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9. juli 2011Stress fractureurtehave_com

cause-article2

9. juli 2011Stress fractureurtehave_com

SportNetDoc

Risk factors for stress fractures.

Bennell K, Matheson G, Meeuwisse W, Brukner P. Sports Med 1999 Aug;28(2):91-122.

Preventing stress fractures requires knowledge of the risk factors that predispose to this injury. The aetiology of stress fractures is multifactorial, but methodological limitations and expediency often lead to research study designs that evaluate individual risk factors. Intrinsic risk factors include mechanical factors such as bone density, skeletal alignment and body size and composition, physiological factors such as bone turnover rate, flexibility, and muscular strength and endurance, as well as hormonal and nutritional factors. Extrinsic risk factors include mechanical factors such as surface, footwear and external loading as well as physical training parameters. Psychological traits may also play a role in increasing stress fracture risk. Equally important to these types of analyses of individual risk factors is the integration of information to produce a composite picture of risk. The purpose of this paper is to critically appraise the existing literature by evaluating study design and quality, in order to provide a current synopsis of the known scientific information related to stress fracture risk factors. The literature is not fully complete with well conducted studies on this topic, but a great deal of information has accumulated over the past 20 years. Although stress fractures result from repeated loading, the exact contribution of training factors (volume, intensity, surface) has not been clearly established. From what we do know, menstrual disturbances, caloric restriction, lower bone density, muscle weakness and leg length differences are risk factors for stress fracture. Other time-honoured risk factors such as lower extremity alignment have not been shown to be causative even though anecdotal evidence indicates they are likely to play an important role in stress fracture pathogenesis.

cause-article1

9. juli 2011Stress fractureurtehave_com

SportNetDoc

Less common stress fractures in the foot.

Meurman KO. Br J Radiol 1981 Jan;54(637):1-7.

In a series of 827 stress fractures in soldiers, 15 were found in the first metatarsal, representing 11% of all stress fractures in the metatarsals. All were in the proximal end of the bone. Eight fractures were found in the fourth and four in the fifth metatarsal. In the cuneiform bones three fractures were found, and one in the talus. One fracture was revealed in the lateral sesamoid of the hallux and one in the peroneal bone. Ten patients had stress fractures in other bones too. The radiological appearance and the corresponding stress mechanisms are discussed.

Degenerative arthritis

9. juli 2011Rupture of the hollow foot tendonurtehave_com

SLIDGIGT

Diagnosis:

(Osteoarthritis)

Anatomy: The surfaces of the joints are lined with a cartilage covering of a few millimetre’s thickness which serves to reduce the load or strain on the joint surfaces.

Phalanx media
Tuberositas ossis metatarsalis V
Os cuboideum
Calcaneus
Talus
Os naviculare
Os cuneiforme laterale
Os cuneiforme intermedium
Os cuneiforme mediale
Os metatarsalei
Os sesamoideum
Phalanx proximalis
Phalanx distalis

THE FOOT FROM ABOVE

Cause: Degenerative arthritis occurs with repeated (over) load when first the cartilage takes damage, and then the bone under the cartilage. Degenerative arthritis can in some instances cause an irritation of the synovial membrane which will result in concentration of fluid, swelling, reduction in mobility and pain in the joints. Degenerative arthritis in the ankle joint is often seen after repeated ligament injuries (outer ankle joint ligaments, inner ankle joint ligaments), where cartilage lesions in the ankle joint have occurred at the same time.

Symptoms: Pain in the joint with movement under load. Occasionally swelling in the joint.

Examination: Normal clinical examination is often sufficient. However, it is also often necessary to perform an x-ray (or ultrasound scan or MRI examination) to make the diagnosis. Ultrasound scanning will often reveal inflammation surrounding new bone development at the joint surfaces.

