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Pathologies

TENDON RUPTIONS:

Tendons are fibrous tissues. Their primary function is to transmit mechanical forces generated by muscles to bones. Causes of tendon injuries include, for example, pre-existing micro-injuries, severe contact trauma, poor blood circulation, etc. They can also occur spontaneously.

The most common injury occurs:

  • Achilles tendons
  • Quadriceps tendons
  • Rotator cuff tendon
  • Long head of biceps tendon

Physiotherapy treatment for this type of problem initially involves outpatient physiotherapy. The main focus is on reducing swelling/hematoma, followed by the preparation of an individual exercise program to improve muscle strength and adapt the tendons to daily stress.

MUSCLE STRAIN

It is an injury caused by excessive uncontrolled strain, which leads to damage to muscle fibers. It most often occurs with jerky movements, e.g. a jerky quick push-off, sprint, landing, ... The hamstrings, glutes and iliopsoas muscle group are most prone to this. The cause is usually poor physical fitness or insufficient warming up before straining. When straining muscles, it is necessary to rest in the first 4-5 days after the injury. Straining a muscle group has a higher probability of muscle tears, so it is crucial that in the second phase a strength exercise program is prepared in combination with regenerative therapy, namely high-energy laser therapy or TECAR therapy. ( HERE YOU CAN ADD A "BUTTON" THAT LEADS TO THE ORDERING PAGE)

MUSCLE TEAR

A muscle tear is an injury to a muscle group where the muscle fibers are damaged, but not completely. There are two levels of tear: in the first degree of laceration There is damage to multiple muscle fibers and there is pain and swelling. Muscle contraction is possible but with pain.

Second degree laceration means that a larger part of the fibers is damaged. It is characterized by more severe pain, swelling and the possibility of hematoma. Full muscle contraction is not possible. Physiotherapy treatment is recommended, namely with Tecar therapy in combination with high-energy laser and individually prepared exercises for the individual.

TORN MUSCLE

A torn muscle can be injured by contact (impact) or non-contact (overuse, poorly warmed up muscle). A complete rupture of the muscle is accompanied by severe pain, extensive hematoma on the surface and complete muscle dysfunction. After a rupture, it is important to immediately stop sports activities and immediately immobilize the affected limb. After surgical treatment, physiotherapy is necessary, where it is important to reduce swelling and restore full muscle function. High-energy laser therapy in combination with TECAR therapy and manual techniques, as well as a carefully designed exercise plan to strengthen the muscles, is considered.

TENDINOPATHIES

Tendinopathy is a degeneration of the tendon in response to chronic overuse. It most commonly occurs in the elbows (tennis and golf elbow), Achilles tendon, quadriceps tendon, patellar ligament (jumper's knee), rotator cuff tendons, long head of biceps tendons, and iliopsoas muscle group. Pain in tendinopathy usually occurs a few hours after activity. It is often accompanied by reduced mobility of the affected area and loss of muscle strength in the final stages of movement. Therapeutic lasers, TECAR, and cryomassage relieve the pain and inflammation. It is important to start treatment and physiotherapy at an early stage.

TENNIS ELBOW

Tennis elbow, also known as lateral epicondylitis, is the most common cause of elbow pain in adults. It is an overuse injury that occurs due to repetitive strain on the tendons of the muscles that extend the wrist – specifically the extensor carpi radialis brevis muscle.

Although the term “epicondylitis” suggests inflammation, we now know that tennis elbow is not primarily an inflammation, but a degenerative process. It also usually occurs in people who physically strain the hand and forearm, especially by performing repetitive dorsiflexion movements in the wrist (moving the palm upwards from the surface). This overload occurs during physical work or frequent computer work (typing, using a mouse).

The pain usually occurs on the outside of the elbow and worsens with weight-bearing on the arm, sometimes radiating down the back of the forearm. It is caused by overuse inflammation of the common tendon attachment on the outside of the elbow. In the early stages, the problems may subside with rest.

Conservative treatment in our clinic initially includes stretching exercises for the forearm muscles, manual massage of the painful area, irradiation of the painful area with a high-energy laser. In case of more serious problems, we recommend deep shock wave therapy (ESWT).

GOLF ELBOW – pain on the inside of the elbow

Inflammation of the forearm muscle attachment point can occur in anyone who overloads the forearm muscles once or repeatedly. This involves movements of strong squeezing with the palm or fingers, turning the wrist and bending the wrist, repetitive arm movements (e.g. in sports - extreme grip of a racket in tennis, badminton, ping pong). Pain on the inside of the elbow occurs at the point where the muscles on the lower side of the forearm attach to the elbow (technically the epicondyle). The wrist flexors, as they are otherwise called, are a group of muscles that run from the fingers to the elbow along the lower side of the forearm. The execution of this movement - bending the wrist - is limited by pain. Conservative treatment is recommended, namely rest, cooling. In terms of physiotherapy, in our clinic we use a high-energy laser in combination with shock waves (focal + radial).

ELBOW BURSITIS

It is an inflammation of the bursa - a small mucous sac located above the bony prominence on the back of the elbow (olecranon). The bursa acts as a friction cushion between the skin, bone and tendons. When bursitis is present in the elbow, swelling is visible on the back of the elbow, pain is felt especially when pressing on the elbow or when moving, and sometimes redness and warmth are also present. Bursitis can occur due to repeated pressure or microtrauma (frequently leaning on the elbow), injuries - blows. Treatment includes therapy with non-steroidal anti-inflammatory drugs and physical therapy. Physical therapy mainly uses high-energy laser therapy.

