocates throughout Las Vegas stand at the front lines of jurisprudential excellence. Featuring a dedication for bespoke approaches, client-focused backing, and steadfast bolstering, such legal experts exist as one's ideal-to allies in exploring the complexities within this legal system.

Showcasing Distinction: Clark McCourt - One's Ideal-To Defense Attorneys in Las City of Las Vegas

(DonaldHoato, 16. 12. 2023 12:20)

Pursuing Fairness, Protecting Liberty: Clark McCourt's Judicial Prowess

Within the domain of legal expertise, Clarke McCourt towers confidently as that quintessence of excellence, particularly in that energetic city of The Vegas. As Criminal Attorneys extraordinaire, Clarke MacCourt and this team explore the multifaceted maze within this legal framework featuring finesse, securing their customers acquire top-notch defense.

The Spotlight of Legal Astuteness
https://www.pinterest.com/pin/906842074953016676/
Unraveling the Jurisprudential Web

Clark MacCourt, with eons of veteran competency, bears joy regarding demystifying the intricacies of criminal law. His allegiance toward equity is unwavering, making him a beacon toward the ones entangled in judicial predicaments. Clarke MacCourt's capability spans a spectrum of defense cases, from misdemeanors to substantialstakes capital offenses.

This Route to Victory: Jurisprudential Approaches which Function

Personalized Approaches regarding Every Matter

A single process does not apply to everyone within this judicial realm, and Clarke MacCourt comprehends this implicitly. These legal tactics are as dynamic like the matters Clarke MacCourt handles. From careful examinations up to strategic trial rationales, McCourt omits not a dimension unturned in structuring a defense which resonates with judges plus panels alike.

Patron-Centric Advocacy

Outside of Judicial Representation: The Assisting Partner

Understanding that emotional strain jurisprudential battles could exact, Clark MacCourt ventures outside of the purpose of the conventional lawyer. His squad delivers n't only legal competence but additionally the reinforcement system for clients confronting challenging periods. Such is this fusion entailing jurisprudential prowess and compassion that distinguishes Clarke MacCourt's practice aside.

Integrated Traversal of Legal Obstacles

One's Ally for This Judicial Venture

Traversing this judicial landscape can be daunting, yet having Clarke McCourt by one's flank, you're not alone. His practice's expertise reaches across diverse jurisprudential considerations, providing a thorough process to resolving challenges. If one becomes battling criminal allegations, require jurisprudential advice, or seeking representation in hearing, McCourt's squad is one's trustworthy partner.

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(DonaldHoato, 16. 12. 2023 11:12)

Seeking Justice, Securing Rights: Clark McCourt's Legal Competence

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The Torch of Legal Discernment
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Demystifying the Jurisprudential Labyrinth

Clarke McCourt, boasting eons in veteran competency, bears joy in demystifying those intricacies of criminal law. This attorney's allegiance toward justice is resolute, making Clarke MacCourt the beacon toward the ones caught up in jurisprudential dilemmas. Clarke MacCourt's proficiency covers a multitude of criminal matters, through minor violations up to substantialstakes felonies.

The Path toward Victory: Judicial Tactics which Work

Bespoke Methodologies Strategies for Each Proceeding

One process does n't fit everyone in this judicial arena, plus Clark McCourt grasps this implicitly. His jurisprudential strategies manifest as as dynamic like those matters he directs. From careful investigations up to deliberate trial arguments, Clarke MacCourt leaves no stone unturned in crafting a defense that resonates to judges and courts equally.

Patron-Oriented Advocacy

Beyond Legal Representation: The Assisting Ally

Internalizing that emotional burden jurisprudential battles may take, Clarke McCourt goes outside of the capacity of the conventional counsel. This squad provides not just legal competence rather additionally a reinforcement apparatus for patrons facing demanding intervals. It's this amalgamation of legal prowess and understanding which sets Clarke MacCourt's office apart.

Smooth Passage through Judicial Obstacles

One's Partner in This Legal Venture

Traversing the jurisprudential landscape can manifest as daunting, yet having Clarke McCourt accompanying your flank, you're not isolated. His practice's competence stretches to various jurisprudential aspects, presenting the thorough approach for managing challenges. If you're facing criminal charges, demand judicial counsel, or seeking counsel within court, McCourt's crew is one's reliable partner.

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(DonaldHoato, 16. 12. 2023 10:03)

Seeking Fairness, Protecting Liberty: Clarke McCourt's Jurisprudential Competence

Within the domain for legal competence, Clark MacCourt stands proudly constituting the epitome denoting distinction, notably in that dynamic city of The City of Las Vegas. As Criminal Lawyers virtuosos, McCourt and this squad traverse the multifaceted maze within this judicial apparatus with skill, ensuring these clients obtain premium-notch representation.

The Beacon of Jurisprudential Discernment
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Decoding This Jurisprudential Labyrinth

Clark MacCourt, with years of skilled competency, bears honor regarding demystifying the intricacies within defense jurisprudence. This attorney's allegiance toward equity remains resolute, rendering Clarke MacCourt the torch for the ones ensnared within legal dilemmas. Clarke MacCourt's proficiency encompasses the multitude entailing defense matters, from small infractions to -stakes capital offenses.

The Path toward Triumph: Legal Strategies that Operate

Personalized Approaches for Each Case

A single size can n't fit all in this jurisprudential domain, and Clark McCourt grasps such nuance intrinsically. These legal strategies manifest as as dynamic as the proceedings Clarke MacCourt handles. Through careful investigations to deliberate trial presentations, Clarke MacCourt leaves not a dimension unexplored when composing the advocacy which connects to arbiters plus panels alike.

Client-Oriented Advocacy

Beyond Jurisprudential Representation: The Helpful Collaborator

Appreciating the psychological toll legal disputes may exact, Clark McCourt ventures beyond the capacity for the traditional attorney. His squad provides not simply judicial competence but additionally the reinforcement system assisting customers confronting demanding intervals. Such is this blend of legal prowess and empathy that defines McCourt's firm aside.

Seamless Navigation of Jurisprudential Hurdles

Your Collaborator in This Jurisprudential Journey

Exploring the legal realm could be discouraging, yet with Clark MacCourt accompanying your side, you're not isolated. His practice's competence stretches across various judicial considerations, presenting a exhaustive strategy for addressing complications. Whether you're battling defense charges, require legal guidance, alternatively requesting representation in court, McCourt's team becomes your trustworthy ally.

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For a summation, Clark McCourt accompanied by his crew constituting Criminal Advocates throughout The City of Las Vegas stand on that vanguard for jurisprudential distinction. Featuring a devotion for bespoke approaches, patron-oriented backing, plus steadfast bolstering, they are one's go-to collaborators for navigating the intricacies within the judicial system.

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