THE ROLE OF PHYSIOTHERAPIST IN THE RECOGNITION AND TREATMENT OF STRESS FRACTURES IN ATHLETES

Stres fraktura je djelomičan ili potpun prijelom kosti koji nastaje kao rezultat ponavljane primjene stresa nižeg od stresa potrebnog za lom kosti u jednom opterećenju. Čimbenici koji pogoduju nastanku su: dob i spol, vrsta sportske aktivnosti, biomehanički čimbenici, mišići, greške u treningu, podloga, sportska obuća i hormonalni disbalans. Najviše podložni tim ozljedama su sportaši koji se bave sportovima gdje su prisutni jaki udarci (trčanje, košarka, nogomet i gimnastika). Za dijagnostiku stres fraktura najčešće se primjenjuju: klinička dijagnostika, radiološka dijagnostika, scintigrafija i diferencijalna dijagnostika. Prevencija takve ozljede zahtijeva prepoznavanje i eliminaciju čimbenika rizika koji su povezani sa sudjelovanjem u kontaktnim sportovima, te izradu plana i programa vježbi prilagođenih za svaki sport i sportaša. U prevenciji je također bitna kvalitetna suradnja između liječnika, sportaša i trenera, i važna je pravilna kondicijska priprema, pravovremeno tretiranje ozljeda i izrada rehabilitacijskog programa. Što se tiče same rehabilitacije, s njom se započinje odmah nakon ozljeđivanja, a ona uključuje mirovanje i imobilizaciju, izometričke vježbe, vježbe balansa i propriocepcije, hidroterapiju, krioterapiju, elektroterapiju, LASER, magnetoterapiju, sportsku masažu, istezanja, metode regeneracije, proprioceptivne treninge, dinamičku neuromuskularnu stabilizaciju (DNS), proprioceptivnu neuromuskularnu facilitaciju (PNF), neurodinamiku živaca (NDS), manualne tehnike (mobilizacijske i manipulacijske tehnike, Kaltenborn-Evjenth, Cyriax, Maitland, McKenzie), Kinesiotape, mekotkivne tehnike (fascijalne manipulacije, frikcijske masaže, funkcionalne masaže), Emmett, Bowen, Rolfing, Yumeiho, Theraband, bandaže itd.Stress fracture is a partial or complete bone fracture resulting from repeated application of stress that is lower than the stress needed for bone fracture at one load. Factors favoring its incurrence are: age and gender, type of sport activity, biomechanical factors, muscles, training errors, groundwork, sports footwear and hormonal imbalance. Most affected are athletes involved in sports where strong kicks are present (running, basketball, soccer and gymnastics). For the diagnosis of stress fractures most commonly used are clinical diagnostics, radiological diagnostics, scintigraphy and differential diagnosis. The prevention of such an injury requires the identification and elimination of risk factors associated with participation in contact sports, as well as the development of training plans and programs tailored for every sport and athlete. Also important for prevention is a quality co-operation between doctors, athletes and trainers, as well as regular conditional preparation, timely treatment of injuries and the compilation of a rehabilitation program. As far as rehabilitation itself is concerned, it starts immediately after injury, and it includes rest and immobilization, isometric exercises, balance exercises and proprioception, hydrotherapy, cryotherapy, electrotherapy, LASER, magnetotherapy, sports massage, stretching, regeneration methods, proprioceptive training, dynamic neuromuscular stabilization (DNS), proprioceptive neuromuscular facilitation (PNF), nuclear neurodynamics (NDS), manual techniques (mobilization and manipulation techniques, Kaltenborn Evens, Cyriax, Maitland, McKenzie), Kinesiotape, soft tissue techniques (fascial manipulation, friction massage, functional massages), Emmett, Bowen, Rolfing, Yumeiho, Theraband, bandages etc