Meniscus Tear

Meniscus tear is one of the most common causes of knee pain. The knee joint consists of the peripheral end of the femur, the central end of the tibia and the patella. Each knee has 2 menisci, the inner meniscus on the inside of the knee and the outer meniscus on the outside of the knee.

The menisci are elastic fibrochondrial formations that consist of water and collagen. They have a crescent shape and act as a “shock absorber” absorbing vibrations during the movement of the knee and distributing the weight evenly throughout the joint. The menisci also contribute to the stability and lubrication of the knee.

How does meniscus tear occur?

Meniscus tear is usually traumatic. The force required to tear depends on the size of the injury and the pre-existing meniscus degeneration. It usually occurs in young patients during a sports activity, but it can also occur in any other activity when they exert rotational and compressive loads that exceed the strength of the meniscus. Older patients with pre-existing degenerative lesions are also vulnerable and are more likely to have a meniscus tear even during daily movement.

Symptoms of meniscus tear

At the time of injury, the patient may feel or even hear a noise as if something had broken. Sometimes it is possible for the patient to continue his activity but gradually the knee may swell and become stiff.

The most common symptoms are:

• Pain in the inside or outside of the knee (corresponding to a broken meniscus) that worsens with the knee bent (as in the deep seat or stairs)
• Swelling and stiffness
• Knee bruise or involvement when there is a dislocated piece
• Feeling of instability

Diagnosis

The diagnosis is made by history and clinical examination with special techniques. MRI serves to confirm the diagnosis, to rule out other lesions and to plan treatment.

Treatment

In case the symptoms are mild, conservative treatment is followed, which includes medication and physiotherapy to prevent stiffness, reduce swelling and avoid muscle atrophy. The patient must follow a special program of strengthening the muscles that contribute to the stability of the joint.

Physiotherapy includes:

• Electrotherapy
• Ultrasound
• Ice therapy
• Manual therapy
• Acupuncture
• Diamagnetic pump
• BFR
• Predisposition and balance exercises

Immediate treatment of the problem can significantly reduce the chances of surgery, unless the extent of the injury is large. In case the conservative treatment fails, the patient should resort to arthroscopic treatment.

Achilles Tendon Rupture

What exactly is a partial rupture of the Achilles tendon?

The group of muscles in the back of our lower leg is called the calf. The calf consists of two main muscles, one of which protrudes above the knee joint (gastrocnemius) and the other below the knee (tibia). Both of these muscles are located in the heel bone through the Achilles tendon.

When the calf muscles contract, force is also exerted on the Achilles tendon. When the contraction is intense due to multiple repetitions or intense effort, it can cause the Achilles tendon to rupture.

Ruptures in the Achilles tendon range from a small, partial rupture with minimal pain and difficulty moving to a total rupture, which may require surgical repair.

Cause

Achilles fractures usually occur when the patient tries to accelerate from a standstill or when he rushes sharply forward, such as during a game of tennis, football, volleyball, etc.

Symptoms

Patients with partial rupture usually experience pain during activities such as walking (especially uphill), climbing stairs, running and jumping. It is also common for them to feel pain at rest after such activities, especially when they wake up in the morning. Swelling or tenderness may occur.

Diagnosis

The diagnosis is usually made during a clinical examination and confirmed by magnetic resonance imaging or ultrasound.

Treatment

Most patients with an Achilles tendon rupture are treated with a physical therapy program. The success rate of this program depends on the patient’s compliance with the program. One of the main keys of the program is to stop the patient any activity that increases the pain, until the symptoms completely subside. This allows the body to begin the healing process, as there will be no further tissue damage. Once this is achieved, a gradual return to these activities is advisable, as long as there is no increase in symptoms.

In the initial phase the inflammation can subside with anti-inflammatory and regular ice packs. To ensure the best possible result it is very important a program of restoration of flexibility and strengthening, under the supervision of a physiotherapist.

Factors Contributing to Achilles Tendon Rupture

There are several factors that can predispose to rupture of the Achilles tendon. These need to be assessed and corrected under the guidance of a physiotherapist. Some of the factors that contribute to this condition are: lack of flexibility, wrong way of exercising, insufficient mechanical support, posture, insufficient warm-up and muscle weakness.