CALCINATION IN THE SHOULDER

Calcification in the shoulder is a common pathological condition of the shoulder joint. It most often affects the population between 40-55 years of age, and occurs more often in women. Calcifications can occur mainly due to constantly repetitive movements in the shoulder, due to micro-injuries in the past, due to prolonged immobilization of the limb after an injury, and also due to tendon degeneration. Calcifications are characterized by pain, which is also disturbing when sleeping and lying on the affected side. The pain is sharp and limits the movement of the arm above shoulder level. The pain also radiates to the elbow.

The most effective and primary method of treating calcinates in physiotherapy is with deep shock waves. Our clinic has the most modern shock waves and we are the only one in the coastal region that uses two types of shock waves (radial and focal), thereby accelerating the treatment of calcinates.

FOCUSED SHOCK WAVES They allow energy to be transferred to a focused area deeper than the device head. With special accessories (applicators), we can regulate the depth where we direct the most energy. The device allows the treatment of tissues below the surface as well as tissues up to a depth of 8 centimeters.

RADIAL SHOCK WAVES They operate on the basis of a pneumatic system that uses compressed air to deliver low-frequency acoustic pulses through a medium. They have the highest power just under the skin, and the power decreases with the depth of the tissue. Therefore, they are most suitable for treating tissue located up to 4 centimeters below the skin.

FROZEN SHOULDER SYNDROME OR ADHESIVE CAPSULITIS

Frozen shoulder syndrome or adhesive capsulitis is a chronic inflammatory disease of the shoulder joint in which the joint capsule thickens, shrinks and becomes fibrotic. The result is a gradual limitation of active and passive movements in the shoulder, often associated with pain. The most characteristic feature of capsulitis is the limitation of external rotation and abduction movements. Capsulitis occurs in three phases (painful phase, stiffness phase and relief phase) and develops slowly, but can spontaneously improve within 1-3 years. It can be accelerated with physiotherapy, namely TECAR therapy in combination with manual joint mobilization according to the Cyriax method.

ROTATOR CUFF TENDON INJURIES

The rotator cuff is made up of four muscles: the supraspinatus, subscapularis, teres minor, and infraspinatus. Rotator cuff tendon injuries are one of the most common causes of shoulder pain. Rotator cuff injuries can be partial or complete ruptures of one or more tendons that stabilize the head of the humerus in the shoulder joint and allow rotation and elevation of the arm. Partial tendon tears are treated with physical therapy, a combination of high-energy laser therapy and TECAR therapy. In cases of complete ruptures, surgery is indicated.

SUPRASPINATUS TENDON INJURY

Among the rotator cuff muscles, the tendon of the supraspinatus muscle is most often injured. Its function is to abduct and stabilize the shoulder. A supraspinatus injury is characterized by limited movement of the arm above the head and pain during abduction. A supraspinatus tear is more common in middle-aged people, as the tendon is already changing with age and less resistant to heavy loads. In the initial phase of physiotherapy, exercises with the arm up to shoulder height are indicated and the asymptomatic range of motion is gradually increased. Later, strength exercises can also be included. In terms of physical therapy, high-energy laser in combination with TECAR therapy is indicated for faster regeneration and acceleration of tendon healing.

WATERFALL LESION

It is an injury to the upper part of the labrum of the shoulder (shoulder socket), where the long head of the biceps tendon emerges from the labrum. The labrum is a connective-cartilaginous tissue that has the task of increasing the joint surface between the humerus and the scapula and helps with joint stability. The long head of the biceps tendon attaches to it and acts as a stabilizer of the shoulder on the front side. When the biceps tendon is injured, the labrum is damaged, which is called a SLAP lesion. The most common cause is repetitive overhead movements (handball, tennis, volleyball, etc.), falls onto an outstretched arm or directly onto the shoulder, and direct blows to the shoulder.

The pain of a SLAP lesion is dull and difficult for the patient to pinpoint inside the joint. It is more pronounced in the front of the shoulder, and does not appear until a long time after the injury occurs. The patient may feel a pop, and during movement, a cracking and crunching sound is heard in the joint. The mobility of the joint is reduced, and the muscles weaken.

Treatment of a SLAP lesion is conservative in the first three months. The aim of conservative treatment is to reduce pain and inflammation, restore shoulder mobility, and strengthen the shoulder and shoulder muscles, thereby improving shoulder joint stability.

SHOULDER BURSITIS

Shoulder bursitis is an inflammatory condition that affects the bursae—small fluid-filled sacs that act as cushions between bones, muscles, and tendons around joints. The subacromial bursa, which lies beneath the acromion, the part of the shoulder blade that sits above the head of the humerus, is often affected. When this bursa becomes inflamed, it can cause pain and limited movement in the shoulder joint.

The main function of the subacromial bursa is to cushion the area between the rotator cuff tendons and the acromion, thereby protecting the supraspinatus muscle from excessive friction with the humeral head and acromion.

Shoulder bursitis often develops due to repetitive movements or prolonged pressure on the shoulder joint, which causes irritation and inflammation of the bursa.

