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complications-article3

Fluid accumulation in the hip joint

Untitled Document

Legg-Calve-Perthes’ disease.

Wall EJ. Curr Opin Pediatr 1999 Feb;11(1):76-9.

The etiology, radiographic classification, and treatment of Legg-Calve-Perthes’ disease remain controversial. Several recent papers focus on these issues in an effort to provide guidance in the clinical care of Perthes’ disease. The research studied in this paper lends further support to the hypothesis of clotting abnormalities with vascular thrombosis, which seems to be the most likely etiology for Legg-Calve-Perthes’ disease. Several studies focus on use of magnetic resonance imaging for the early diagnosis and prognosis of Perthes’ disease. A few researchers whose work is featured in this paper add information on the treatment of Perthes’ disease, supporting surgical treatment for older patients with more severe disease and non-surgical treatment for younger patients with less extensive femoral head involvement.

complications-article3

Tendinitis at the ischiatic bone

Untitled Document

Legg-Calve-Perthes’ disease.

Wall EJ. Curr Opin Pediatr 1999 Feb;11(1):76-9.

The etiology, radiographic classification, and treatment of Legg-Calve-Perthes’ disease remain controversial. Several recent papers focus on these issues in an effort to provide guidance in the clinical care of Perthes’ disease. The research studied in this paper lends further support to the hypothesis of clotting abnormalities with vascular thrombosis, which seems to be the most likely etiology for Legg-Calve-Perthes’ disease. Several studies focus on use of magnetic resonance imaging for the early diagnosis and prognosis of Perthes’ disease. A few researchers whose work is featured in this paper add information on the treatment of Perthes’ disease, supporting surgical treatment for older patients with more severe disease and non-surgical treatment for younger patients with less extensive femoral head involvement.

complications-article2

Fluid accumulation in the hip joint

Untitled Document

Diagnosis and treatment of slipped capital femoral epiphysis.

Reynolds RA. Curr Opin Pediatr 1999 Feb;11(1):80-3
.
Slipped capital femoral epiphysis remains a diagnostic problem despite numerous papers written on the subject. The most important factor in the diagnosis of slipped capital femoral epiphysis is suspicion by the practitioner. The history, physical examination, and radiographic imaging are important in the confirmation of the diagnosis. Imaging is the topic of 1998 with advances in the areas of ultrasound. Ultrasound may be better in experienced hands than plain radiography in the diagnosis of slipped capital femoral epiphysis. Magnetic resonance imaging is used for diagnosis of slipped capital femoral epiphysis and in the assessment of pre-slips. The magnetic resonance image can be oriented to a plane orthoganol to the plane of the physis to assess the width of the physis and to detect edema in the area of the physis.

complications-article2

Tendinitis at the ischiatic bone

Untitled Document

Diagnosis and treatment of slipped capital femoral epiphysis.

Reynolds RA. Curr Opin Pediatr 1999 Feb;11(1):80-3
.
Slipped capital femoral epiphysis remains a diagnostic problem despite numerous papers written on the subject. The most important factor in the diagnosis of slipped capital femoral epiphysis is suspicion by the practitioner. The history, physical examination, and radiographic imaging are important in the confirmation of the diagnosis. Imaging is the topic of 1998 with advances in the areas of ultrasound. Ultrasound may be better in experienced hands than plain radiography in the diagnosis of slipped capital femoral epiphysis. Magnetic resonance imaging is used for diagnosis of slipped capital femoral epiphysis and in the assessment of pre-slips. The magnetic resonance image can be oriented to a plane orthoganol to the plane of the physis to assess the width of the physis and to detect edema in the area of the physis.

complications-article1

Fluid accumulation in the hip joint

Untitled Document

Hip pain in athletes.

Adkins SB 3rd, Figler RA. Am Fam Physician 2000 Apr 1;61(7):2109-18.

Hip pain in athletes involves a wide differential diagnosis. Adolescents and young adults are at particular risk for various apophyseal and epiphyseal injuries due to lack of ossification of these cartilaginous growth plates. Older athletes are more likely to present with tendinitis in these areas because their growth plates have closed. Several bursae in the hip area are prone to inflammation. The trochanteric bursa is the most commonly injured, and the lesion is easily identified by palpation of the area. Iliotibial band syndrome presents with similar lateral hip pain and may be identified by provocative testing (Ober’s test). A methodical physical examination that specifically tests the various muscle groups that move the hip joint can help determine a more specific diagnosis for the often vague complaint of hip pain. A number of hip conditions are more prevalent in athletes of certain ages. Transient synovitis is a common diagnosis in the very young, Legg-Calve-Perthes disease causes bony disruption of the femoral head in prepubescents, and slipped capital femoral epiphysis is seen most commonly in obese adolescent males. Femoral neck stress fractures are seen in adult athletes, especially those involved in endurance sports, and can progress to necrosis of the femoral head if not found early. Older athletes may be limited by degenerative joint disease but nonetheless should be encouraged to stay active.

complications-article1

Tendinitis at the ischiatic bone

Untitled Document

Hip pain in athletes.