Physiotherapy for Partial Rupture of the Achilles Tendon

Physiotherapy for Achilles tendon rupture is valuable for speeding up recovery, ensuring a very good result and reducing the chance of re-injury. Physiotherapy includes:

• Soft molecule techniques (therapeutic massage)
• Electrotherapy
• Taping
• Exercises to strengthen and improve muscle elasticity
• Retraining
• Articular Mobilization (manual therapy)

Muscle Strain

Strain is a muscle injury. The most common strains are strains of the muscles of the lower extremities, such as the strain of the thigh muscles, and the strain of the gastrocnemius (calf). There is no difference in gender and age.

Strains are divided into three categories:

First degree strains: small rupture of muscle elements.

Second degree strains: partial rupture of muscle elements, but maintenance of muscle continuity.

Third degree strains: complete cross section of the muscle, ie the muscle is cut.

Cause of a muscle strain

Muscles can be injured in two ways, by direct blows, or by over-stretching. The result is a rupture of muscle fibers (which can reach a full cross section of the muscle) and the formation of a hematoma.

The most common cause of a strain is a local injury to the muscle area, or to the myotendinous area near the joints. People who engage in sports activities are more likely to have strains. Also, people who have had strains in the past are more likely to have strains again in the same area.

There are several factors that contribute to muscle spasm:

• Poorly prepared muscles due to poor training or poor warm-up during exercise.
• Weak muscle due to previous injury and poor recovery.
• The muscle has developed scar tissue inelastic at the site of the previous strain.
• The muscle is overloaded and has reached a point of great fatigue.
• Tight muscles or muscles exposed to cold are more easily injured.

Preventing during sports activities and strengthening the areas that have a history of strains with elastic bandages, reduces the chances of muscle injury.

Symptoms

Obviously, the symptoms depend on the severity of the injury. In the case of muscle strain, the rupture of the muscle fibers is accompanied by the leakage of blood, which accumulates in the tissues causing hematoma, the dimensions of which are proportional to the severity of the injury. The main symptom is pain at rest, which is aggravated by the effort to move the muscle concerned and is accompanied by functional disability, making it impossible to use the affected muscle.

Muscle strains occur more in the area where the muscle connects to the tendon and less in the main muscle mass. The main symptoms in these conditions are immediate pain, local tenderness in the area, the development of edema (swelling), as well as the restriction of movement in the nearby joints. Ecchymosis (bruising) can often be seen immediately in the area of ​​the strain. This is also called a hematoma.

Diagnosis

Clinical examination is the main diagnostic tool in muscle strains. The use of ultrasound and magnetic resonance imaging in recent years complements the clinical examination and mainly helps to determine the size of the injury.

Complications

Complications after a muscle strain usually occur in cases of inadequate or incomplete treatment. They concern the increasing formation of scar tissue in the area of ​​the strain, the creation of an encapsulated hematoma and the creation of bone tissue (ossifying myositis) which often leads to the limited functionality of the muscle and the joint in which it affects. Surgical treatment is usually the method of choice in these cases.

Treatment of a muscle strain

Conservative treatment is first and foremost the first approach to treating strains.

It consists of:

• Bandaging the muscle (upper or lower limb) with an elastic bandage
• Use of rest splints
• Administration of non-steroidal anti-inflammatory drugs
• Laying ice for the first two days
• Physiotherapy for rehabilitation, if necessary
• Second and third degree strains are assessed by the doctor and depending on other possible lesions, surgery (muscle suturing)

The physiotherapist with the means at his disposal, for the first 24 hours tries to reduce the swelling and pain using TECAR, TENS currents, cross currents and cryotherapy.

After the first 24 hours, the physiotherapist’s goal is to increase blood flow to the site of injury (via TECAR, ultrasound, hot pads, diathermy and laser) to achieve the maximum degree of nutrient supply for wound healing.

Then a program of stretching exercises is imposed on the injured muscle. After the rehabilitation, the isotonic exercises for additional strengthening gradually begin.

Following are specialized exercises of susceptibility and neuromuscular fitting, ie exercises of retraining the muscles for a safe return to daily activity.

SOURCES
Evans W.J., & Cannon J.G., (1991). The metabolic effects of exercise in muscle damage, Exercise Sport Sc. Rev, (19): 99 – 125.

Frozen Shoulder

What is a frozen shoulder?