Treatment: Treatment comprises relief from the painful activities until the swelling has gone down, after which training can commence with the primary aim to strengthen the muscles surrounding the joint and retain joint mobility. There is no treatment which can restore the damaged cartilage (and bone). Cartilage transplants are, as yet, not suitable for general degenerative arthritis. In cases of swelling in the joint, and with inflamed new bone development at the joint surfaces, inflammation of the synovial membrane can be attempted subdued by using rheumatic medicine (NSAID), or by draining the fluid and injecting corticosteroid. The injections can be performed to advantage by utilising an ultrasound guided method. Pain without swelling of the joints is best treated with paracetamol. In severe cases of degenerative arthritis where there is pain when resting (at night), it may be necessary to fix the joint by operation.

Rehabilitation: Rehabilitation is completely dependent upon the degree of the degenerative arthritis and in which joints it is located.
Also read rehabilitation, general.

Bandage: A supportive tape (Hollywood bandage) can be attempted to aid degenerative arthritis in small joints (toes) (tape-instruction). Tape provides no help to attacks in the ankle joint.

Complications: Degenerative arthritis which sits on the weight bearing parts of the joint is one of the most serious sports injuries, and often results in a termination of active sport. It is usually possible to continue sport activities with light strain on the joints (cycling, swimming), whereas it is advisable to participate in activities with great strains on the joint (running, ball games) with restraint. The diagnostic considerations in connection with degenerative arthritis include:

Special: Shoes with shock absorbing inlays will reduce the discomfort of degenerative arthritis.

Stress fracture

9. juli 2011Rupture of the hollow foot tendonurtehave_com

STRESS FRACTURE

Diagnosis:

Anatomy: The foot bones comprise the 7 tarsal bones (ossa tarsi), the 5 metatarsal bones (ossa metatarsi) and the 14 bones in the toes (phalanx).

Phalanx media
Tuberositas ossis metatarsalis V
Os cuboideum
Calcaneus
Talus
Os naviculare
Os cuneiforme laterale
Os cuneiforme intermedium
Os cuneiforme mediale
Os metatarsalei
Os sesamoideum
Phalanx proximalis
Phalanx distalis

THE FOOT FROM ABOVE

Cause: Repeated load or strain (walking or running) can in some cases entail the load exceeding the strength of the bone tissue, thus resulting in a stress (or fatigue) fracture. Stress fractures are most often seen in the metatarsal bones, (article) (article).

Symptoms: Pain when applying pressure (direct or indirect tenderness), and when applying load or strain.

Examination: X-ray examination will usually, but not always, reveal a stress fracture. The x-ray examination can be repeated after a few weeks as a number of stress fracture are not easily discernible in the early stages. Bone scintigraphy, ultrasound scanning and MRI examination can often diagnose a stress fracture much earlier than x-ray examination (Ultrasonic image), (Scintigraphy-image).

Treatment: Treatment is primarily relief and rest, and possible bandaging. Surgical intervention is only required in very special cases. It is imperative that shoes are equipped with impact absorbing soles (article).

Rehabilitation: Rehabilitation is totally dependent upon the type of fracture, and the treatment (conservative or surgical). Until the pain has subsided, the guidelines under rehabilitation, general should be followed.

Complications: If there is not a steady improvement in the condition a medical examination should be performed once more to ensure that the fracture is healing according to plan. In some cases, a false joint can develop which will require surgical treatment.

Bone fracture in the ankle

9. juli 2011Rupture of the hollow foot tendonurtehave_com

BONE FRACTURE IN THE ANKLE

Diagnosis:

Anatomy: The foot bones comprise the 7 tarsal bones (ossa tarsi), the 5 metatarsal bones (ossa metatarsi) and the 14 bones in the toes (phalanx). Furthermore, the lower part of the shin bone (tibia) and calf bone (fibula) form a part of the ankle joint.

Phalanx media
Tuberositas ossis metatarsalis V
Os cuboideum
Calcaneus
Talus
Os naviculare
Os cuneiforme laterale
Os cuneiforme intermedium
Os cuneiforme mediale
Os metatarsalei
Os sesamoideum
Phalanx proximalis
Phalanx distalis

THE FOOT FROM ABOVE

Cause: A blow or violent twist can cause a fracture of the bone (X-ray picture).

Symptoms: Pain when applying pressure (direct or indirect tenderness), and when applying load or strain.

Acute treatment: Click here.

Examination: X-ray examination will usually reveal the fracture. The fracture can in some cases first be seen after 14 days, thus the x-ray examination should be repeated if there is a continued suspicion of a fracture.

