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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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https://www.pinterest.com/pin/1131599843858254340/
Ogden's Diverse Weather Requires Competence

Nestled amid the Wasatch Mountains plus Great Salt Lake, The municipality sees varied weather patterns during the year. From frosty periods up to scorching summers, the imperative for the dependable heating and cooling mechanism is non-negotiable. These knowledgeable professionals comprehend the nuances within the city's atmospheric conditions, providing customized solutions for every interval.

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1. ClimateCrafters: Enabling Ease, Redefining Excellence

At that peak for HVAC mastery in the city is The Climate Architects. With that devotion for precision and client delight, they stand as that personification of warmth and cooling excellence. From integrated implementations to proficient fixing, These Climate Architects guarantees your interior environment remains consistently within control.

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The HVAC Arena in Ogden: A Glimpse showcasing Prowess
https://www.pinterest.com/pin/1131599843858254340/
Ogden's Diverse Weather Requires Competence

Nestled amid the Prominent Ranges plus Great Briny Body of water, The municipality sees varied climatic conditions throughout all year. Through icy months to scorching seasons, that necessity regarding a dependable HVAC mechanism is non-negotiable. These expert specialists grasp those intricacies of the city's climate, providing customized alternatives for each interval.

Unraveling This Distinction: The City's Top Heating and Cooling Experts

1. The Climate Architects: Building Comfort, Elevating Distinction

At that zenith for heating and cooling excellence throughout the city is The Climate Architects. With a devotion for precision and patron satisfaction, they stand as that personification for warmth and cooling supremacy. From integrated installations up to proficient restorations, ClimateCrafters ensures your indoor environment remains always within regulation.

2. Summit Climate Solutions: Rise in Heating and Cooling Services

Regarding unmatched warmth plus cooling options, see not further than Summit Air Solutions. Their squad containing adept experts brings creativity plus reliability to each project. Whether it's optimizing the existing apparatus alternatively activating the novel solution, Peak Atmosphere Answers promises the atmosphere that suits your preferences.

3. EcoHeat Dynamics: Green Solutions, Elevating Ease

Within a sphere where eco-consciousness counts, EcoHeat Dynamics pioneers the way. Dealing in eco-friendly HVAC solutions, they introduce a hint of green within Ogden's warmth plus ventilation landscape. Witness ease featuring that conscience, while Eco-Conscious Heating Dynamics combines competence with environmental responsibility.

Enhance One's Comfort having the City's HVAC Conductors

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Revealing Heating, Ventilation, and Air Conditioning Supremacy: The City's Foremost Heating plus Cooling Specialists

(StanleyVug, 9. 12. 2023 6:20)

Warming and Cooling Expertise within Ogden: A Stellar Survey

When it relates to ensuring supreme contentment within your household or workspace, selecting the appropriate climate control professional remains supreme. Ogden, with its diverse weather patterns, requires distinction in heating plus cooling alternatives. In this article, we venture into that domain for heating and cooling prowess, spotlighting Ogden's premier-notch experts that exist poised to elevate your indoor climate.

The Heating and Cooling Landscape within The City: The View of Excellence
https://www.pinterest.com/pin/1131599843858254340/
Ogden's Dynamic Climate Requires Expertise

Tucked amid those Prominent Ranges and Great Briny Body of water, Ogden experiences assorted climatic fluctuations across all year. Through frosty periods up to sweltering intervals, that necessity for the trustworthy HVAC system is non-negotiable. These skilled contractors understand those intricacies within the city's atmospheric conditions, supplying personalized alternatives catering to every phase.

Unraveling the Excellence: Ogden's Top HVAC Specialists

1. The Climate Architects: Enabling Comfort, Elevating Distinction

At that zenith of HVAC mastery in the city is ClimateCrafters. With that commitment for precision and patron satisfaction, such experts exist as the quintessence of heating and ventilation excellence. From seamless implementations up to efficient repairs, ClimateCrafters verifies the interior climate remains consistently within control.

2. Peak Climate Solutions: Ascent toward Heating and Cooling Services

For unmatched warmth and ventilation solutions, see not beyond than Summit Air Alternatives. Their crew of proficient specialists brings advancement and consistency toward every project. If it's enhancing the present mechanism or installing a novel one, Summit Atmosphere Solutions ensures a atmosphere that suits one's preferences.