Physiotherapy is key in the treatment of shoulder bursitis and is the most common way to manage pain in the shoulder area. It is intended to maintain and improve the range of motion, strength and functionality of the shoulder and associated structures. In the initial phase of treatment, the focus is on reducing pain and inflammation, using tecar therapy and rest. Once the acute symptoms subside, specific exercises are included in the treatment to gradually restore shoulder function. The exercises are tailored to the individual and are aimed at strengthening the muscles of the shoulder girdle and improving joint stability.

WRIST FRACTURES

Among wrist fractures, the most common is the scaphoid fracture, followed by the triquetrum fracture.

The healing of navicular fractures, as with other bones, depends on the blood supply to their fragments. However, due to the anatomical characteristics of the position of the blood vessels, the healing of these fractures can be difficult. The vessels that supply the navicular are in its distal part. The proximal part is less well supplied with blood and the healing of more proximal fractures is longer, and the probability of non-union is higher.

Treatment of navicular fractures depends on the location, shape, and stability of the fracture. Transverse fractures that are non-displaced and stable are treated conservatively. The wrist is immobilized with an elbow-length cast. The cast is removed after six weeks. All proximal third fractures and all dislocated fractures are primarily treated surgically. After surgery, the wrist is immobilized with a cast.

A triquetrum fracture is less common than a navicular fracture, but the mechanism of injury is similar. A triquetrum body fracture is rare, but a fracture of the dorsal side near the insertion of the dorsal "V" ligament is common. This is manifested by the greatest pain over the triquetrum on palpation and radial deviation. A radius cast for six weeks is sufficient for treatment.

Physiotherapy is indicated before and after surgery for exercise and for regenerative therapy.

WRIST LIGAMENT INJURIES

Isolated injuries to the wrist ligaments are typical of the younger period of life and are rare, while combined injuries to both bone and ligaments equally affect people of all ages. They can be injuries to extra-articular and/or intra-articular ligaments. Wrist ligament injuries can be the result of a single injury, or the result of several smaller, repeated injuries. Many such injuries are overlooked in the acute phase, which may be the result of additional “more significant” injuries, or injuries in the immediate vicinity of the wrist (e.g. fracture of the distal radius).

The success of treatment depends primarily on the time elapsed between injury and treatment. Intra-articular fractures and ligament tears heal only if they are stably fixed. Delay in recognizing and treating such injuries is fatal, as ligament reconstructions more than six weeks after injury do not yield satisfactory results.

CARPAL CANAL ANCHOR

Carpal tunnel syndrome is the most common overuse injury to the wrist. The carpal tunnel is a narrow passage in the wrist, bounded on the upper side by the eight carpal bones and on the lower side by the transverse carpal ligament. The tendons of the wrist flexors and the median nerve (nervus medianus), which innervates the first 3 fingers and half of the ring finger, pass through it. Inflammation of the wrist flexor tendons causes compression of the median nerve in the carpal tunnel area.

Carpal tunnel syndrome most often occurs in office workers, as frequent typing and mouse use overload the wrist flexor muscles.

Initial symptoms include tingling, numbness, and altered sensation in all fingers except the little finger. This most often occurs at night. Numbness of the fingers is characteristic towards morning. Decreased muscle strength and occasional dropping of objects from the hands are also characteristic.

During conservative treatment, it is recommended to wear a splint and avoid repetitive wrist movements for an extended period of time. In the early stages of carpal tunnel syndrome, conservative treatment with physical therapy and exercises to improve the mobility of the carpal tunnel is recommended.

PAIN IN THE CROSS

Low back pain is a phenomenon that can develop without any prior injury. In this case, it is a non-specific pain in the lower back, which can be caused by stress, prolonged sitting, strain, etc. This is often the beginning of chronic spinal problems.

The most common occurrence of low back pain is in the lumbar spine, where it often extends to the pelvis.

The treatment of low back pain in our clinic is comprehensive, which primarily includes manual treatment, namely manual relaxation of the lumbar muscles, various manual techniques and TECAR therapy, and education on exercises to strengthen the lumbar muscles. 

LUMBAR SPINE HERNIA DISC

A herniated disc is a common painful pathological condition of the spine, which is one of the specific causes of low back pain.

Intervertebral discs are soft, gelatinous structures between the vertebrae of the spine. Their function is to absorb forces in the spine.

In a herniated disc, the nucleus pulposus pushes through the cracks in the annulus fibrosus, which are caused by degenerative changes. The most common herniations are at the L4-L5 and L5-S1 levels. The direction of the herniation determines which nerve root is affected.

In case of protrusion A herniated disc is a protrusion of the nucleus pulposus of the disc into the fibers of the annulus fibrosus.

In extrusion A herniated disc is a condition in which part of the nucleus pulposus breaks through the annulus fibrosus, but the nucleus remains intact.

The cause of hernias is prolonged incorrect postures and body positions, such as sitting in an office, prolonged sitting in a car, etc.

Pain occurs during activities that involve bending, squatting, sneezing, coughing, and lifting. The patient feels the pain in the lumbar region, often radiating to the buttocks, shin, or foot. Physical therapy includes manual therapy, therapeutic massage, TECAR therapy, and exercises to strengthen the back muscles.

