Kategoriarkiv: Hip

week7-9

19. juli 2011_Degenerative arthritis in the hip jointurtehave_com

GENOPTRÆNING

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR RUPTURE OF THE POSTERIOR CRUCIATE LIGAMENT
(RUPTURA LIGAMENTUM CRUCIATUM POSTERIUS)

Uge 7-9

The following exercises can only be considered as a supplement to the guidelines furnished by the doctor which performed the operation. Specific precautions are necessary as the operation can be complicated. The training must not bring about swelling or pain in the knee.

Unlimited: Cycling with raised saddle. Swimming. Running in deep water.

(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 side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side 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 standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

Stand with one leg outstretched and the other slightly bent. Thrust your weight to the side over the bent leg so that the inner side of the opposite thigh becomes increasingly stretched. Hold the position for 20 seconds and relax 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.

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.

(25 min):


Lie on the floor with slightly bent knees. Put the elastic under the foot and hold firmly with your hands. Stretch the knee so that the elastic is drawn tight and slowly bend the knee again.

Go up and down from the stool. Go up with alternating right and left legs.

Lie on your back with a ball or firm round cushion under both feet. Raise your backside up from the floor and hold your feet on the ball. Hold the position for a few seconds.

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.

Lie on your back with a ball or firm round cushion under the injured leg. Lift your backside up from the floor and stretch the healthy leg. Hold the position for a few seconds.

Stand on the good leg with the elastic around the inner side of the injured leg above the knee. Move the injured leg from side to side in a slow movement.

Stand on the good leg with the elastic around the outer side of the injured leg above the knee. Move the injured leg from side to side in a slow movement.

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.

week4-6

19. juli 2011_Degenerative arthritis in the hip jointurtehave_com

GENOPTRÆNING

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR RUPTURE OF THE POSTERIOR CRUCIATE LIGAMENT
(RUPTURA LIGAMENTUM CRUCIATUM POSTERIUS)

Uge 4-6

Unlimited: Swimming. Running in deep water.

(5 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.


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.


Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side 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 standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

(5 min):

Stand on one leg. Play the ball up against the wall.

Stand on your toes with bent knees. Place your weight forward on the toes and keep your balance.

(20 min):


Lie on the floor with slightly bent knees. Put the elastic under the foot and hold firmly with your hands. Stretch the knee so that the elastic is drawn tight and slowly bend the knee again.

Stand on the injured leg on a stool. Go up and down to bend the knee, with the healthy leg hanging over the edge of the stool.

Lie on your back with a ball or firm round cushion under both feet. Raise your backside up from the floor and hold your feet on the ball. Hold the position for a few seconds.

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.

Lie on your back with a ball or firm round cushion under the injured leg. Lift your backside up from the floor and stretch the healthy leg. Hold the position for a few seconds.

Stand on the good leg with the elastic around the inner side of the injured leg above the knee. Move the injured leg from side to side in a slow movement.

Stand on the good leg with the elastic around the outer side of the injured leg above the knee. Move the injured leg from side to side in a slow movement.

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

week2-3

19. juli 2011_Degenerative arthritis in the hip jointurtehave_com

GENOPTRÆNING

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR RUPTURE OF THE POSTERIOR CRUCIATE LIGAMENT
(RUPTURA LIGAMENTUM CRUCIATUM POSTERIUS)

Uge 2-3

Unlimited: Swimming (crawl).

(5 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.

(5 min):

Stand on one leg on the floor or a mattress. Look straight ahead and keep the knee slightly bent.

Stand on your toes with bent knees. Place your weight forward on the toes and keep your balance.

(15 min):

Sit on a chair with the injured leg on a stool or similar. Lift the leg above the stool with the foot flexed at a maximum, and hold the position for 10 seconds, followed by 10 seconds rest. The exercise should be repeated for approx. 3 minutes.

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 the floor with the injured leg. Press the leg against the floor and tip the foot up. Hold the position for approx. 10 seconds. You have to feel a stretching of the anterior thigh. Rest for approx. 10 seconds. Repeat the exercise for approx. 3 minutes.

Lie on your back with a ball or firm round cushion under both feet. Raise your backside up from the floor and hold your feet on the ball. Hold the position for a few seconds.


Lie on your back with the heel of the injured leg resting on the bench or a smooth floor. Bend and stretch the injured leg while keeping contact with the surface at all times.

Lie on your back with legs bent and a ball between your knees. Squeeze your knees together for 25 seconds, and rest for 10 seconds before repeating.