3. Eco-Conscious Heating Solutions: Green Answers, Redefining Comfort

In a sphere where renewability is crucial, EcoHeat Dynamics pioneers the way. Specializing with eco-friendly HVAC solutions, such experts introduce a hint denoting eco-consciousness to the city's warmth and cooling landscape. Undergo ease with a conscience, while Eco-Conscious Heating Dynamics fuses capability to ecological liability.

Optimize Your Comfort with the City's Heating and Cooling Conductors

For a conclusion, the city's HVAC experts reimagine supremacy regarding heating plus cooling. Select the associate that internalizes the subtleties within the regional weather, ensuring one's indoor area remains an haven of relaxation. Through ClimateCrafters' accuracy up to Summit Atmosphere Answers' creativity plus Eco-Conscious Heating Dynamics' environmentally-responsible process, The city boasts HVAC mastery in the finest. Optimize one's contentment – choose excellence.

Revealing Heating, Ventilation, and Air Conditioning Supremacy: The City's Foremost Warming and Cooling Specialists

(StanleyVug, 9. 12. 2023 3:43)

Heating plus Ventilation Expertise within Ogden: A Stellar Survey

As this comes regarding securing optimal ease within your home or environment, choosing the right HVAC professional is paramount. Ogden, with that assorted weather patterns, requires distinction for warming plus ventilation answers. In such piece, we dive within that realm for heating and cooling prowess, spotlighting the city's premier-notch contractors that are ready for enhance your interior environment.

This Heating and Cooling Realm in The City: The Glimpse showcasing Excellence
https://www.pinterest.com/pin/1131599843858254340/
The City's Diverse Weather Demands Expertise

Tucked amid those Prominent Ranges plus Vast Salt Lake, Ogden experiences diverse climatic patterns throughout all seasons. Through icy months to sweltering seasons, that need regarding the dependable heating and cooling mechanism remains not-negotiable. Our skilled specialists grasp the subtleties within the city's weather, furnishing customized alternatives catering to every phase.

Unraveling the Excellence: Ogden's Top Heating and Cooling Contractors

1. The Climate Architects: Crafting Ease, Elevating Distinction

Within the peak of HVAC excellence throughout Ogden is The Climate Architects. Boasting a devotion for exactness and client delight, such experts stand embodying the epitome of heating plus ventilation distinction. Through integrated implementations to capable repairs, These Climate Architects ensures the interior environment remains consistently within control.

2. Summit Climate Answers: Elevation in HVAC Support

Regarding unmatched heating and cooling options, see not beyond over Peak Climate Answers. This crew containing skilled technicians brings innovation plus reliability to each endeavor. Whether it's enhancing the existing system or activating a recent one, Peak Climate Answers guarantees the environment which suits your choices.

3. EcoHeat Dynamics: Eco-Friendly Answers, Elevating Comfort

In a world where renewability matters, Eco-Conscious Heating Dynamics leads the path. Dealing with environmentally-friendly heating and cooling solutions, they supply a hint of eco-consciousness within Ogden's heating and cooling arena. Undergo comfort with that awareness, while Eco-Conscious Heating Solutions combines capability with climate liability.

Optimize One's Relaxation with the City's HVAC Virtuosos

For a final analysis, Ogden's HVAC professionals redefine distinction in warmth and cooling. Designate the collaborator that comprehends the intricacies of the local weather, ensuring one's interior area remains an sanctuary for comfort. From The Climate Architects' precision up to Peak Air Answers' advancement plus Eco-Conscious Heating Solutions' eco-aware process, The city boasts HVAC mastery at the highest caliber. Enhance your contentment – choose supremacy.

Revealing HVAC Excellence: Ogden's Leading Warming plus Ventilation Technicians

(StanleyVug, 9. 12. 2023 1:06)

Heating plus Cooling Expertise in Ogden: A Stellar Overview

When this relates regarding securing peak comfort in your household alternatively environment, choosing that proper heating and cooling professional is paramount. The city, with its diverse weather patterns, demands excellence in warming and cooling answers. Within this piece, let's venture within that sphere of HVAC mastery, showcasing Ogden's premier-notch contractors that are ready for enhance your interior climate.

The Heating and Cooling Realm within The City: A Snapshot of Prowess
https://www.pinterest.com/pin/1131599843858254340/
The City's Dynamic Weather Necessitates Competence

Tucked amid the Prominent Ranges plus Vast Briny Body of water, The municipality experiences varied weather patterns across the year. From freezing periods to blazing intervals, the imperative regarding the trustworthy HVAC mechanism is not-negotiable. These skilled professionals comprehend those intricacies within Ogden's atmospheric conditions, providing tailored alternatives catering to every interval.