Frozen shoulder is a condition characterized by inflammation and stiffness of the connective tissue that covers the shoulder joint.

Sometimes the articular pock of the shoulder joint becomes inflamed and “tightens” the joint. When this happens then we have frozen shoulder syndrome.

In general, frozen shoulder syndrome can be divided into three stages:

• Painful stage: In the first stage there is pain in all movements of the shoulder. Also at this stage the shoulder stiffness begins.
• Stiffness stage: The second stage of the frozen shoulder is characterized by a great lack of movement, due to the scar tissue that develops in the joint pocket. Patients have great difficulty reaching the hand back to their back. The pain at this stage begins and subsides.
• Stage of remission of symptoms: At this stage the symptoms begin to subside as the shoulder becomes more relaxed and moves comfortably.

Causes

Although the exact cause is not known, some injury to the shoulder joint or adjacent tissues is thought to be responsible. Frozen shoulder is more common in cases where proper treatment has not been applied. It is also more common in cases where the shoulder has been immobilized for a long time (eg after surgery), if the patient has diabetes or another autoimmune disease.

Symptoms

Symptoms associated with a frozen shoulder develop gradually. Initially, patients experience a shoulder discomfort that develops into “sharp” pain with specific movements or activities. The pain is deep in the shoulder, although sometimes there is discomfort in both the arm and the neck. In the above areas there is stiffness. The pain associated with frozen shoulder syndrome increases with all shoulder movements.

Activities such as raising the hand, carrying, lifting objects, pushing or pulling, shoulder pressure during sleep, loosening a bra increase the symptoms. A common phenomenon is night pain and pain in the first days of the day. When we move to the second stage of the frozen shoulder then the pain begins to decrease. In addition to pain, patients with frozen shoulder have a high degree of stiffness in the shoulder joint. Stiffness affects all shoulder movements but more the lifting and turning.

Diagnosis

Subjective (history taking) and objective (clinical examination) evaluation are sufficient to lead the physiotherapist to diagnose frozen shoulder syndrome. Sometimes tests such as MRI scans can help.

Treatment

Once frozen shoulder syndrome appears, a few things can be done to speed up recovery. The best treatment is prevention. For this reason, any shoulder injury must be completely healed, according to the treatment protocols prepared by the physiotherapist in each case.

The goal of treatment once frozen syndrome is established is to maintain shoulder mobility and strength, as well as reduce pain. It is very important to avoid activities and increase the symptoms. This helps our body heal damaged tissues and reduce inflammation.

Prognosis

In some cases the frozen shoulder subsides after months. Rarely do the symptoms go away after eighteen months or more. The painful stage usually lasts from two to six months. The stage of stiffness lasts four to twelve months and the last stage of recovery four to eighteen months.

Prognostic factors of frozen shoulder syndrome

There are several factors that contribute to the development of frozen shoulder. They all need to be evaluated and corrected during rehabilitation by the physiotherapist. Some of them are:

Chronic Lateral Ankle Pain

The ankle is the joint that forms between the tibia and the ankle. This joint is located in the lower part of the lower limb and connects the tibia to the foot.

The bones are connected to each other and fixed with connective tissue strips, which are called ligaments. The ligaments guide the movements of the joints and do not allow the bones to move too far apart. The joints are normally very elastic and when stretched they return to their normal length without any other problems. However, when due to a violent movement the bones are significantly separated from each other then the ligaments are significantly stretched and it is possible to cut. In this case the patient feels intense discomfort.

In the ankle joint there are ligaments on the outside and on the inside. On the outside of the ankle there are 3 tapered ligaments and on the inside there is a flattened ligament, the medial lateral ligament. The 3 ligaments on the outside of the ankle have different names depending on the area of ​​protrusion and bulge. The more severe the sprain, the more joints have been injured.

Recurrent or permanent (chronic) pain in the outside of the ankle often develops after an injury such as a sprained ankle. However, many other conditions can also cause chronic ankle pain.

Symptoms

The ankle shows swelling (swelling) almost immediately after turning the foot. The swelling is usually more severe on the outside of the ankle and may be accompanied by hematoma. At the same time charging the limb is painful or even impossible.