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

week1

19. juli 2011_Degenerative arthritis in the hip jointurtehave_com

GENOPTRÆNING

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR RUPTURE OF THE POSTERIOR CRUCIATE LIGAMENT
(RUPTURA LIGAMENTUM CRUCIATUM POSTERIUS)

Uge 1

(5 min):

Stand on one leg on the floor or a mattress. Look straight ahead and keep the knee slightly bent.

(15 min):

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.

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

Degenerative arthritis in the hip joint

19. juli 2011Tendinitis at the ischiatic boneurtehave_com

RUPTURE OF THE POSTERIOR CRUCIATE LIGAMENT

Diagnosis:

(Ruptura ligamentum cruciatum posterius)

Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). There is furthermore a small joint between the shin bone and the calf bone (fibula). The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). Inside the knee there are two ligaments, the anterior and posterior cruciate ligaments (ligamentum cruciatum anterius and ligamentum cruciatum posterius).

Ligamentum cruciatum posterius
Ligamentum collaterale mediale/tibiale
Meniscus medialis
Insertio anterior
menisci medialis
Ligamentum transversum genus
Tibiae
Fibulae
Ligamentum cruciatum anterius
Ligamentum collaterale laterale/fibulare
Meniscus lateralis
Femur

KNEE JOINT FROM THE FRONT

Cause: Rupture of the posterior cruciate ligament usually occurs following a blow or kick direct on the front of the shin bone just below the knee (Photo).

Symptoms: Usually a snap can be heard or felt and continued sports activity must be aborted. The knee can swell within the first few hours, after which the knee can not bend completely. You can subsequently often sense that the leg gives way (knee failure).

Acute treatment: Click here.

Examination: If a partial or complete rupture of the cruciate ligament is suspected, you should seek medical attention (casualty ward) immediately, to obtain a diagnosis. The doctor can perform various tests on the knee (rear drawer looseness) to examine the stability of the knee. It should be noted that the looseness in the knee can often only be demonstrated after two weeks. It is often necessary to supplement the examination with a MR-scan, ultrasound scan (Ultrasonic image) (article), or arthroscopy to make the diagnosis with certainty.

Treatment: Treatment of a rupture of the posterior cruciate ligament usually comprises relief and rehabilitation. It is only in cases of pronounced looseness, or if the rupture is combined with other ligament ruptures, that surgery is recommended (article).

Rehabilitation: INSTRUCTION

GENERAL Week 1 Week 2-3 Week 4-6 Week 7-9

Week 10-12 Week 13-15 Week 15+

An intensive rehabilitation period of at least six months is to be expected.

Bandage: Hinge bandages (Don-Joy) can be utilised the first few weeks. Tape treatment of cruciate ligament ruptures in the knee has no sure effect.

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

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

bursitis

18. juli 2011_Outer snapping hipurtehave_com

BURSITIS

Diagnosis:

(Inflammation of the bursa)

Anatomy: There are numerous bursas around the hip joint, serving the purpose of reducing the pressure on muscles, tendons and ligaments where these lie close to a bone projection.

Cause: In case of repeated loads or blows, the bursa can produce additional fluid, swell and become inflamed and painful.

Symptoms: Pain when applying pressure on the bursa, which sometimes (but far from always) can feel swollen. Pain is aggravated upon activation of the muscle closest to the bursa.

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness, medical examination is not necessarily required. In case of more pronounced pain or lack of progress, a medical examination should be carried out to ensure the correctness of the diagnosis and the commencement of any treatment. The diagnosis is most easily and quickly made with ultrasound (which allows simultaneous treatment).

Treatment: The treatment primarily comprises relief. If the direct cause of the complaint is known, it should of course be removed. The treatment can be supplemented by rheumatic medicine (NSAID) or injection of corticosteroid in the bursa, preceded by draining of this, which can advantageously be performed under ultrasound guidance.

Rehabilitation: The treatment is dependant upon which bursa is inflamed, but sports activity can usually be cautiously resumed when pain has diminished, especially if the provoking factor has been identified and removed.
Also read rehabilitation, general.

Complications: If progress is not smooth, the correctness of the diagnosis or whether complications have arisen should be considered:

Special: Shock absorbing shoes or inlays will reduce the load.

