| Abstract | Sindrom sraza ramena (engl. impingement syndrome shoulder-SIS) bolni je proces upale burze i pripadajućeg dijela rotatorne manžete ramenog zgloba. Uzrok ovome su dugotrajne aktivnosti rukom iznad glave ili učestale kratke, ali snažne aktivnosti s podignutom rukom kao što je to slučaj u odbojkaškoj igri. U terapiji sindroma prenaprezanja, a sve češće i u terapiji SIS, primjenjuje se terapija ekstrakorporalnim udarnim valom (engl. extracorporeal shock wave therapy - ESWT), o čijoj učinkovitosti u literaturi postoje kontradiktorni podaci, ovisno o načinu primjene. Također se primjenjuje kineziterapija u okviru koje su izučavani različiti modaliteti vježbanja, veće ili manje učinkovitosti. U ovom istraživanju se znanstvenim metodama utvrđivalo učinkovitost kompleksnog pristupa kineziterapijskog programa koji uključuje veliki broj vježbi koje su u funkciji boljitka kod odbojkašica sa SIS.
U radu se uspoređivao učinak izoliranog kompleksnog kineziterapijskog programa i kombinacije s ESWT na funkcijsku sposobnost odbojkašica sa SIS-om. U istraživanju je sudjelovalo 56 odbojkašica u dobi od 20 do 35 godina, raspoređenih u dvije skupine. Prvu skupinu su činile ispitanice koje su provodile kineziterapijski program i ESWT, i sveukupno primile 14 ESWT tretmana i 28 kineziterapijskih tretmana u 7 tjedana, dok su u istom vremenskom razdoblju ispitanice druge skupine koristile kineziterapijski program bez ESWT, te bile podvrgnute 14 lažnih "placebo" ESWT i 28 kineziterapijskih tretmana. U obje skupine, podaci su bili prikupljeni metodom ankete i kliničkim pregledom i to u tri vremenska intervala: na početku tretmana, nakon eksperimentalnog perioda od 7 tjedna, te mjesec dana nakon završetka tretmana. Oba primijenjena tretmana su u sva tri promatrana segmenta dali statistički značajne učinke. Na kraju primjene tretmana efekti oba tretmana su podjednaka, dok je na kraju produljenog razdoblja od 30 dana veću učinkovitost pokazao tretman kineziterapije. Testiranje razlike SDQ (engl. self description questionnaire-SDQ) rezultata između inicijalnog i finalnog mjerenja, pokazalo je da je kod obje skupine ispitanica na kraju primjene tretmana dobiveno statistički značajno smanjenje boli na razini procjene od p<0,01, čime su stvoreni uvjeti za veću specifičnu funkcijsku sposobnost u ramenu sa sindromom sraza kod odbojkašica. Kada se analiziraju promjene na pojedinim elementima SDQ skale između inicijalnog i finalnog mjerenja kod obje skupine ispitanica konstatirano je statistički značajno poboljšanje rezultata u svim elementima. U skupini ispitanica koje su bile podvrgnute kineziterapiji bez ESWT, osjećaj boli je smanjen u više od 70% slučajeva, dok se u sedam elemenata svodi na 83,3% slučajeva. U skupini koja je provodila kineziterapijski program udarnim valom, neznatno je smanjen postotak smanjenja boli, ne više od 70% slučajeva. Terapija ne samo da znatno doprinosi povećanju opsega pokreta, smanjenju boli i poboljšanju u izvršavanju svakodnevnih aktivnosti, nego i daje boljitak u mentalnom zdravlju ispitanica što pokazuju odgovori u SDQ upitniku nakon eksperimentalnog razdoblja od 7 tjedana, te mjesec dana nakon svršetka tretmana. Zaključno, u ovom istraživanju je dokazan pozitivan terapijski učinak kompleksnog kineziterapijskog programa na bol, povećanje pokretljivosti i funkcijsku sposobnost odbojkašica s SIS, ali ne i hipoteza prema kojoj će kombinacija kineziterapije i ESWT imati značajno bolji učinak na iste parametre u odnosu na primjenjen samo izoliran kineziterapijski program. Rezultati istraživanja mogu značajno utjecati na svakodnevni klinički rad, te na liječenje i rehabilitaciju pacijenata s SIS. |
| Abstract (english) | Shoulder impingement syndrome (SIS) is a common cause of shoulder pain. It occurs when there is an impingement of tendons or bursa in the shoulder from the bones of the shoulder. Overhead activity of the shoulder, especially repeated activity, is a risk factor for shoulder impingement syndrome, as is the case in a volleyball game. With impingement syndrome, pain is persistent and affects everyday activities. Motions such as reaching up behind the back or reaching up overhead to put on a coat or blouse, for example, may cause pain. Extracorporeal shock wave therapy (ESWT) is applied in the treatment of overload syndrome, and more often in SIS therapy, of which effectiveness, in the literature, there are contradictory data, depending on the method of application. Kinesitherapy is also used in which various modalities of exercise are learnt, with more or less benefits. In this study, the scientific methods determined the effectiveness of a complex approach to the kinesitherapy program, which includes a large number of exercises that should lead to the improvement of volleyball player with SIS. The paper compared the effects of an isolated complex of kinesitherapy program and combination with extracorporal shock wave therapy on the functional ability of volleyball players with shoulder impingement. 56 volleyball players aged 20-35 participated in the survey, arranged into two groups. The first group was consisted of patients who implemented kinesitherapy program with ESWT, and generally received 14 ESWT treatment and 28 kinesitherapy treatment, in 7 weeks, while at the same time members of the other group performed kinesitherapy program without ESWT, and received 14 false "placebo" ESWT and 28 kinesitherapy treatment. In both groups, data variables were collected by survey method and clinical examination in three time intervals: at the beginning of the treatment, after an experimental period of 7 weeks and also one month after the end of the treatment. Both applied treatments gave statistically significant effects in all three observed segments. At the end of treatment, the effects of both treatments are equal, while at the end of a prolonged period of 30 days, the effectiveness of kinesitherapy has been shown to be more effective. Testing the self description questionnaire (SDQ) difference between initial and final measurements showed that statistically in pain at the assessment level of p<0.01 was obtained at both treatment groups at the end of the treatment, which created the conditions for greater specific functionality of the impingement shoulder of the volleyball players.
When analyzing the changes in individual subjects of the SDQ scale between the initial and final measurements, in both groups statistically significant improvement of the score in all items is concluded. In the group of patients who underwent to kinesitherapy without ESWT, pain is reduced in more than 70% of cases, while in 7 items it is reduced to 83.3% of cases. In the group which implemented kinesitherapy program with Schokwave therapy, there is a slightly reduced percentage of pain reduction, in no more than 70% of cases. The therapy not only greatly contributes to increasing the range of movement, reduced pain and improvement in daily activities, but also gives improvements in mental health of the patients, which is shown in responses in the SDQ questionnaire after an experimental period of 7 weeks and also one month after the end of the treatment. In conclusion, this study demonstrated the positive therapeutic effect of a complex kinesiotherapy program on pain, increased mobility and functionality of volleyball players with SIS, but not the hypothesis according to which the combination of kinesitherapy and ESWT will have a significantly better effect on the same parameters than only isolated kinesiotherapy the program. The results of the research can significantly influence the daily clinical work, as well as the treatment and rehabilitation of the patients with SIS. |
