Bolovi u koljenima čest su problem među sportašima i općom populacijom.
Etiologija
Etiologija boli u koljenu
Postoje mnogi uzroci bolova u ili oko koljena u sportaša, osobito trkača, uključujući:
subluksacija patele prilikom savijanja koljena
Hondromalacija donje površine patele (trkačko koljeno, omekšavanje hrskavice na kapici koljena)
intraartikularna patologija, poput razdora meniska i plike (uvučenja normalne sinovijalne ovojnice koljena)
upale masnog jastučića
stresni prijelomi tibije
nepravilan položaj donjih ekstremiteta
Patelarni (ili infrapatelarni) tendinitis (skakačko koljeno, povreda zbog prekomjernog korištenja patelarnog tetiva na mjestu pričvršćenja za donji pol patele)
Bol u koljenu može se reflektirati iz lumbalnog dijela kralježnice i kuka ili nastati kao rezultat problema sa stopalom (npr. prekomjerne pronacije ili okretanja stopala prema unutra za vrijeme hodanja ili trčanja).
Mišićno-koštani sustav koljena
Dijagnoza
Dijagnoza boli u koljenu
Dijagnoza zahtijeva temeljit pregled programa treninga ozlijeđenog sportaša, uključujući povijest početka simptoma i faktore koji pogoršavaju stanje, te potpuni pregled donjih ekstremiteta (za pregled koljena, vidi Pristup pacijentu s bolovima u zglobovima: fizički pregled i vidi Uganuća koljena i ozljede meniskusa).
Mehanički simptomi, kao što su zaključavanje ili zakočenje koljena, govore u prilog unutarnje degeneracije koljena kao što je razdor meniska. Simptomi nestabilnosti kao što su propadanje ili gubitak sigurnosti u ekstremitetu prilikom uvijanja ili okretanja koljena, govore u prilog ozljede ligamenata ili subluksacije patele.
Na hondromalaciju ukazuje bol u prednjem dijelu koljena nakon trčanja, osobito po brdovitom terenu, kao i bol i ukočenost nakon sjedenja bilo kojeg trajanja. Prilikom pregleda bol se tipično pojavljuje radi pritiska patele o bedrenu kost.
Bol koja se pogoršava prilikom nošenja tereta ukazuje na stres frakturu.
Liječenje
Liječenje boli u koljenu
vježbe jačanja kvadricepsa
ponekad stabilizirajući jastučići, podupirači ili udlage
nesteroidni antireumatici (NSAR)
Liječenje je usmjereno k osnovnom uzroku nastanka boli.
Liječenje hondromalacije uključuje vježbe za jačanje kvadricepsa uz uravnotežene vježbe jačanja mišića stražnje strane natkoljenice, primjenu lučnih podupirača ako postoji pretjerana pronacija, i primjenu NSAID–a.
Stabilizatori patele, jastučići ili udlage mogu biti potrebni kod subluksacija patele, osobito u sportovima kod kojih dolazi do brzih, žustrih pokreta u različitim ravninama (npr. košarka, tenis).
Ako postoji prekomjerna pronacija stopala te su isključeni svi drugi mogući uzroci bolova u koljenu, ponekad može biti korisno nošenje ortopedskih uložaka.
Stres nakon frakture zahtijeva odmor i prestanak aktivnosti pri kojima se nosi teret.
Intraartikularna patologija često zahtijeva operaciju.
Vježbe za jačanje koljenaStraight Leg Raise
1. Lie on back with uninvolved knee bent so foot is on the floor/table.
2. Contract quadriceps muscle on the involved side then raise straight leg to thigh level of uninvolved leg.
3. Return to starting position slowly to control the lowering phase.
4. Perform 3 sets of 10 repetitions, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Quadriceps Set
1. Sit with involved leg extended.
2. Contract quadriceps muscle on the front of the leg to push back of knee down to the floor/table.
3. Hold exercise for 10 sec.
4. Perform 1 set of 10 repetitions, every hour.
5. Special Instructions
a. Do not hold your breath during the exercise.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Prone Resisted Knee Flexion
1. Once the inflammatory phase has subsided and the patient is able to perform knee flexion without pain:
2. Lie on stomach.
3. Begin with knee straight.
4. Bend knee through available range that is pain free.
5. Slowly return to starting position.
6. Perform 3 sets of 10 repetitions, 1 time a day.
7. Special Instructions
a. Start with least resistance, adding weight as tolerated. Band resistance can also be used.
b. Focus on eccentric lowering phase with a count of 4 to lower and extend knee to starting position and a count of 2 for knee flexion.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Prone Hip Extension
1. Lie on stomach, keep knee straight on involved side.
2. Perform abdominal contraction.
3. Lift involved leg up off the floor/table.
4. Return to starting position.
5. Perform 3 sets of 10 repetitions, 1 time a day.
6. Special Instructions
a. Keep the knee straight and abdominals contracted through the repetition.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Prone Quadriceps Stretch
1. Lie on stomach.
2. Bend involved knee and loop towel or band around the ankle.
3. Gently pull towel or band to stretch muscle on front of thigh pulling ankle toward buttocks.
4. Hold exercise for 30 sec.
5. Perform 1 set of 4 repetitions, 3 times a day.
6. Repeat on the other leg.
7. Special Instructions
a. For added stretch, place a towel roll just above the knee to place the hip in slight extension.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Standing Iliotibial Band Stretch
1. Stand about a foot away from the wall with the involved leg closest to the wall.
2. Place the uninvolved leg in front of the involved leg.
3. Keep the involved knee straight.
4. Lean trunk away from the wall so the hip on the involved side goes toward the wall.
5. Be sure not to lean forward at the waist.
6. Hold exercise for 30 sec.
7. Perform 1 set of 4 repetitions, 3 times a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Supine Active Hamstring Stretch
1. Lie on back, hold behind the involved knee to pull it gently toward the chest.
2. Gently extend the knee to straighten the leg.
3. Hold exercise for 30 sec.
4. Perform 1 set of 4 repetitions, 3 times a day.
5. Repeat on the other leg.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Sidelying Hip External Rotation (Clamshell Exercise)
1. Lie on involved side.
2. Keep shoulders and hips in line with ankles slightly behind the body with the knees bent approximately 90°.
3. Keep feet together while lifting left knee up toward the ceiling.
4. Lower and repeat.
5. Repeat exercise lying on the uninvolved side.
6. Perform 3 sets of 10 repetitions, 3 times a day.
7. Special Instructions
a. For added resistance, place a band around the knees, start with the least resistance.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Squats
1. Stand with feet about hip width apart.
2. Toes should point forward to stay aligned with the knees.
3. Keeping core tight, move buttocks backward, similar to beginning to sit in a chair, and squat down until the thighs are almost parallel with the floor.
4. Return to start position and repeat.
5. Perform 3 sets of 10 repetitions, 1 time every other day.
6. Special Instructions
a. Keep weight on outside of foot and heels.
b. Start with a partial squat and increase as you become familiar with the movement.
c. Add weight only as tolerated. Start with 1 to 2 pounds (0.5 to 1 kg [ie, a soup can]).
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.