Adkins SB 3rd, Figler RA. Am Fam Physician 2000 Apr 1;61(7):2109-18.

Hip pain in athletes involves a wide differential diagnosis. Adolescents and young adults are at particular risk for various apophyseal and epiphyseal injuries due to lack of ossification of these cartilaginous growth plates. Older athletes are more likely to present with tendinitis in these areas because their growth plates have closed. Several bursae in the hip area are prone to inflammation. The trochanteric bursa is the most commonly injured, and the lesion is easily identified by palpation of the area. Iliotibial band syndrome presents with similar lateral hip pain and may be identified by provocative testing (Ober’s test). A methodical physical examination that specifically tests the various muscle groups that move the hip joint can help determine a more specific diagnosis for the often vague complaint of hip pain. A number of hip conditions are more prevalent in athletes of certain ages. Transient synovitis is a common diagnosis in the very young, Legg-Calve-Perthes disease causes bony disruption of the femoral head in prepubescents, and slipped capital femoral epiphysis is seen most commonly in obese adolescent males. Femoral neck stress fractures are seen in adult athletes, especially those involved in endurance sports, and can progress to necrosis of the femoral head if not found early. Older athletes may be limited by degenerative joint disease but nonetheless should be encouraged to stay active.

NSAID

Fluid accumulation in the hip joint

Untitled Document Untitled Document

NSAID (rheumatism medicine)

Use of NSAID is widespread in sport as a painkiller, and as treatment to subdue inflammation.

Indication. Over-load symptoms from tendons. A considerable number of scientific studies have been performed comprising NSAID treatment on acute tendon injuries. In the majority of studies, but not all, healing was achieved slightly quicker, and inflammation was slightly reduced compared with placebo treatment. Some studies have shown increased instability and reduced mobility in the joints after NSAID treatment.
Acute muscle injuries. There are only a handful of animal studies dealing with NSAID treatment of acute muscle injuries. Increased muscle strength has been proven, however, also reduced healing of damaged tissue.
Myositis ossifans (calcification in muscles after bleeding). One study shows that calcification in the muscles following a hip operation is reduced in patients who are treated with NSAID after the operation.
Chronic muscle and tendon injury. There is no conclusive scientific evidence supporting use of NSAID on chronic muscle or tendon injuries.

Side effects. Side effects from the abdomen and intestines (heartburn, gastric ulcer and sour eructation) are frequent following treatment with NSAID. The new rheumatism pills (“selective COX-2 inhibitors”, as for example, Vioxx) are by and large free of serious side effects from the abdomen and intestines. Serious side effects are rare, but allergic shock, kidney damage and bone marrow damage has been described. Only moderate side effects are seen following localised treatment with NSAID (allergy).

Contraindications. Allergy is on the whole the only contraindication for NSAID treatment in healthy athletes. Patients with gastric ulcer, high blood pressure, liver, heart and kidney illnesses should be cautious with NSAID treatment.

Administration. Tablet treatment is recommended. Some placebo controlled studies show that local NSAID as gel is better than placebo on acute injuries, despite the concentration of blood following localised treatment constituting less than 10% of the level after tablet treatment or after injection in the muscles. There are no scientific grounds for using injection methods. There are no studies which document the ideal point in time to start NSAID treatment, or the length of duration.

Discussion. There is no conclusive clarification as to whether inhibiting the acute inflammation is an absolute advantage. Pain and discomfort are in any event partially conditional upon the inflammation. By reducing the inflammation the symptoms are reduced, thereby allowing rehabilitation to start at an earlier stage. On the other hand, the inflamed cells are responsible for the decomposition of the tissue which has been destroyed, which is necessary for removal of dead muscle fibre and the like.

Conclusion. Several clinical studies have documented that treatment with NSAID has some effect on sports injuries. There are, however, still many unanswered questions preventing a sure, unequivocal indication for treatment with NSAID to be given. If systematic NSAID treatment is indicated, the new rheumatism pills (“selective COX-2 inhibitors” for example Vioxx), can be recommended. As mentioned above, NSAID treatment is merely a supplement to the base treatment which is “active rest” with increasing intensity in training within the pain threshold. If NSAID is misused as a painkiller to continue a potentially damaging sports activity, the treatment will indirectly increase the risk of the chronic injury. It is for this reason that all NSAID treatment on athletes must be administered by a physician with knowledge of the basic rehabilitation principles.

NSAID

Tendinitis at the ischiatic bone

Untitled Document Untitled Document

NSAID (rheumatism medicine)

Use of NSAID is widespread in sport as a painkiller, and as treatment to subdue inflammation.