The symptoms concern:

• Pain usually on the outside of the foot (the pain may be so severe that the patient has difficulty walking, in some cases the pain is a permanent, hazy pain)
• Difficulty walking on uneven ground or toes
• Feeling of instability
• Swelling
• Stiffness
• Sensitivity
• Repetitive ankle sprains

Causes

The most common cause of a persistently sore foot is inadequate healing after an ankle sprain. When you get a sprained ankle, the ligaments between the bones stretch. Without a complete recovery, the ligaments and surrounding muscles may remain weak, leading to recurrent instability. As a result, you may experience further ankle injuries.

Other causes of chronic pain include:

• Injury to the nerves that penetrate the ankle. The nerves can be stretched or injured by a direct hit or by constant pressure while the foot is trapped.
• Cut or inflamed tendon.
• Ankle arthritis.
• Fracture of one of the bones that make up the ankle joint.
• Inflammation of the synovial membrane.
• Development of scar tissue in the ankle after a sprain. The scar tissue takes up space in the joint, squeezing the ligaments.

Diagnosis

Ankle x-rays are usually requested by a specialist. An x-ray of the other leg may also be needed so that the doctor can compare the injured to the non-injured ankle. In some cases, additional tests may be needed, such as a bone scan, CT scan, or MRI scan.

Treatment

The treatment will depend on the final diagnosis and should be individualized to the needs of the individual. Both conservative and surgical methods are used.

The conservative method includes:

• Anti-inflammatory drugs such as aspirin or ibuprofen to reduce swelling.
• Physiotherapy, which includes natural means (Diagnostic pump, TECAR, currents, LASER etc) & exercises (on a balance disc, with the aim of strengthening the muscles, restoring range movement, and increase the perception of the position of the joint.)
• Ankle splint or other support.
• Injection of a steroid medication.
• In the event of a fracture, immobilize to allow the bone to heal.

Sources
Harmon K.G., (2007). Which support is best for first-time ankle sprains? Clin J Sport Med, 17 (4): 333 – 334.
Weber J.M., & Maleski R.M., Conservative treatment of acute lateral ankle sprains, Clin Podiatr Med Surg, 19 (2): 309 – 318.

Physiotherapy for Parkinson’s Patients

Parkinson’s disease is one of the most common neurological diseases. As in all degenerative conditions, the onset is insidious and once the patient seeks medical advice, it is often possible to report a history of a few months or even years. This disease can be characterized as a disease of wear and tear. That is, it occurs when certain brain cells can no longer produce dopamine. Because of this, the chances of developing Parkinson’s increase with age.

Possible causes of the disease are atherosclerosis, alcoholism, drug use, metabolic disorders, toxic substances (such as manganese and MPTP toxin), medication (mainly neuroleptics), brain tumors, and and premature aging of the neurons of the substantia nigra. Finally, the existence of an inherited predisposition to the disease has not been proven and does not seem possible.

So far there is no cure for the disease or a way to prevent the disease from progressing. But there are several drugs that significantly improve the symptoms for many years, thus improving the quality of life. Drug therapy is based on replenishing dopamine levels in the brain. There is also surgery, when the drugs work but do not constantly control the symptoms. Patients must meet specific criteria to be eligible for surgery. Exercise has also been shown to help a lot in controlling symptoms and well-being.

Symptoms

The disease first appears with the combination of two symptoms, bradykinesia and stiffness or tremor and stiffness, and as it progresses, all the characteristic manifestations of the disease appear slowly. It most often occurs in the sixth and seventh decade of life and affects both sexes equally. It can, however, occur at almost any age although it is very rare under thirty. As age increases, so does the frequency.

Essentially, the onset of the disease is slow and the course progressive. The initial symptoms are not typical. Diffuse pains are observed, mainly in the shoulders, due to the stimulation of the joints, feeling of fatigue and reduction of daily activities. The patient complains that he has become sluggish and cumbersome, but often attributes the discomfort to old age. When the disease is established, then the characteristic four symptoms are observed: bradykinesia, tremor at rest, stiffness, as well as loss of corrective reactions.

Non-motor symptoms, such as constipation, urinary disorders (frequent urination, nocturia, urination), olfactory disorders and depression, are also common, which may precede motor manifestations. Over time, and especially when the disease begins in old age, dementia (about half of patients after 15 years of follow-up) is very common, often accompanied by visual hallucinations.

