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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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Whole-Body Care from Delaware Integrative Healthcare

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(RobertSEP, 14. 11. 2023 9:31)

Overview of Diamond state Complementary Medical as well as his or her alternative approach to be able to remedies throughout Middleton, De

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1. Complementary Treatments Model
-Treats the complete individual - mind, physique and character
-Combines mainstream along with substitute techniques
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-Physician-individual collaboration focused in wellbeing targets
https://www.pinterest.com/pin/991354936714391952/
2. Providers Offered
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(RobertSEP, 14. 11. 2023 8:26)

Overview of Delaware Complementary Health care and their integrative strategy to treatments within Middletown, De

Primary Portions:

1. Complementary Treatments Model
-Dog snacks the actual entire particular person - thoughts, physique and character
-Mixes conventional and substitute methods
-Addresses bodily, mental along with life-style elements
-Physician-affected individual partnership centered upon wellness goals
https://www.pinterest.com/pin/991354936714391952/
2. Services Offered
-Key treatment and continual disease management
-Acupuncture, therapeutic massage, natural medicine
-Diet counseling as well as wellbeing teaching
-Yoga exercises remedy, deep breathing and recognition
-Bioidentical hormone treatment
-Intravenous remedies as well as aesthetic treatments

3. Primary Care Vendors
-Doctor. Melinda Panaccione, Doctor of medicine
-Dr. Kristin Sniatkowski, Doctor of medicine
-Health professional specialist Teresa Gillman
-Places of expertise covered

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-Natural vitamin supplements as well as medicinal foods
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-Neighborhood classes and well-being events

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Permit myself understand in the event that you would like myself to expand on virtually any specific section throughout far more fine detail.

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(RobertSEP, 14. 11. 2023 6:05)

Overview of De Complementary Healthcare along with their alternative method in order to remedies in Middletown, Del.

Primary Portions:

1. Integrative Treatments Design
-Dog snacks the particular whole individual - brain, body along with spirit
-Combines conventional and substitute methods
-Contact information physical, mental along with lifestyle factors
-Physician-patient collaboration concentrated on wellness targets
https://www.pinterest.com/pin/991354936714391952/
2. Providers Provided
-Main treatment along with persistent illness management
-Homeopathy, rub down, naturopathic medicine
-Nourishment counseling and health coaching
-Yoga remedy, relaxation along with mindfulness
-Normal junk treatment
-Intravenous treatments and aesthetic remedies

3. Primary Attention Vendors
-Dr. Melinda Panaccione, MD
-Dr. Kristen Sniatkowski, MD
-Health professional specialist Teresa Gilman
-Places of expertise included

4. Holistic Wellbeing Strategy
-Natural vitamin supplements and medicinal foods
-Body cleanse programs
-Tension management along with life-style adjustments
-Local community classes along with health activities

5. Medical center Atmosphere
-Tranquil environment favorable to be able to recovery
-Relaxing beautification and rest and relaxation space
-Onsite yoga facility
-Local pharmacy of organic remedies

Conclusion:
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-Get in touch with particulars and area within Middle village, De

Permit myself recognize in the event that you would similar to myself to increase on just about any certain portion throughout more aspect.

Educating Ones Pet Utilizing Dominant Reactions

(MilfordLew, 12. 11. 2023 9:19)

Overview of Dominant Behavior canine education ideology and methods. These people concentrate in positive motivation while creating the particular user since bunch leader.

Main Areas:

1. Leader Reactions Training Method
-Using dog's natural bunch reactions in order to respect user because leader
-Positive reinforcement methods
-Incentive-based education methods
-Understanding dog psychology along with habits
-Custom made training plans regarding each dog
https://twitter.com/alpha_instincts
2. Obedience Coaching
-Simple commands - remain, keep, appear, back heel, along
-Leash training for walking properly
-Checking jumping, biting, woofing
-Interpersonal interaction along with some other puppies along with folks
-Off-leash control

3. Habits Modification
-Coping with problem habits - aggression, anxiety, chewing, burrowing, and so on.
-Rectifying unwanted routines
-Controlling animated and substantial vitality puppies
-Education regarding splitting up nervousness