Treatment: Treatment is completely dependent upon which bones are broken, and whether there is a dislocation of the fracture. In some cases relief and rest without bandaging can be opted for, whereas other types of fracture require bandaging and possibly surgical intervention (article) (X-ray picture).

Rehabilitation: Rehabilitation is totally dependent upon the type of fracture, and the treatment (conservative or surgical).
Also read rehabilitation, general.

Special: As there is a risk that the injury can cause permanent disability, all cases should be reported to your insurance company.

STEP4

8. juli 2011Crooked backurtehave_com

GENOPTRÆNING

[Back]

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR CROOKED BACK
(SCOLIOSIS)

STEP 4

Instruction from the physiotherapist in correct back posture (ergonomic guidance) is important.

Unlimited: Cycling. Swimming. Running with increasing distance.

(10 min)


Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.

Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Lie on your back with one leg over the other, and hold behind the lower leg’s knee. Draw the leg up towards your head so that the buttock on the upper leg becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Lie on your back and draw your knee up towards your head while lifting your head so that your back becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your hands on your hips and slowly sway your back, pushing slightly with the hands to increase the sway, so that the stomach muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Lie on your stomach. Rise up and support yourself on your elbows keeping your hip against the floor. Hold the position for 20 seconds. Rest for 20 seconds before repeating.

(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

Lie on the floor on a cushion. Bend your knees. Lift your hands from the floor and keep your balance.

(20 min)


Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards.

Lie on your stomach across a chair with both feet supported under a tabletop. Lift both hands from the floor and hold the position for 2 seconds. Support with your hands for 2 seconds and repeat the exercise 10 times in quick succession.


Go down on all fours with elastic around one foot. Attach the elastic to the wall, lift the leg and draw the knee forwards so that the elastic is tightened.

Lie on your back and place your hands behind your neck. Alternately move your right elbow towards left knee, and left elbow towards right knee.


Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards.

Go down on all fours. Lift right arm and left leg and hold the position for a few seconds, followed by left arm and right leg and hold for a few seconds.

Lie on your back with bent knees. Lift one leg and stretch while at the same time lifting your hip from the floor.

Lie on your back with a ball or firm round cushion under both feet. Roll the ball backwards and forwards in a steady pace while lifting your backside.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated.

The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

STEP3

8. juli 2011Crooked backurtehave_com

GENOPTRÆNING

[Back]

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR CROOKED BACK
(SCOLIOSIS)

STEP 3

Instruction from the physiotherapist in correct back posture (ergonomic guidance) is important.

Unlimited: Cycling. Swimming. Running over short distances on a soft surface.

(10 min)


Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.

Lie on your stomach. Rise up and support yourself on your elbows keeping your hip against the floor. Hold the position for 20 seconds. Rest for 20 seconds before repeating.

(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

Lie on the floor on a cushion. Bend your knees. Lift your hands from the floor and keep your balance.

(20 min)

Go down on all fours. Alternately lift and stretch the right and left legs, fully stretching the knee.


Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards.

Sit on a chair with a broom handle behind your back as shown in the sketch. Rotate from side to side at a steady pace.


Lie on your back with bent legs. Lift your hip from the floor and hold the position for 5 seconds. Rest for 5 seconds before repeating.


Go down on all fours with elastic around one foot. Attach the elastic to the wall, lift the leg and draw the knee forwards so that the elastic is tightened.

Lie on your back with bent knees. Lift one leg and stretch while at the same time lifting your hip from the floor.


Lie on your back and place your hands behind your neck. Move your head and knees towards each other. Remember not to pull on your neck during the exercise.

The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

Tendonitis at the ischiatic bone.

8. juli 2011Tendinitis at the ischiatic boneurtehave_com

Diagnosis:

(ENTESOPATIA TUBER ISCHIADICUM

Anatomy: The large posterior thigh muscles (hamstring muscles) have a common muscle tendon fastening on the ischiatic bone (tuber ischiadicum). The posterior thigh muscles flex the knee and stretch the hip.