JOINT ARTHRITIS

Arthritis is a general term for inflammatory joint diseases. It is a process in which the joint lining, cartilage, and surrounding tissues become inflamed, causing pain, swelling, decreased mobility, and in severe cases, permanent joint changes.

The most common forms are:

Rheumatoid arthritis (RA) – autoimmune disease.

Osteoarthritis (OA) – degenerative, a result of cartilage wear.

Gout (uricemic arthritis) – due to the deposition of uric acid crystals.

Infectious arthritis – result of a bacterial or viral infection.

Symptoms vary depending on the type of arthritis, but common signs include:

  • Joint pain
  • Swelling and redness of the joint
  • Warmth over the affected joint
  • Morning stiffness
  • Reduced joint mobility and function
  • Joint deformity in chronic forms

Physiotherapy treatment for joint arthritis involves a combination of instrumental therapy and exercise, the most effective being TECAR therapy in combination with a high-energy laser.

SPINAL STENOSIS

Spinal stenosis is a narrowing of the spinal canal or nerve exit openings (foramina) through which the spinal cord and nerve roots pass. This puts pressure on nerve structures, causing pain and neurological problems.

Types of spinal stenosis:

Lumbar spinal stenosis – the most common form, affects the lower spine.

Cervical spinal stenosis – affects the cervical spine, can be more serious because it can affect the spinal cord.

Thoracic spinal stenosis – rarer, in the thoracic spine

SCIASIS

Sciatica is a set of symptoms caused by irritation or pressure on the sciatic nerve (n. ischiadicus) – the largest nerve in the body, which runs from the lower spine, through the buttocks and down the back of the leg to the foot.

Typical signs of sciatica are:

Pain: sharp, burning, or electrical pain that radiates from the lower back through the buttocks down the back of the leg (maybe to the foot).

Unilateral involvement: Usually the pain is only on one side.

Ants and numbness: in the leg, foot, or toes.

Muscle weakness: especially in the muscles of the hamstrings and glutes.

Increased pain when coughing, sneezing, or straining.

Relief when lying down, worsening when sitting or standing for a long time

Serious signs (urgent case): If you experience bladder or bowel control problems (so-called cauda equina syndrome), immediate medical attention is required.

In the acute phase, rest and pain-relieving electrotherapy are indicated. In the subacute phase, it is recommended to start with stretching exercises, exercises for lumbar spine mobility, and isometric exercises for trunk stabilization.

In the chronic phase, strengthening of deep core stabilizers, exercises for correct posture, and education on correct lifting of weights and prevention of recurrences

SCOLIOSIS

Scoliosis is briefly defined as a lateral curvature of the spine with rotation of the vertebrae. It often first appears in childhood, may be in adolescence, or is congenital. The angle of curvature can be small, large or medium, but anything measuring more than 10 degrees of deviation on an X-ray is considered scoliosis. The synonyms “C” and “S” curvatures are often used to describe the curvature, and they are usually divided into structural and non-structural types.

The exact cause of scoliosis is not yet known, but the most common type is often attributed to genetic factors, as the disorder often runs in families. Less common types of scoliosis can also be caused by:

  • Certain neuromuscular diseases, such as cerebral palsy or muscular dystrophy
  • Birth defects that affect the development of the bones of the spine
  • Previous chest surgery during infancy
  • Spinal injuries or infections
  • Spinal cord abnormalities

Scoliosis treatment requires an individual approach and varies from person to person, depending on the type of scoliosis, the child's needs and abilities. Inappropriate exercises can also worsen the condition or increase the risk of progression of the disorder and its complications.

 

SPONDYLOSIS

It is a degenerative disease that describes the formation of bone deformities or osteophytes on the edges of the vertebrae of the spine, where they border the intervertebral discs.

Cervical spondylosis often causes pain in the back of the head. It may radiate to the jaw or shoulders. It can reduce mobility in the cervical spine and may lead to more severe migraines.

Physiotherapy treatment is mainly focused on exercise and muscle strengthening.

PRONOUNCED OR LEVELING THORACIC KYPHOSIA

This indicates an unnatural pathological position of the thoracic spine, which usually affects the adult population as a result of long-term incorrect postures. Emphasized or flattened thoracic kyphosis is treated with targeted physiotherapy exercises, based on an individual exercise program depending on the causes. In accentuated kyphosis, strengthening of the spinal extensors is recommended, and in flattened kyphosis, strengthening of the trunk stabilizers is recommended.

PIRIFORMIS SYNDROME

Piriformis syndrome is a clinical condition of inflammation of the sciatic nerve. Although several factors contribute to the development of the syndrome, the clinical picture is fairly uniform, with patients often reporting pain in the gluteal region, which may radiate down the back of the leg. In addition, numbness of the buttocks and tingling along the sciatic nerve are also common.

Patients often present with symptoms of sciatica, and it is often difficult to distinguish between the origin of radicular pain resulting from spinal stenosis and piriformis syndrome. The pain may radiate into the posterior thigh, but can sometimes also occur in the lower leg at the L5 or S1 dermatomes.

The causes of piriformis syndrome are as follows:

  • hip or buttock injury
  • piriformis muscle overload
  • hypertrophy of the piriformis muscle (common in athletes during periods of increased weightlifting demands or pre-season)
  • prolonged sitting (taxi drivers, office work, cyclists)
  • anatomical anomalies that may contribute to nerve compression

Patients may experience the following problems:

  • chronic pain in the buttocks and hip area
  • pain when getting out of bed
  • inability to sit for long periods of time
  • pain in the buttocks that increases with hip movement.