4. Customized Coaching
-Assistance pet preparation
-Therapy pet certification
-Defend dog fitness and health
-Diagnosis as well as tracking capabilities
-Searching for canine proficiency
-Competition as well as demonstrate coaching

5. Within-Home along with Boarding Training
-Private throughout-house sessions
-Evening education along with kennel software
-Group courses at their education facility
-Twenty-four/7 coach help regarding companies

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-Review of Leader Reactions' encounter along with multipurpose coaching expert services
-Get in touch with info with regard to evaluating as well as costs

Permit me know in the event that an individual would certainly similar to me to be able to expand or perhaps add a lot more details on just about any certain area.

Coaching The Dog With Leader Instincts

(MilfordLew, 12. 11. 2023 7:09)

Review of Alpha Instincts pet training thinking and approaches. They focus upon constructive motivation although creating the user since pack innovator.

Primary Areas:

1. Dominant Reactions Coaching Method
-Using pet's organic pack behavior to be able to value proprietor because leader
-Constructive reinforcement methods
-Reward-structured coaching approaches
-Understanding puppy psychology and manners
-Personalized training ideas for each and every pet
https://twitter.com/alpha_instincts
2. Obedience Coaching
-Simple instructions - sit, keep, come, heel, lower
-Leash training regarding walking adequately
-Controlling bouncing, biting, woofing
-Interpersonal interaction with some other puppies and people
-Away from-leash control

3. Behavior Modification
-Dealing with problem habits - hostility, anxiety, gnawing, searching, and so forth.
-Rectifying unwanted routines
-Controlling excitable along with higher power puppies
-Education regarding spliting up stress and anxiety

4. Specific Education
-Service pet processing
-Therapies canine recognition
-Safeguard pet health and fitness
-Recognition as well as monitoring skills
-Searching for dog proficiency
-Rivals along with display education

5. In-Home along with Boarding Training
-Private in-house classes
-Evening coaching as well as pet programs
-Team courses at their own coaching service
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Realization:
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-Get hold of info regarding evaluating along with charges

Let myself know in the event that you would certainly similar to me in order to broaden or include far more information on virtually any particular area.

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(MilfordLew, 12. 11. 2023 4:54)

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https://twitter.com/alpha_instincts
2. Compliance Coaching
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-Curbing bouncing, nipping, too much barking
-Interpersonal interaction together with other dogs along with people
-Away from-leash manage

3. Conduct Alteration
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4. Specific Education
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5. In-Home as well as Kennel Training
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Bottom line:
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-Get hold of details for evaluations as well as costs

Allow everyone know when an individual would such as myself to broaden or include far more details on just about any certain portion.

Educating Your Dog Utilizing Dominant Reactions

(MilfordLew, 12. 11. 2023 1:36)

Introduction of Alpha Reactions canine coaching philosophy along with approaches. That they concentrate on constructive reinforcement although establishing the actual owner because load up head.

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-Using dog's organic bunch reactions to be able to value owner because leader
-Good reinforcement strategies
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https://twitter.com/alpha_instincts
2. Compliance Education
-Simple instructions - sit, keep, arrive, heel, down
-Lead coaching with regard to strolling adequately
-Curbing bouncing, nipping, barking
-Interpersonal interaction together with additional canines and individuals
-Away-leash manage

3. Conduct Alteration
-Addressing problem manners - hostility, anxiety, gnawing, burrowing, etc.
-Fixing unwanted habits
-Coping with excitable as well as substantial vitality puppies
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4. Specialized Coaching
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5. Throughout-Home and Kennel Coaching
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Conclusion:
-Overview of Leader Instincts' encounter as well as adaptable education services
-Get in touch with info for evaluations as well as costs

Permit everyone understand if a person would certainly such as me to be able to increase or even include far more information about virtually any specific area.

Educating The Puppy Utilizing Leader Behavior

(MilfordLew, 12. 11. 2023 0:27)

Introduction of Leader Instincts pet training ideology as well as techniques. They concentrate upon constructive encouragement although creating the owner as bunch innovator.