Indication. Over-load symptoms from tendons. A considerable number of scientific studies have been performed comprising NSAID treatment on acute tendon injuries. In the majority of studies, but not all, healing was achieved slightly quicker, and inflammation was slightly reduced compared with placebo treatment. Some studies have shown increased instability and reduced mobility in the joints after NSAID treatment.
Acute muscle injuries. There are only a handful of animal studies dealing with NSAID treatment of acute muscle injuries. Increased muscle strength has been proven, however, also reduced healing of damaged tissue.
Myositis ossifans (calcification in muscles after bleeding). One study shows that calcification in the muscles following a hip operation is reduced in patients who are treated with NSAID after the operation.
Chronic muscle and tendon injury. There is no conclusive scientific evidence supporting use of NSAID on chronic muscle or tendon injuries.

Side effects. Side effects from the abdomen and intestines (heartburn, gastric ulcer and sour eructation) are frequent following treatment with NSAID. The new rheumatism pills (“selective COX-2 inhibitors”, as for example, Vioxx) are by and large free of serious side effects from the abdomen and intestines. Serious side effects are rare, but allergic shock, kidney damage and bone marrow damage has been described. Only moderate side effects are seen following localised treatment with NSAID (allergy).

Contraindications. Allergy is on the whole the only contraindication for NSAID treatment in healthy athletes. Patients with gastric ulcer, high blood pressure, liver, heart and kidney illnesses should be cautious with NSAID treatment.

Administration. Tablet treatment is recommended. Some placebo controlled studies show that local NSAID as gel is better than placebo on acute injuries, despite the concentration of blood following localised treatment constituting less than 10% of the level after tablet treatment or after injection in the muscles. There are no scientific grounds for using injection methods. There are no studies which document the ideal point in time to start NSAID treatment, or the length of duration.

Discussion. There is no conclusive clarification as to whether inhibiting the acute inflammation is an absolute advantage. Pain and discomfort are in any event partially conditional upon the inflammation. By reducing the inflammation the symptoms are reduced, thereby allowing rehabilitation to start at an earlier stage. On the other hand, the inflamed cells are responsible for the decomposition of the tissue which has been destroyed, which is necessary for removal of dead muscle fibre and the like.

Conclusion. Several clinical studies have documented that treatment with NSAID has some effect on sports injuries. There are, however, still many unanswered questions preventing a sure, unequivocal indication for treatment with NSAID to be given. If systematic NSAID treatment is indicated, the new rheumatism pills (“selective COX-2 inhibitors” for example Vioxx), can be recommended. As mentioned above, NSAID treatment is merely a supplement to the base treatment which is “active rest” with increasing intensity in training within the pain threshold. If NSAID is misused as a painkiller to continue a potentially damaging sports activity, the treatment will indirectly increase the risk of the chronic injury. It is for this reason that all NSAID treatment on athletes must be administered by a physician with knowledge of the basic rehabilitation principles.

KONDITION

STEP4

Ligament injury in the ankle joint, inner ligament
[Back]

GENOPTRÆNING

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
 FOR INNER LIGAMENT INJURY IN THE ANKLE JOINT
(RUPTURA TRAUMATICA LIGAMENTI DELTOIDEI PEDIS)

STEP 4
KONDITION
Unlimited: Cycling. Swimming. Running with directional change.

UDSPÆNDING
(10 min)

Stand with the injured leg stretched backwards with the toes facing front. Slowly bend the knee so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with the injured leg outstretched with the ankle joint bent up against the wall. Press your abdomen against the wall so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand on the good leg while gaining support on the wall with the hand on the same side. Bend the knee of the injured leg and draw the heel towards the buttocks. Take hold of the big toe side of the foot and draw slowly upwards so that the ankle joint is stretched to the maximum and drawn slightly outwards so that increased stretching is experienced on the inside of the shin bone. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand on the good leg while gaining support from the wall with the opposite hand. Bend the knee of the injured leg and draw the heel towards the buttocks. Take hold of the little toe side of the foot and draw slowly upwards so that the ankle joint is stretched to the maximum and drawn over the good leg so that increased stretching is experienced on the outer side of the shin bone. Hold the position for 20 seconds and relax for 20 seconds before repeating.

KOORDINATION
(15 min)

Stand on the leg to be trained. Take-off and land on the same leg.

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.

Stand on the injured leg with your upper body bent forwards at 90 degrees. Lift the good leg in a straight line behind you. When you feel comfortable with the exercise, it can be made more difficult by closing your eyes.

STYRKE
(10 min)

Sit on the floor. Tip the foot up and down with elastic under the forefoot so that the elastic becomes taut.

Sit on the floor. Tip the foot up and down with elastic on top of the forefoot so that the elastic becomes taut.

Sit on the floor. Tip the foot from side to side with elastic on the outer side of the foot, without moving the knee.

Sit on the floor. Tip the foot from side to side with elastic on the inner side of the foot, without moving the knee.

Stand on the healthy leg with elastic fixed around the hip. The elastic should be fixed to the wall or a wall bar. Take-off on the healthy leg and land on the leg to be trained and keep your balance. Remember that the elastic should be positioned so that it gives resistance at the moment of take-off. Change legs.

Stand with both legs on the stool with elastic around the hip. Take-off and land with feet together.

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.