Treatment in the acute phase includes:

  • Tecar therapy
  • K-laser therapy
  • neurodynamic exercises

As the symptoms of piriformis syndrome improve, we begin with manual techniques and exercises for hip joint mobility.

Surgery is a last resort for patients with piriformis syndrome. It should only be considered in patients in whom conservative treatment, including exercise, has failed. Surgery can help decompress the nerve if it is affected, but the results after surgery are not always predictable and some patients continue to have pain.

HIP BURSITIS

This pain syndrome is characterized by severe pain in the lateral area of the hip (the outer side in the area of the femoral head), also in the buttock area, both with movement and when pressure is applied to the inflamed area.

The pain occurs because there is inflammation of the bursa or mucous sac on the outside of the hip, where the iliotibial tract slides over the area of the femoral head (greater trochanter).

The most common cause is previous tendinopathy.

The inflammatory condition of trochanteric bursitis develops over time when there is too much friction, excessive tension and pressure on the bursa. Most often, bursitis is simply the result of inflammation of the muscle tendons. Inflammation of the bursa occurs over time most often due to tendinopathy. Isolated bursitis without additional injuries in this area is extremely rare.

Other possible causes of the appearance:

  • overweight
  • previous trauma in the greater trochanter area
  • bad footwear
  • bacterial infection
  • hip prosthesis
  • other inflammatory systemic diseases

Patients report pain when lying on their side, walking up stairs, standing for a long time, getting up from a chair, sitting with their legs crossed, running, etc. The pain is usually localized to the lateral area of the hip, but in some cases it can spread along the thigh all the way to the knee. In trochanteric bursitis, the area near the greater trochanter is extremely painful to the touch. Pain can also be provoked by stretching the lateral line of the thigh with the leg abducted, by activating the hip abductor muscles, active external rotation of the hip, passive internal rotation, and certain other clinical tests.

Physiotherapy is the first thing that will help you the most, so don't delay.

Tecar therapy is an innovative therapy that triggers natural and restorative processes. Tecar therapy also accelerates lymphatic drainage and stimulates blood circulation, as it delivers heat deep into the tissue (up to 40 degrees).

Deep shock waves are a widely used treatment method for trochanteric bursitis, as the application causes hyperstimulatory analgesia and mechanotransduction (the conversion of mechanical stimuli into electrochemical signals in the cell), which activates the cell to regenerate, divide, or multiply more rapidly.

COMPLETE OR PARTIAL RUPTURE OF THE ANTERIOR CRUCIFIC LIGAMENT (ACL)

An anterior cruciate ligament (ACL) injury is one of the most common knee injuries, especially in athletes and active individuals. However, it can happen to anyone and is an injury that requires treatment.

The anterior cruciate ligament (ACL) is one of four ligaments that stabilize the knee. The ACL is located on the inside of the knee and connects the thigh bone (femur) to the shin bone (tibia). Its main function is to prevent excessive forward movement of the shin bone relative to the femur.

An ACL injury usually occurs when the knee is moved suddenly and forcefully, such as when turning, jumping, or falling. This can cause excessive strain on the ACL, leading to a strain/tear or rupture of the anterior cruciate ligament. Risk factors for ACL injury include sports such as football, basketball, skiing, and tennis, as well as improper movement technique, inadequate warm-up, or exhaustion.

An ACL injury usually causes severe pain, swelling, and a feeling of instability in the knee.

In addition, other parts of the knee, such as the medial collateral ligament (MCL) and medial meniscus, can be injured in addition to the ACL during a movement/fall.

In cases of more severe ACL injuries, even active individuals usually opt for surgery, in which the surgeon reconstructs the cruciate ligament (usually a graft is taken from the semitendinosus, semimembranosus, gracilis muscle or from the quadriceps tendon, from which a new cruciate ligament is woven). In cases of minor injuries or in individuals who do not play sports, treatment can be carried out without surgery.

Physiotherapy in the acute phase

Physiotherapy plays a key role in the recovery from an ACL injury. In the acute phase, it is important to reduce swelling and inflammation, which is achieved through instrumental therapy such as tecar therapy and high-energy laser therapy. This is followed by manual therapy based on techniques such as OMMT and IASTM, which helps to reduce pain and improve mobility.

When the acute phase is over, we start strengthening the synergist muscles with the help of electrostimulation, which specifically activates a larger number of muscle fibers of the synergist muscles. In addition to using the electrostimulator, it is also important to perform correct exercises that activate the desired muscles that help replace the cruciate ligament or help it retain forces (partial rupture).

If you do not choose to have surgery, strengthening the muscles is key, with an emphasis on the synergists (muscles that assist the anterior cruciate ligament) of the ACL, which are the knee flexor muscles, especially the semitendinosus and semimembranosus. Since the ACL is no longer doing its job, the force that would otherwise be held by the anterior cruciate ligament must be replaced by these muscles.

It is important to have strong knee flexor muscles, as they help to keep the knee stable during all activities. Because of a complete or partial rupture, the muscles must be stronger than in an individual without ACL problems. This is the only way to conservatively help reduce the risk of recurrent injuries and improve joint stability.