Diagnostic Approach

The diagnosis of the disease is made only by clinical examination. An experienced neurologist is able to diagnose the disease through the patient’s symptoms and clinical examination. There is no laboratory test to confirm the disease.

There are only tests recommended by a neurologist to rule out other conditions similar to Parkinson’s disease.

Parkinson’s disease is divided into idiopathic and secondary.

Parkinson’s idiopathic disease is a progressively developing disease with the main manifestations being restlessness, stiffness, sluggishness and loss of reflex postures (corrective postures). There must be at least two of the above main symptoms in practice to diagnose the disease.

Secondary Parkinsonism presents a similar clinical picture to the idiopathic and is caused by factors such as infections (viral encephalitis), toxic substances, brain tumors, etc.

Every patient has a different development. Still, the evolution can stop for some other time. It can be slow and mild, or for no apparent reason lead to significant deterioration.

Prevention

To date, no reliable method of preventing the disease has been found. Therefore, early or even early diagnosis does not help anything. There is no way to reverse or even delay the progression of the disease. Neither early medication nor any exercise or special diet has been shown to slow the progression of long-term disability caused by the disease.

On the contrary, there is evidence that early administration of dopamine or similar dopamine-mediated drugs, called dopamine agonists, may damage specific cells. For this reason there is no need to rush into the treatment of the disease.

Self-restraint and the most conservative medication possible are the best strategy in Parkinson’s disease.

Physiotherapy Treatment

The current model of physiotherapy intervention in patients with Parkinson’s is based on the assumption that normal movement can be acquired through teaching. Knowledge of the features of motor disorders in Parkinson’s patients is the starting point for designing a rehabilitation program. Most patients with Parkinson’s have difficulty walking at some stage of the disease. The use of external stimuli and cognitive strategies are the main therapeutic options of the physiotherapist for the gait disorder. Consequently, the elimination of falls is an important goal of physiotherapy, especially in patients in the later stages of the disease. Also, the prevention of muscle weakness and atrophy, limited range of motion and reduced ability to exercise, is a major goal of physical therapy in the Parkinson’s patient. Continuous physiotherapy is not necessary, but frequent meetings and advice are valuable.

Aging, any concomitant pathological conditions and secondary adaptive changes in the musculoskeletal and cardiovascular systems are also very important issues in the design of the physiotherapy program. Because Parkinson’s generally progresses slowly, patients and their families need to be supported in developing programs that should be implemented during long-term treatment. This support can help them take on more responsibility for their health and well-being in general.

Sources
by Goede G.J.T., Keus S., Kwakkel G., & Wagenaar R., (2001). The effects of physical therapy in Parkinson’s Disease: A research synthesis, Archives of Physical Medicine and Rehabilitation, 82 (4): 509 – 515.
Kwakkel G., de Goede G.J.T., & van Wegen E., (2007). Impact of physical therapy for Parkinson’s disease: A critical review of the literature, Parkinsonism & Related Disorders, 13 (3): 478 – 487.

Herniated Disc

Spinal disc herniation (herniated disc) is a common condition mainly in the lumbar spine but also the other degrees of the spine. At the same time it is and is the most common cause of pain in both the upper and lower extremities.

The intervertebral discs are located between the vertebrae and absorb the vibrations of the spine. Each disc is hard on the outside (fibrous ring) and contains a soft core inside, called the gel nucleus. Herniated disc occurs when the hard ring ruptures and the nucleus from the inside of the disc slides into the spinal canal and presses on a nerve.

A hernia can occur in any part of the spine, but the highest frequency is clearly seen in the lumbar spine, then in the cervical spine and much less frequently in the thoracic spine.

The risk factors for herniated disc are:

• Age: As we get older, our discs become damaged (corresponding to the deterioration of the skin and the appearance of wrinkles).
• Lifestyle: Lack of exercise, being overweight and smoking lead to poor intervertebral disc function.
• Poor posture: Poor posture and repeated weight lifting or waist turns cause stress on the discs.

Symptoms

This disease (disc disease) often occurs in young people, but also in middle and old age. Symptoms may include lower back pain (back pain) and leg pain (sciatica), and sometimes weakness (paralysis) and numbness of the leg.

The symptoms that appear vary depending on the severity of the hernia and its location.

Patients complain of acute or chronic low back pain (back pain), while in nerve root involvement there may be reported pain, numbness or paraesthesia in the lower extremities (sciatica).