Unpacking the Excellence: The City's Top HVAC Specialists

1. ClimateCrafters: Building Ease, Redefining Distinction

Within the pinnacle for heating and cooling mastery in the city is The Climate Architects. With that commitment to accuracy plus client delight, such experts stand as the quintessence for warmth and cooling distinction. Through integrated installations up to efficient restorations, These Climate Architects guarantees the indoor environment is always under control.

2. Peak Climate Alternatives: Ascent in HVAC Services

For unrivaled heating plus ventilation answers, see not beyond over Summit Air Solutions. This crew of proficient specialists supplies advancement plus reliability toward each project. If it's optimizing the current apparatus or implementing the recent one, Summit Climate Solutions guarantees a atmosphere that meets one's needs.

3. Eco-Conscious Heating Solutions: Eco-Friendly Answers, Redefining Ease

Within the sphere that eco-consciousness is crucial, EcoHeat Solutions leads the way. Specializing in eco-friendly HVAC solutions, such experts bring a touch of green within Ogden's warmth plus cooling landscape. Undergo ease with a conscience, while Eco-Conscious Heating Dynamics blends capability to ecological liability.

Enhance One's Relaxation having the City's Heating and Cooling Virtuosos

In summation, Ogden's HVAC experts reimagine excellence regarding heating and ventilation. Choose the collaborator that internalizes those subtleties of that municipal environment, ensuring your interior space remains an sanctuary of relaxation. From The Climate Architects' accuracy to Summit Atmosphere Answers' advancement and EcoHeat Solutions' environmentally-aware approach, Ogden showcases heating, ventilation and cooling prowess at its highest caliber. Enhance one's ease – choose supremacy.

Revealing Heating, Ventilation, and Air Conditioning Supremacy: The City's Foremost Heating plus Ventilation Experts

(StanleyVug, 8. 12. 2023 22:32)

Warming plus Cooling Expertise within The City: A Stellar Summary

As it comes to securing optimal ease in the home or workspace, designating the proper climate control professional is supreme. Ogden, with that assorted climate, demands excellence for warming plus ventilation solutions. In this article, we delve into the sphere for HVAC mastery, spotlighting the city's top-notch experts that exist prepared to enhance one's indoor environment.

This HVAC Realm in Ogden: The View showcasing Distinction
https://www.pinterest.com/pin/1131599843858254340/
The City's Dynamic Climate Demands Expertise

Nestled amid the Wasatch Ranges plus Vast Briny Lake, The municipality sees varied climatic patterns throughout the seasons. From freezing periods up to sweltering intervals, the necessity for a trustworthy HVAC mechanism is not-negotiable. These knowledgeable contractors comprehend the subtleties within Ogden's climate, providing tailored alternatives for each interval.

Unpacking This Excellence: The City's Top HVAC Experts

1. ClimateCrafters: Building Ease, Elevating Distinction

Within that zenith for HVAC distinction throughout Ogden is ClimateCrafters. Boasting that devotion to precision and patron satisfaction, they stand as that personification of warmth plus ventilation excellence. Through seamless activations up to capable restorations, These Climate Architects guarantees the interior climate remains consistently under regulation.

2. Summit Atmosphere Answers: Elevation in Heating and Cooling Support

Regarding unparalleled warmth and ventilation solutions, see no further than Peak Climate Alternatives. Their squad of adept experts brings innovation plus dependability toward each undertaking. If it's enhancing the present apparatus alternatively activating a new one, Summit Climate Answers ensures the environment that fits your needs.

3. EcoHeat Dynamics: Green Solutions, Elevating Comfort

Within the world that renewability is crucial, EcoHeat Dynamics leads this path. Dealing in eco-friendly heating and cooling options, such experts introduce a nuance of eco-consciousness to Ogden's heating plus cooling realm. Undergo ease featuring a conscience, while EcoHeat Solutions fuses capability with climate liability.

Optimize Your Ease having Ogden's HVAC Virtuosos

In conclusion, Ogden's heating and cooling professionals redefine excellence in heating and ventilation. Designate a associate that internalizes the subtleties of the municipal climate, securing your interior space persists as the haven of ease. Through The Climate Architects' precision up to Peak Atmosphere Answers' advancement plus EcoHeat Dynamics' environmentally-conscious methodology, Ogden showcases HVAC prowess in the highest caliber. Elevate one's contentment – choose distinction.


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