PARTIAL OR COMPLETE RUPTURE OF THE POSTERIOR CRUCILATERAL LIGAMENT (PCL)

The posterior cruciate ligament prevents the tibia from sliding backward and excessive internal rotation of the tibia. The PCL is a stronger ligament than the anterior cruciate ligament. The posterior cruciate ligament is considered the strongest ligament in the knee. Injuries to the posterior cruciate ligament are much rarer than injuries to the anterior cruciate ligament. When the posterior cruciate ligament is injured, a large force often occurs, which also damages the ligaments, cartilage and even bones. The treatment is mostly surgical. Rehabilitation lasts between 6 and 9 months depending on the injury and progress. Physiotherapy is indicated before surgery, with a large emphasis on exercises and strengthening the knee muscles.

KNEE MENISSUS INJURIES (MEDIAL AND LATERAL)

More than half of all knee joint injuries are meniscal injuries. The meniscus is a connective-cartilaginous structure, crescent-shaped. There are two menisci in the knee: the inner and outer.

The main function of the meniscus is to fill or smooth out the large discrepancy between the femur and tibia. In addition, they distribute pressure from the femur to the tibia, alleviate joint stress, contribute to joint stability, and participate in the nutrition of articular cartilage.

Typical mechanisms of injury are twisting the body with the knee bent and the foot fixed, and squatting. Meniscus injury is also a common accompanying injury to knee ligament injuries.

A meniscus injury usually causes severe pain in the knee. The knee may also swell later. When injured, a person often feels as if their knee is about to dislocate.

Signs of a meniscus injury may include::

  • sudden, sharp pain in the knee
  • knee swelling
  • increased local temperature
  • feeling of knee instability
  • unstable knee
  • jumps agility
  • cracking in the knee
  • reduced mobility
  • atrophy of the muscles around the knee

Treatment depends primarily on the problems caused by the damaged meniscus. It can be conservative or surgical.

Surgical treatment is recommended.:

  • in case of complete knee blockage
  • for pain, swelling, limited mobility and/or mobility blockages lasting several weeks.

In most cases, surgery is not necessary, as the vast majority of meniscus injuries are successfully treated with modern physiotherapy methods. The rehabilitation program includes exercises to strengthen the thigh muscles and exercises for proprioception. If surgical treatment is indicated, preoperative rehabilitation is recommended, where exercises are performed to prevent atrophy of the thigh muscles.

UNSTABLE KNEE

The sensation of a popping knee can be caused by various pathological conditions in the knee. A common cause of knee joint instability is ligament damage, such as rupture of the anterior cruciate ligament, posterior cruciate ligament, or medial or lateral collateral ligament.

Physiotherapy is considered, with a strong emphasis on strengthening the knee muscles.

 

JUMPING KNEE OR. PATELLAR TENDINOPATHY

It is an overuse injury of the knee joint. It occurs mostly in athletes who engage in sports that involve jumping, e.g. running, volleyball, tennis, football, handball, basketball, etc.

Severe pain is characteristic even with basic movements, walking, sitting, and standing up. Loss of full knee extension and swelling after exertion are also characteristic.

PATELOFEMORAL PAIN SYNDROME

Patellofemoral pain syndrome (PFPS) is one of the most common diagnoses in active athletes. It is a condition that causes pain in the front of the knee, especially around the kneecap, which can seriously interfere with daily activities and sports participation.

Pain usually occurs during movement under heavy loads, when the knee is bent by more than 30 degrees, when cycling, while running and getting up from a sitting position. If the patient does not eliminate the biomechanical causes that cause pain, the condition may recur. It is necessary to ensure the establishment of a balance of forces in the patellofemoral joint area.

Physiotherapy for patellofemoral syndrome includes manual therapy, open (lower

part of the limb moves freely in space) and closed kinetic chain (the lower part of the limb is fixed on

floor exercises, e.g. squats), exercises to increase thigh muscle strength, kinesiotaping and electrotherapy

(pain-relieving currents).

Main goals of the physiotherapy program are exercises to increase the strength of the thigh muscles (musculus

quadriceps). In the initial phase of the exercises, these are based on isometric contraction, as this reduces

load on the patellofemoral joint.

In physiotherapy, you are often alone.

At the beginning of rehabilitation, we help with stimulation (electrotherapy) of the inner group

thigh muscles. The physiotherapy program also includes strengthening the hip muscles and balance

exercises.

DISLOCATION OF THE PATELLAR

Patellar instability occurs when the foot is externally rotated with the knee extended. The person subconsciously tenses the quadriceps muscle, causing the patella to dislocate outward.

The cause can also be a direct blow to the patella area.

Chronic dislocations occur when there is general laxity of the ligaments and anatomical abnormalities in the patella area. There are also habitual dislocations, when the patella dislocates without any obvious injury and these are usually painless.

Treatment is mostly conservative. This includes targeted exercises to strengthen the anterior thigh muscle and temporary adaptation of sports activities.

If conservative treatment is unsuccessful, surgical reconstruction of the medial patellofemoral ligament may be considered.

RUNNER'S KNEE OR ILITIBIAL TRACT INFLAMMATION

Runner's knee, also known as iliotibial band syndrome (ITBS), is a common overuse injury that primarily affects runners, cyclists, and other athletes whose activities involve repetitive bending and extending of the knee. The iliotibial band is a strong fibrous band that runs along the outside of the thigh, from the pelvis to the shin, and helps stabilize the knee joint during movement. When this structure becomes overused or inflamed, it causes the pain known as runner's knee.