Bursitis on the front of the hip joint (bursitis iliopectinea)

18. juli 2011_Degenerative arthritis in the hip jointurtehave_com

BURSITIS ON THE FRONT OF THE HIP JOINT

Diagnosis:

(Bursitis iliopectinea)

Anatomy: Between the deep hip flexor and the joint capsule is a large bursa (bursa iliopectinea), with the function to reduce the load on the muscle, when it slips over the hip joint. The bursa often communicates with the hip joint.

Cause: Upon repeated loads or blows the bursa can produce increased amounts of fluid, swell and become inflamed and painful.

Symptoms: Pain when applying pressure on the bursa, which occasionally (but far from always) may feel swollen. Pain is agravated upon activation of the deep flexor (flexing the hip joint).

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness medical examination is not necessarily required. In case of more pronounced pain or lack of progress a medical examination should be carried out to ensure that the diagnosis is correct and commence any treatment. The diagnosis is most easily and quickly made with ultrasound (which allows simultaneous treatment) (article).

Treatment: The treatment primarily comprises relief. The treatment can be supplemented with rheumatic medicine (NSAID) or injection of corticosteroid in the bursa preceded by draining of the bursa, which can advantageously be done under ultrasound guidance (article).

Rehabilitation: INSTRUCTION

GENERAL STEP1 STEP2 STEP3 STEP4

Complications: If progress is not smooth the correctness of the diagnosis or whether complications have arisen, should be considered:

Special: Shock absorbing shoes or inlays will reduce the load.

Inguinal hernia

18. juli 2011_Degenerative arthritis in the hip jointurtehave_com

INGUINAL HERNIA

Diagnosis:

Anatomy: The various muscles of the abdominal wall are penetrated by the inguinal canal, which contains nerves (N ilioinguinalis and the genital branch of N genitofemoralis) and in men the spermatic cord (funilicus spermaticus). In women the inguinal canal instead contains a small fibrous ligament. Where the inguinal canal penetrates the abdominal wall weak spots arise (anulus inguinalis superficialis and anulus inguinalis profundus).

M. recti abdominis
Funiculus spermaticus
Ligamentum inguinale
Spina iliaca anterior superior
M. obliquus externus abdominis

INGUINAL CANAL

Anulus inguinalis superficialis
Crus mediale
Funiculus spermaticus et m. cremaster
V. femoralis
Hiatus saphenus
Lig. lacunare
Anulus femoralis
Margo falciformis (cornu superius)
Lig inguinale
Fibrae intercrurales
M. obliquus externus abdominis

RIGHT INGUINAL CANAL

Cause: If the abdominal wall becomes too weak, the intestines can be pressed through the weak spots in the abdominal wall causing a hernia.

Symptoms: Pain in the groin, aggravated when coughing. Sometimes a swelling in the groin is visible. Usually the swelling (containing intestine) can be pushed into place. If the swelling is painful and cannot be pressed into place the hernia may be strangulated (which requires acute medical assistance).

Examination: In obvious cases with visible swelling in the groin the diagnosis is easy to make. With lack of swelling in the groin the diagnosis is naturally difficult. (article 1) A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis a MRI-scan or a dynamic ultrasound scan, where weaknesses in the abdominal wall can be detected while increasing the pressure in the abdominal cavity by applying pressure can be performed (article 2) (article 3).

Treatment: With modest discomfort, you can primarily attempt training of the abdominal muscles (article). If discomfort continues, surgery is advised. If strangulated hernia is suspected you should seek acute medical assistance to evaluate the indication for acute surgery, as there is a risk of lasting damage to the intestine. With uncomplicated surgery, a relief period of approx. two months should be expected before maximal sports activity can be resumed (very dependent on the sport in question).

Rehabilitation: INSTRUCTION

GENERAL STEP1 STEP2 STEP3 STEP4

Complications: If progress is not smooth (even after operation) it should be considered whether the diagnosis is correct or whether complication have arisen. In particular the following should be considered:

Nerve entrapment

18. juli 2011_Degenerative arthritis in the hip jointurtehave_com

NERVE ENTRAPMENT

Diagnosis:

Anatomy: Numerous nerves penetrate the abdominal wall and transmit nerve branches to the area on the stomach, groin and thigh. The nerve can be entrapped where it penetrates the abdominal wall.

Umbilicus (Navlen)
M. obliquus internus abdominis
Rami cutanei anteriores n. intercostalis XII
Anulus inguinalis superficialis
Funiculus spermaticus
N. ilioinguinalis
N. iliohypogastricus (ramus cutaneus lateralis)
Ramus muscularis
N. iliohypogastricus
M. transversus abdominis
N. intercostalis XII

NERVES AROUND THE GROIN

Cause: If one of the nerve branches is entrapped, pain and sensation disturbances will occur in the area that the nerve supplies sensory nerves to.

