REHABILITACIJA POSLE POVREDE Veliki broj biciklista je otkrilo MTB sport dok su skijali, igrali kosarku, tenis, fudbal

i druge sportive koji zahtevaju lateralne pokrete. Ako se pitate kako i na koji nacin posle ozbiljne povrede kolena! Nacin rehabilitacije posle povreda je tokom niza godina doziveo dosta promena. Raniji standardi su bili da se sportisti mogu vratiti svojim sportskim aktivnostima sest meseci nakon operacije kolena. Ali, kako je napredovala tehnika u medicini, sve vise je preovladjivao stav da se povratak na nivo pre povrede bazira na kvalitetu i nacinu rehabilitacije pre nego na samom zahvatu, bio on operativni ili ne. Tradicionalni pristup rehabilitaciji je bio sa prolongiranom imobilizacijom, rad bez tegova i tezine, kao i spora progresija ka predjasnjoj aktivnosti. Sada se, nasuprot ovom stavu, praktikuje odmah rad na pokretanju misica, mnogo raniji rad sa teretom i ubrzan povratak u sport. Nova teorija ima stav: sto vise ulozite napora, brze cete se vratiti u igru! Na zapadu se forsira rehabilitacija po sistemu 50% rada u kucnom okruzenju a 50% na klinici ili rehabilitacionom centru. Ovo se objasnjava time sto prvih 50% bude fokusirano na povratak snage i izdrzljivosti u kucnim uslovima ili teretani na primer, dok se u strucnim rukama vezba stepen agilnosti (spretnost, hitrina, okretnost), balansa, segmenti vezbanja koji se cesto zanemare. Sa ove tacke gledista, razvijen je proces rehabilitacije u 3 stadijuma i to od druge nedelje pa do 12 meseca posle operativnog postupka. Ovde cemo govoriti o prvom stadijumu koji pokriva prvih nekoliko meseci posle rekonstrukcije kolena. Kada i kako poceti sa rehabilitacijom odgovor je odmah nakon operacije ili lekarskog zahvata.Vracanje punog radijusa pokreta savijanje i istezanje je najvazniji postupak. Ukoliko ovo ne budete forsirali, u vecini slucajeva ce se ovo odraziti na hod i cak prouzrokovati hramanje pri istom. Kojim god sportom da ste se bavili, vracanje punog radijusa kretanja je neophodan korak pre pocetka voznje trenazera ili laganog dzoging-a.

Evo nekih vezbi prvog stadijuma rehabilitacije koje ce povecati opseg pokreta kolena: Podizanje pete - Lezite na ledja sa ispruzenim nogama. Drzeci zdravu nogu pravo, podignite petu koliko god mozete i potom vratite nogu u prvobitni polozaj. Ponovite ovo u tri seta po 10 ponavljanja. Istezanje - Vitalna vezba za postizanje pune ekstenzije misica. Lezite na stomak i nogu postavite na ivicu kreveta malo iznad kolena. Gravitacija ce uciniti svoje i povecati nivo ekstenzije vase noge koji je pottreban za normalan hod. Trenazer - Kada doktor proceni da ste sazreli za voznju trenazera, vazno je da imate pravo opterecenje i nacin voznje da se ne bi tek rekonstruisano koleno ponovo povredilo. Koristite ravne pedale i pocnite sa lakim otporom. Pozicionirajte visinu sedista tako da kada postavite petu na pedalu, u krajnjoj tacki koleno bude blago savijeno. Pojacavajte postepeno intenzitet i