Bursa trochanterica m. glutei maximi
M. gluteus maximus
M. biceps femoris (caput longum)
M. semitendinosus
M. semimembranosus
M. adductor magnus
M. gracilis
M. quadratus femoris
Bursa ischiadica m. glutei maximi

(Photo)

RIGHT GLUTEAL MUSCLES
FROM THE REAR

Cause: Inflammation of the tendon fastenings (tendinitis) at the ischiatic bone (tuber ischiadicum) occurs following repeated uniform (over)loads (e.g. running, sprinting) causing microscopic ruptures in the tendon, and especially at the tendon fastening. Tendinitis is a warning that the training performed is too strenuous for the muscles in question, and if the load is not reduced a rupture of the posterior thigh muscle fastening on the ischiatic bone (“pulled muscle”) may occur. This will result in a considerably prolonged rehabilitation period.

Symptoms: Pain in the ischiatic bone can occasionally radiate down into the rear of the thigh. The pain is aggravated when applying pressure on the bone (e.g. sitting position), stretching and activating the posterior thigh muscles (flexing the knee against resistance).

Acute treatment: Click here.

Examination: In slight cases with only minimal tenderness and no discomfort with walking, medical examination is not necessarily required. The extent of the tenderness is, however, not always a mark of the degree of the injury. In cases of more pronounced pain or tenderness, medical examination is required to ensure the correct diagnosis and treatment. The diagnosis is usually made on the basis of a normal medical examination, however, if there is any doubt concerning the diagnosis, this can be confirmed by ultrasound scanning or MR scanning (article).

Treatment: The treatment usually comprises relief, stretching and rehabilitation (article). If the rehabilitation does not progress satisfactorily, medicinal treatment in the form of rheumatic medicine (NSAID) can be considered, or corticosteroid injection in the area surrounding the inflamed tendon fastening on the ischiatic bone. As the injection of corticosteroid is always an element in the long term rehabilitation of a very serious, chronic injury, it is vital that the rehabilitation period lasts over several months in order to reduce the risk of a relapse or ruptures. The tendon can naturally not sustain maximal load after a long-term injury period and only a short-term rehabilitation period. If the diagnosis is made by use of ultrasound scanning, the injections are performed under guidance of ultrasound, and the rehabilitation is progressed in accordance with the guidelines mentioned, then the treatment involving corticosteroid injections has very few risks connected. If satisfactory progress is not made following the rehabilitation and medicinal treatment, surgical intervention can be considered. Long-term results of operations are often disappointing, despite publication of a minor series with good results (article).

Rehabilitation: INSTRUCTION

GENERAL STEP1 STEP2 STEP3 STEP4

Complications: If the treatment does not progress according to plan, it should be considered if the diagnosis is correct or whether complications have arisen. The following should in particular be considered:

STEP2

8. juli 2011Crooked backurtehave_com

GENOPTRÆNING

[Back]

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR CROOKED BACK
(SCOLIOSIS)

STEP 2

Instruction from the physiotherapist in correct back posture (ergonomic guidance) is important.

Unlimited: Cycling. Swimming. Light jogging on a soft surface.

(10 min)


Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.

Lie on your stomach. Rise up and support yourself on your elbows keeping your hip against the floor. Hold the position for 20 seconds. Rest for 20 seconds before repeating.

(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

Lie on the floor on a cushion. Bend your knees. Lift your hands from the floor and keep your balance.

(15 min)

Go down on all fours. Alternately lift and stretch the right and left legs, fully stretching the knee.

Lie on your stomach on the floor with your arms above your head and with outstretched legs. Lift right arm and left leg together, changing to lift left arm and right leg together.


Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards.

Sit on a chair with a broom handle behind your back as shown in the sketch. Rotate from side to side at a steady pace.

Lie on your stomach. Rise up and support yourself on your elbows keeping your hip against the floor. Hold the position for 20 seconds. Rest for 20 seconds before repeating.


Go down on all fours with elastic around one foot. Attach the elastic to the wall, lift the leg and draw the knee forwards so that the elastic is tightened.

Lie on your back with your hands on your chest. Bend your knees and lift your upper body up from the floor while keeping the small of your back against the floor the whole time.

The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.