Symptoms: Pain in the groin region. Discomfort and sensory disturbances can often be induced if the area where the nerve is entrapped is scratched/pushed.

Examination: In the medical examination the doctor attempt to produce the discomfort symptoms by scratching or pushing the area in which the nerve is entrapped. By administering a couple of millilitres of local anaesthetic in this area the symptoms should disappear if the diagnosis is correct (otherwise the diagnosis is wrong). There is no examination (X-ray, ultrasound, MRI, scintigraphy) that can detect the nerve entrapment. The real frequency of the diagnosis is debated amongst professionals.

Treatment: Since the condition is harmless and without risk even if you continue sports activity, continuing sport is recommended in the hope that the discomfort will pass on its own. Pausing and alternative training of the abdominal muscles can be attempted. If the discomfort is long-lasting with no sign of abatement, even during summer or winter breaks, you can consider surgically severing the nerve, provided that pain abates when local anaesthesia is administered (article-1) (article-2).

Rehabilitation: If the discomfort stems from the nerve, you should be able to resume sports activity immediately following the operation.
Also read rehabilitation, general.

Complications: Since it can be difficult to make a correct diagnosis in athletes with long-term groin pain (article), it should be supplemented with, amongst other things, ultrasound scanning and consideration of x-ray scintigraphy and possibly an MRI scan. It should be considered whether the diagnosis is correct, and amongst other things consider the following:

Rupture of the adductor muscle of the thigh

18. juli 2011_Degenerative arthritis in the hip jointurtehave_com

MUSKELBRISTNING AF LÅRETS INDADFØRER

Diagnosis:

(Ruptura M adduktor longus)

Anatomy: The thigh’s adductor muscles (M adductor longus, M adductor brevis, Madduktor magnus, M gracilis and M pectineus) are all fastened in the groin on the pubic bone (tuberculum pubicum).

Spina iliaca anterior superior
M. iliopsoas
Lig. inguinale
Lig. lacunare
Tuberculum pubicum
M. pectineus
M. adductor longus
M. gracilis
M. adductor magnus

THIGH FROM THE FRONT

(Photo)

Cause: When a muscle is subjected to a load beyond the strength of the muscle (jumping, kicking), a rupture occurs. Muscle ruptures in the groin occur most often at the fastening of the adductor longus muscle, which feels like a firm string in the groin. The rupture may be located on the fastening (where there is the greatest risk of the course being long) or in the muscular belly a few centimetres from the fastening (where experience shows that the damage heals faster). The muscle is especially damaged in sports characterised by sprinting with sudden changes of direction and sports with a lot of weight training and modest agility training (football, ice hockey), while it is rarely seen in sports characterised by agility (gymnastics). The vast majority of ruptures are partial ruptures, although total ruptures are described (article).

Symptoms: Pain upon applying pressure along the tendon with worsening upon stretching and activation of the muscle tendon (squeezing stretched legs together against resistance). In light cases a local tenderness is felt after the load (“muscle strain”, “imminent pulled muscle”). In severe cases a sudden shooting pain in the muscle is felt (partial “muscle rupture” or “pulled muscle”) and in the worst case a sudden snap is felt, rendering the muscle unusable (“total muscle rupture”). In case of total rupture a swelling can often be felt on the inside of the thigh.

Acute treatment: Click here.

Examination: In light cases medical examination in not necessarily required. Severe cases or cases not improved by treatment should be evaluated by a doctor so that a precise diagnosis can be made. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis an ultrasound scan can be performed. Ultrasound is well suited to evaluate the tendons. If in the medical examination there is pain when applying pressure on the muscle attachment point in the groin, and aggravation at the same location upon stretching and activation of the adductor, there is hardly any doubt about the diagnosis and an ultrasound scan is not necessary. However, the diagnosis of groin pain can be particularly difficult (article).

Treatment: Relief, stretching and slowly increasing load within the pain threshold.

Rehabilitation: INSTRUCTION

GENERAL STEP1 STEP2 STEP3 STEP4

Complications: If progress is not smooth it should be considered whether the diagnosis is correct or whether complication have arisen. In particular the following should be considered:

Special: Shock absorbing shoes or inlays will reduce the load in the groin. In case of lack of progress or relapse after successful rehabilitation, a running style analysis can be considered to evaluate whether correction of the running style should be recommended.