opterecenje srazmerno jacanju vaseg kolena. Inicijalno drzite kadencu izmedju 80 i 90 okretaja. Ne ustajte u voznji pre treceg meseca rehabilitacionog postupka, ili dok doktor ovo ne dozvoli. Leg pres nozni potisak teretom - Misici zatezaci i tetive posle operacije ili lekarskog zahvata teze atrofiranju i postaju slabi. Da bi izazvali sok terapiju i vratili ih u akciju, pocnite ovu vezbu sa tezinom koja nece predstavljati veliki napor pri izvodjenju iste. Uradite 3 seta od po 10 ponavljanja. Tetive obmotavaju zadnji deo i strane kolena, pa prema tome kako one postaju snaznije, vase koleno ce biti stabilnije. Tajna stabilizacije kolena posle povrede je ojacati tetive, misice gluteusa i misice zatezace. Vezbe na gredi - Vezbajuci balans i hod na gredi je jedna od vezbi za povecanje otpornosti, cvrstoce i izdrzljivosti. Vezbe za pravilnu duzinu i polozaj misica Vezbe sa rolerom od pene ili nekog drugog mekog materijala - Previse zategnuti misici kolena mogu da dodju u sukob sa kvadriceps misicima i mogu meniskus izbaciti iz svog prirodnog lezista. Odlicna vezba da bi se ovo sprecilo je upravo ova, lezite na bok i postavite pomenuti roler ispod kolena. Kotrljajte roler dole-gore i to od malo iznad kolena do malo ispod. Istezanje tetiva - Misicne tetive se ponasaju skoro kao i tri najbitnija prednja ligamenta, s obzirom da obuhvataju koleno kako sa strane, tako i iza. Tetive ce biti zategnute posle zahvata iz razloga nedostatka aktivnosti. Jedan od primarnih ciljeva je povratiti elasticnost tetiva i to odmah po zapocinjanju procesa rehabilitacije. Ove vezbe ce vam pomoci da krenete pravim putem posle operacije ili kidanja misica ili ligamenata, tamo gde operacija nije ni radjena. Dalji proces stavlja vaznost na pravilni odabir geometrije bicikla, pravilno pozicioniranje na isom, a sve u cilju smanjenja sanse za povredom, pogotovu na vec povredjenom ili kolenu u rehabilitacionom procesu. How do I do exercise to heal my meniscus?
For most tears, some simple exercises can help maintain muscle strength in the front of the thigh (quadriceps), back of the thigh (hamstrings), calf, and hip. All of these areas are important for your overall leg function while your knee heals after an injury or after surgery. Exercises should only be done on the advice of your doctor, and only if you feel very minimal or no pain while you perform them at home. The list below has links to specific exercises with pictures and instructions.

Quad sets Straight leg raises

o o o o

Straight-leg raise to the front Straight-leg raise to the outside Straight-leg raise to the back Straight-leg raise to the inside

Hamstring curls Heel raises Unilateral stance Heel dig bridging Shallow standing knee bends

Quad set

Quad sets help you build and maintain strength in the muscles on top of your thigh. With this action, you are setting these quadricep muscles by holding them tight. Do 8 to 12 repetitions several times during the day.

Sit on the floor with your injured leg straight out in front of you.

Tighten the muscles on top of your thigh by pressing the back of your knee flat down to the floor. Hold for about 6 seconds, then rest up to 10 seconds.

If you feel discomfort under your kneecap, try putting a small towel roll under your knee during this exercise.

Straight-leg raise to the front

These straight-leg raises help you strengthen the muscles on top of your thigh and around your hip. Do 8 to 12 repetitions.

Lie on your back with your good knee bent so that your foot rests flat on the floor. Your injured leg should be straight. (During this exercise, your low back should have a normal curve. Your back has a normal curve if you can slip your flat hand in between the floor and the small of your back, with your palm touching the floor and your back touching the back of your hand.)

Tighten the thigh muscles in the injured leg by pressing the back of your knee flat down to the floor. Hold your knee straight. Keeping the thigh muscles tight, lift your injured leg up so that your heel is about 12 inches off the floor. Hold for 5 seconds, then lower slowly.

Straight-leg raise to the outside

These straight-leg raises help you strengthen the muscles around your hip. Do 8 to 12 repetitions.