Also often accompanied by muscle spasm, loss of lordosis in the waist and worsening of symptoms with coughing or sneezing. Sometimes analgesic scoliosis is created, ie distortion of the body, in the involuntary reaction of the person so that it does not hurt at the point where the root is pressed.

It should be mentioned here that in very serious situations, such as hippocampal syndrome, where there is weakness of the lower extremities, saddle type anesthesia, problems with urination, etc., immediate surgical treatment is required.

Diagnosis

Diagnosis begins with a history and clinical examination of the lower back (lower back) and lower limbs. The diagnosis is then confirmed by magnetic resonance imaging.

The diagnosis of hernia is made accurately by magnetic resonance imaging (MRI), but plain X-ray is also useful in differentiating from other conditions, such as tumors, and stenosis of the intervertebral space on X-ray is an indication of possible hernia.

However, this does not mean that anyone with a hernia should necessarily be in pain or undergoing treatment, as a large percentage remain asymptomatic or the pain disappears over time.

Dealing

Initial treatment of herniated disc should be conservative and focused on relieving pain and other symptoms. Research has shown that the vast majority of back pain is due to discogenic problems, with prominent projection or herniation of the intervertebral disc.

Drug analgesia, bed rest and conventional physical therapy using machines such as TENS, laser, diathermy and massage aim to reduce pain, but only provide a temporary relief and not a substantial treatment of the problem.
An appropriate program of exercises to strengthen the stabilizers and supporting muscles of the waist, seems to offer something more than the above means.

Physiotherapy Treatment

The McKenzie Method – Mechanical Diagnosis and Treatment (MDT) is a comprehensive system for the proper evaluation and treatment of back pain. An important advantage of the method, compared to the other approaches, is the prognosis from the first sessions, ie which incident will respond positively to treatment and which will not. This gives confidence and security to the sufferer and reduces the unnecessary waste of time and money on dubious treatments.

The other great advantage of the McKenzie method is that it is based on Self-Healing, through special individualized exercises that are designed based on the appropriate assessment that precedes, while no machines or drugs are used. Thus, little by little, the patient becomes completely independent of the therapist, as he is trained for a correct attitude in everyday life and eventually learns to manage his condition on his own, preventing any relapses in the future.

The McKenzie method has avoided a very large percentage of planned surgeries for herniated disc and now the method has gained the recognition of orthopedic surgeons and neurosurgeons. Thus, surgery is chosen only when a proper conservative treatment fails to reduce the patient’s symptoms or when there are severe neurological lesions with pressure on the nerves or spinal cord.

Sources
Kontzaelias DA, (2011). Physiotherapy in diseases of the musculoskeletal system, Publications: University Studio Press, Thessaloniki.

Anterior Cruciate Ligament Rupture

The anterior cruciate ligament (ACL) is the main stabilizer of the knee joint. Its role is to protect the joint from the anterior displacement of the tibia in relation to the thigh, to control the rotation of the joint and its lateral displacements (stiffness, flexibility).

Its function provides significant stability to the joint during daily activities, running, changing directions and landing by jumping. Rupture of the anterior cruciate ligament involves injury to the ligament in the knee that connects the lower thigh to the upper tibia. It is characteristic that a patient with a rupture of the anterior cruciate ligament complains of instability of his joint but also of episodes where his knee slides anteriorly(παρεμβολη εικονας : anterior cruciate ligament rupture).

Epidemiology
The incidence of anterior cruciate ligament injury in the knee is two to eight times higher in women than in men. In basketball in particular, women are four times more likely to be injured than men. This difference between the sexes is even greater in people attending military academies. Also, people who have had joint ligament repair have a higher risk of rupture in both the (most often) and healthy limb.

The incidence of anterior cruciate ligament injury is high in basketball, hockey, soccer, American football, gymnastics, skiing, and volleyball. Anterior cruciate ligament ruptures are constantly increasing due to the large participation of the population in these sports. Especially in skiing, anterior cruciate ligament injuries cover 25% to 30% of all knee injuries. Professionalism and the high level of sports today reinforce the above phenomenon.

Diagnosis
A good history combined with special tests can make the diagnosis without the need for additional tests. Measuring the relaxation of the ligament with special instruments enhances the clinical examination and provides an objective reference point for future comparisons. The most commonly used articulator is the KT-1000 which uses constant forces to determine the anterior tibial displacement.