Running, which is an aerobic exercise, with its cardiovascular benefits ensures optimal vital signs and functional functioning of the musculoskeletal system. Despite all its good qualities, running can cause more harm than good if performed incorrectly.

The causes of runner's knee are often related to a combination of biomechanical factors and overload.

The most common reasons include:

  • Incorrect running technique: Excessive pronation of the foot (rolling inward) or valgus knee position (legs in an X-shape) can increase the strain on the iliotibial tract.
  • Overexertion: A sudden increase in training intensity or volume, such as running longer distances or over rugged terrain, can cause irritation.
  • Muscle weakness: Weak or unbalanced hip muscles, such as the gluteus medius, can contribute to improper movement and increased stress on the tract.
  • Inappropriate footwear: Worn or ill-fitting running shoes without sufficient cushioning increase the risk.
  • Hard surface: Running on concrete or uneven surfaces can put additional stress on the structures of the foot.

The main sign of runner's knee is pain on the outside of the knee, which usually occurs during or after activity.

Other symptoms include:

  • Sharp or burning pain that worsens when the knee is bent to about 30 degrees.
  • Sensitivity to touch in the area of the outer epicondyle of the femur.
  • Occasional swelling or crepitus (crackling) in the knee.
  • The pain often worsens when running downhill or after a prolonged period of activity.

Physiotherapy plays a key role in the rehabilitation of runner's knee. The physiotherapist assesses the biomechanics of movement and performs manual techniques to release tension in the iliotibial tract. Stretching exercises, such as Tensor fasciae latae manual therapy, and roller massage are often used to improve flexibility. Kinesiology complements the process with exercises to strengthen the gluteal muscles and improve knee stability. An individually tailored program helps to address the weaknesses that contributed to the injury.

TECAR therapy and laser therapy are two quality therapeutic options for treating runner's knee. TECAR therapy is a thermal therapy that delivers energy deeply to the injured area, reducing pain and promoting venous and lymphatic drainage. It also helps with tendonitis, bursitis, soft tissue pain, and joint, bone and muscle injuries.

LASER therapy uses an amplified laser beam to accelerate metabolic and soft tissue healing processes. The light penetrates tissues and has biological and physiological effects.

OSGOOD-SCHLATTER SYNDROME

Osgood Schlatter syndrome (OSS) is a common cause of knee pain in adolescents. It occurs more often in boys between the ages of 10 and 15, while in girls between the ages of 8 and 13. It most often affects young athletes who perform numerous jumps and other explosive movements during their activities (basketball players, athletes, football players, etc.). The pain occurs at the point where the anterior thigh muscle attaches to the shin via the patellar tendon. During the growth period, growth cartilage is still present at this point, which is less resistant to mechanical stimuli and increased loads. Due to the increased loads brought about by sports, symptoms may occur.

The main symptom is localized pain a few centimeters below the kneecap, which adolescents experience during sports activities, but can also occur after prolonged periods of sitting with bent knees, walking up stairs, or kneeling. In practice, the pain decreases after the activity is over, but over time, with an inappropriate approach, it can become long-lasting. In addition to pain, OSS is characterized by a pronounced bony protrusion below the kneecap.

In the acute phase, the physiotherapist focuses on relieving symptoms, using modern technologies such as ultrasound, tecar and laser. He can use isometric exercises, which, when performed and dosed correctly, provide an analgesic effect. In addition to the therapy itself, the patient must be advised during this period regarding the adjustment of sports activity. Complete rest is usually not necessary, but a reduction in intensity is advised. In the subacute and late phase of rehabilitation, muscle stretching follows if they are overstretched and muscle strengthening when there is an imbalance. The physiotherapist will create an exercise program together with the patient, which must be progressively increased over time. For a successful return to the training and competition process, it is necessary to include proprioceptive training, strengthening of the deep stabilizers of the trunk, neuromuscular control training and plyometrics, which represents the most important stone in the last phase before the return itself.

KNEE LATERAL LIGAMENT INJURY (MCL AND LCL)

The knee ligaments are strong, yet flexible structures that stabilize the knee joint. They can be injured during sudden movements, twisting, falls, or direct blows. These problems are most commonly encountered by athletes and active people, but they can also occur during everyday activities. In addition to instability, ligament injuries can also cause pain, swelling, and reduced mobility of the knee.

The medial collateral ligament (MCL) runs along the inside of the knee and prevents the knee from bending excessively outward. The injury usually occurs when the knee is hit on the outside, which is common in football or skiing. The lateral collateral ligament (LCL) runs along the outside of the knee and prevents the knee from bending inward. Injuries occur when the knee is hit directly on the inside.

In most cases, MCL treatment is successful conservatively, while LCL injury can only be resolved with surgical treatment.

KNEE OATRIDE

Knee osteoarthritis or gonarthrosis is a practically inevitable condition in the knee joint, as the joint structures wear out more and more with age. You could even say that life takes its toll in the form of cartilage wear in the constantly loaded knee, which leads to pain and limited mobility in the knee joint. Osteoarthritis can be relieved with physiotherapy, hyaluronic injections, anti-inflammatory drugs... all of which are beneficial, but not in the long term.