Lie on your side, with your injured leg on top. Tighten the muscles on the front of the thigh of your injured leg to keep your knee straight.

Keep your hip and your leg straight in line with the rest of your body, and keep your knee pointing forward. Don't drop your hip back. Lift your injured leg straight up toward the ceiling, about 12 inches off the ground. Hold for 5 seconds, then slowly lower your leg.

Straight-leg raise to the back

These straight-leg raises help you strengthen the muscles in your buttocks and in the back of your thigh. Do 8 to 12 repetitions.

Lie on your stomach, and lift your leg straight behind you (toward the ceiling). Lift your toes about 6 inches off the floor, hold for 5 seconds, then lower slowly.

Straight-leg raise to the inside

These straight-leg raises help you strengthen the muscles of your inner thigh. Do 8 to 12 repetitions.

Lie on the injured side of your body.

You can either prop your other (good) leg up on a chair, or you can bend your good knee and put that foot in front of your injured knee. Don't drop your hip back. Tighten the muscles on the front of your thigh to straighten your injured knee.

Keep your kneecap pointing forward, and lift your whole leg up toward the ceiling about 6 inches. Hold for 5 seconds, then lower slowly.

Heel raises

Heel raises strengthen the calf muscles. Do 8 to 12 repetitions several times during the day.

Stand with your feet a few inches apart, with your hands lightly resting on a counter or chair in front of you. Slowly raise your heels off the floor while keeping your knees straight. Hold for about 6 seconds, then slowly lower your heels to the floor.

Hamstring curls

Hamstring curls strengthen the muscles in the back of the thigh. Do 8 to 12 repetitions.

Lie on your stomach with your knees straight. If your kneecap is uncomfortable, roll up a washcloth and put it under your leg just above your kneecap. Lift the foot of your injured leg by bending the knee so that you bring the foot up toward your buttocks. If this motion hurts, try it without bending your knee quite as far, in order to avoid any painful motion.

You may also want to add a cuff weight to your ankle (not more than 5 pounds), or use soup cans in a plastic bag with the loops around your ankle. With weight, you don't have to lift your leg more than 12 inches to get a hamstring workout.

Unilateral stance

The unilateral stance will strengthen your stability. This exercise should only be done if you don't have any locking, clicking, or giving way in your injured knee.

Stand in front of a counter or chair with your hands lightly resting on the counter/chair. Shift all of your weight to your injured leg, and stand only on the injured leg.

Stand just on that leg for 30 to 60 seconds, then put the other foot down and rest. Repeat 8 to 12 times during the day. As long as there is no pain, you can make this exercise a little harder by slightly bending your injured knee and standing on just that leg. Hold 30 to 60 seconds. Repeat 8 to 12 times during the day.

Heel dig bridging

The heel dig bridging exercise works your hamstrings and the muscles around your hip. Do 8 to 12 repetitions. Do not continue with this exercise if it causes pain.

Lie on your back with both knees bent and your ankles bent so that only your heels are digging into the floor. At this point, your knees should be bent about 90 degrees. From here, push your heels into the floor, squeeze your buttocks, and lift your hips off the floor until your shoulders, hips, and knees are all in a straight line. Hold about 6 seconds as you continue to breathe normally, and then slowly lower your hips back down to the floor and rest for up to 10 seconds.

Shallow standing knee bends

Shallow standing knee bends build strength in the muscles on top of your thigh. This exercise should only be done if you have very minimal pain; if you have no clicking, locking, or giving way in the injured knee; and if it doesn't hurt while you are doing 8 to 12 repetitions.

Stand with your hands lightly resting on a counter or chair in front of you with your feet shoulder-width apart. Slowly bend your knees so that you squat down just like you were going to sit in a chair. Make sure your knees don't go in front of your toes. Lower yourself about 6 in. (15 cm). Your heels should remain on or barely off the floor. Rise slowly to a standing position.