Of great importance are the simple radiographs with which fractures of the knee must be ruled out (but also detached fractures in the protrusion of the ligament). Although usually not necessary for diagnosis, magnetic resonance imaging (MRI) is useful as it is more than 95% accurate in diagnosing anterior cruciate ligament rupture. It is also extremely useful in the search for concomitant lesions. Another imaging examination is the knee arthroscopy which, in addition to being diagnostic, also has therapeutic value for the restoration of ligament damage.

Treatment
Combined anterior and posterior cruciate ligament injuries are rare but present with serious complications especially if accompanied by nerve and vascular damage. Although many different views have been recorded on what is the best way to treat these injuries, there are many who argue that the best functional result results from surgical treatment of the anterior and posterior cruciate ligament, rather than conservative treatment. There is also the view that immediate surgery for both ligaments yields a better functional outcome.

In the postoperative rehabilitation of the combined surgical treatment of the two ligaments, the main priority is the early mobilization of the joint, the gradual loading of the limb and secondarily the gradual recovery of the joint flexion. The aim is for the trajectory of the movement to be gradually recovered.

Anterior cruciate ligament rupture is treated with cryotherapy, continuous passive mobilization (CPM), and isokinesis. The methods of cryotherapy are many and include cooling sprays, immersion in cold water, ice cubes with ice cubes, gel pads, crushed ice pads, continuous flow ice water systems (Cryocuff) and cold air generators. Continuous passive mobilization (CPM), in contrast to intermittent passive motion, is motion that remains uninterrupted for long periods of time. It is usually applied by a mechanical device, which moves the desired joint continuously within a controlled range of motion, without the patient’s effort up to 24 hours a day for 7 or more consecutive days. The movement is passive, so that muscle fatigue does not interfere with movement. The machine is used because the person could not apply the controlled movement continuously for a long period of time. Isokinization is a process in which a part of the body accelerates until it reaches a default constant angular velocity against an adjustable resistance. Regardless of the magnitude of the force applied by the patient, the velocity of the segment does not exceed the default angular velocity. As the patient tries to overcome it, the resistance is modified so that it corresponds exactly to the force applied at each point of the range of motion. The force applied by the patient is measured in appropriate units and is represented numerically and graphically to be a reference point for future comparisons.

Restoration of anterior cruciate ligament rupture is a long process (6-8 months) which requires proper planning and full cooperation with the patient to complete with the best possible results.

Ideal Return to Activities and Reduce the Risk of Re-injury.
The decision as to when a patient may be allowed to fully return to activities is, in most cases, empirical because there is little correlation between functional and clinical trials. The use of multiple criteria, including return to range of motion, muscle strength and balance, static and dynamic stability, is necessary to determine the appropriate time for a patient to return to full activity.

Sources
Prentice W.E., & Onate J.A., (2007). Knee Injury Rehabilitation: Sports Injury Rehabilitation Techniques, 4th Edition, (Edited – Translated from English by Athanasopoulos, Katsoulakis), Scientific Publications: Parisianou, Athens

Clinical Suspension Training Seminar by PhysioGalinos and TherapyLab

As part of TherapyLab Academy seminars, TherapyLab Physiotherapy laboratories are organizing the Clinical Suspension Training seminar, in collaboration with the PhysioGalinos Center, in Kalloni, Lesvos on July 11th and 12th.

The Clinical Suspension Training method is a useful therapeutic exercise with significant results in the proper activation of the muscles of the trunk and limbs, in the increase of strength, range of motion, in the restoration of stability, balance and in the improvement of the neuromuscular joint.

With the completion of the training in the Clinical Suspension Training method, the therapist will be able to know how and for more purpose he applies each exercise, to select the appropriate exercises according to the needs of each patient, to apply them safely but also to modify them. where necessary.

The aim of the method is the prevention of injuries, the reduction of symptoms and motor deficits, the improvement of functionality, the increase of physical activity and the prevention of re-injuries in musculoskeletal cases

The seminar is addressed to Physiotherapists. Colleagues interested in being trained in this method are kindly requested to contact 22510 43947 or 22530 25205 PhysioGalinos Rehabilitation Clinic 2 Kalloni.