We talk about knee arthrosis when there is pain and impaired mobility. We talk about osteoarthritis when there is also inflammation in the joint.

Hereditary factors, gender, age, hormonal status, obesity, climatic conditions, and diet play an important role in primary arthrosis.

Secondary arthrosis is the result of a condition, which can be congenital deformities (loose ligaments or joint deformation), metabolic diseases, joint injuries, avascular necrosis, or mechanical overload from certain long-term sports activities.

The loss of articular cartilage leads to changes in the surrounding tissues. Calcium crystals form in the cartilage of a joint affected by osteoarthritis, to which the knee joint is particularly susceptible. Osteoarthritis in such joints is more severe and also deteriorates more quickly.

Later, the knee may also experience crepitus, joint effusion, muscle weakness, ankylosis (stiffening of the joint), and a thickened or deformed joint.

It has been shown that people with knee osteoarthritis experience constant knee pain, short-term morning stiffness, and reduced function, which makes walking difficult and generally burdensome. They experience the most pain when standing up and walking up stairs, where patients also complain of an unstable and buckling knee.

In an arthritic knee, full flexion (bending) of the leg is most often limited, and in severely deformed joints, full extension is also limited. People always look for a leg position in which they feel best and the pain is as little as possible - this is a slightly padded knee. Again, padding the knee is not the best in the long term, as it leads to contractures and rigidity of the muscles of the hindquarters.

Physical therapy methods are used to relieve pain in knee osteoarthritis. The following are used:

Tecar therapy (A state-of-the-art device that acts as a stimulator of biological processes. Tecar therapy is an innovative therapy that triggers natural and restorative processes. It uses heat to perform a deep massage of soft tissue with the aim of relaxing and enabling easier mobility in the joint itself.)

ANKLE

Ankle fracture or dislocation

The most commonly broken bones are the heel and ankle, and when a fracture occurs, there is immediate pain and swelling. Since the fracture is often accompanied by damage to the ankle ligaments, the symptoms usually appear as a sprain, so there is a risk that bone fractures are overlooked.

An ankle fracture is a serious injury that requires hospital care. It is a complete or partial break in bone or cartilage tissue. A fracture can cause pain, swelling, deformity of the limb, difficulty or inability to move, and a clicking sound.

A sprain is a serious injury to the ankle joint, where the ligaments are stretched so much that they cannot hold the joint in its anatomical position. In this case, there is an externally visible deformation of the ankle joint. Such a joint must be brought back into its natural position either mechanically or surgically.

Ankle sprains are certainly one of the most common musculoskeletal injuries. In an ankle sprain, the ligaments on the outside of the ankle are damaged due to a sudden inward bend of the ankle. Sprains due to sudden outward bends of the ankle are less common. They are usually accompanied by severe pain, which can occur immediately or only after some time, and its intensity is not always a measure of the extent of the injury.

For more severe sprains, fractures, and dislocations, physiotherapy is required, which is started after the injury. We most often use high-energy laser and TECAR therapy.

UNSTABLE ANKLE SYNDROME

In other words, chronic ankle instability is a condition in which the passive stabilization function of the ankle is affected due to laxity or damage to the ligament. Typical symptoms include a feeling of instability, swelling of the joint, foot drop, occasional pain, and difficulty walking. The focus of physiotherapy treatment is on exercises to improve proprioception and stabilization. Improving the strength of the ankle muscles reduces the risk of recurrent sprains.

A THORN IN THE HEEL

Heel pain can be really annoying, as the heel spur causes irritation of the soft tissue and thus inflammation.

Heel spurs occur in people due to increased stress on the area where the arch tendon attaches or due to inflammation of the plantar fascia at its attachment point. At this point, bone begins to grow or there are deposits that irritate the soft structures around it. Many people also experience referred pain from inflammation in the Achilles tendon and ankle.

Heel pain most often occurs in the morning, when we get out of bed, when we first make contact with the ground. At that time, we feel a stinging sensation in the heel, a sharp pain. The morning stiffness and pain subside, but the constant pain accompanies the person throughout the day, especially when putting weight on it.

A heel spur occurs when calcium deposits build up on the heel bone, which irritates the soft tissue. It is not painful in and of itself. The pain is caused by inflamed tissue on the sole of the foot rubbing against a bony spur or a spur where tendons attach to the heel bone. This is called Plantar Fasciitis.

In the initial phase, you can help yourself by cooling and massaging the arch of the foot with a ball, massaging the shin muscles with a roller, and doing stretching exercises for the plantar fascia.

You can also try changing your footwear, but make sure that your shoe has a high enough heel (when buying shoes, this is called the "Heel drop", which should be 10-15mm), and that the shoe allows you to walk comfortably.

Physiotherapy

Deep shockwave therapy or ESWT is not the only possible therapy for treating heel spurs, but it is certainly the most effective. In fact, it is the only slightly more “invasive” or powerful one that physically causes changes in the hard structures. ESWT therapy is said to reduce pain, stimulate stem cell activity, and thus affect more successful tissue regeneration and healing. the shoe allows for comfortable walking. The therapy is more effective when combined with education on the correct implementation of stretching exercises for the plantar fascia, cryomassage, friction massage, and the application of kinesiotaping.