Key Areas:

1. Alpha Reactions Education Method
-Making use of dog's all-natural pack instincts to be able to value user since head
-Good encouragement strategies
-Incentive-dependent education approaches
-Knowing canine mindset and behaviors
-Custom made coaching plans with regard to each dog
https://twitter.com/alpha_instincts
2. Conformity Training
-Simple instructions - take a seat, keep, arrive, back heel, down
-Leash education regarding strolling correctly
-Curbing getting, nipping, too much barking
-Socializing with additional puppies along with people
-Away from-leash handle

3. Conduct Changes
-Addressing difficulty behaviors - aggression, nervousness, chewing, digging, and so on.
-Rectifying unwanted practices
-Controlling enthusiastic and substantial power dogs
-Training with regard to spliting up nervousness

4. Specific Coaching
-Service pet processing
-Therapy pet certification
-Guard pet fitness and health
-Recognition along with monitoring skills
-Searching for canine proficiency
-Opposition along with display training

5. Within-Home along with Pet Training
-Private throughout-home periods
-Time education along with pet programs
-Team instruction in their education facility
-Twenty four/6 coach help for ship owners

Conclusion:
-Overview of Alpha Reactions' encounter as well as adaptable coaching services
-Get in touch with info regarding evaluations along with costs

Let everyone know when an individual might similar to everyone in order to broaden or even include a lot more particulars on any certain portion.

Zgromadź nieaktywności w skończonej polsce niebawem plus fachowo

(ChesterAtrOt, 11. 11. 2023 23:04)

Skoncentruj działki w nieuszkodzonej polsce wtem zaś fachowo

Istniejemy plakietką, jaka rządzi obrót parcele za walutę – w całkowitym noka. Działki jakie sprawiamy biorą bary także siedliska, niezawiśle od światka uzasadnionego spójniki fachowego. Swojskim kontrahentom świadczymy współpraca w wnioskowaniu defektów niepisanych, niczym także aktualnych, które prosto spętane są spośród prawowitą posiadłością. Formujemy aktualne przyimek uprzejmością krótkotrwałego obrotu parceli wewnątrz walutę – bez wydatków, robiąc usterkę o nabytku chociażby w układzie 24 pór.

Zniewalają nas lokale dochodowe, bloki i obrót miejsc zadłużonych, ze służebnością, spośród dożywociem, do remontu, po żarze, nietrzeźwe oraz z oryginalnymi motywami jakie że korzystać własność.

Doświadczamy swojskich spożywców. Umiemy z iloma namiętnościami pragnie zmagać się oferujący. Jesteśmy złożenia, iż radośnie zawierzyć znawcom. Goli nie umiemy pełnego, ponieważ zasuwamy spośród pracowniami oficjalnymi natomiast wieloma odrębnymi gośćmi, którzy są opiniodawcami w naszej płaszczyźnie. Przyzwala nam owo na funkcjonalne kombinowanie wywiadów z posiadłościami tudzież ekspersowy przywóz.

Jak wywoływali przedtem rankiem (wszak należałoby wznowić o niniejszym więcej klaps) – współczesne na nas spoczywają jakiekolwiek koszty, jakie przyswajają się ze transakcją tudzież wwozem działki. Przedstawiamy duszyczka, iż gwoli znajomych klientów transakcję zajmowania owo bodaj najistotniejsza sprawa w ożywieniu (no gdy obok mnogości jegomościów). Stąd egzystujemy z Tobą przez całkowity bieg wysyłki, i kasa jaką jesteśmy w poziomie zaproponować jest kwotą netto, jaka podejmujesz do dłoni czy na konto w egzystencje rejenta.

czytaj wiecej

https://newsnowe.s3.eu.cloud-object-storage.appdomain.cloud/newsnowe/news/nieruchomosci-w-polsce-najpopularniejsze-regiony-i677721.html

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(Kennethcof, 31. 10. 2023 15:27)

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Конец тегов.


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