As a therapist within the multi-disciplinary setting, one is confronted with a wide array of pathology and diagnoses. Care is taken to optimize treatment outcomes and overall return of function to every patient admitted to the various rehabilitation facilities. Treatment is often standardized to ensure quality care benchmarked against outcome parameters. The aforementioned is also true for medical practitioners, pharmacists and other auxiliary service providers. Research is aimed at improving quality of care, finding and establishing the best practises through all hospitals and care facilities. Medical care has undergone a transformation over the past few decades with a strong emphasis being placed on protocols and procedures. Through applying standardized care, protocols and procedures, the researcher have come to realize that certain denominators within patient care have no prediction or outcome control. After more than a decade of treating patients in various rehabilitation settings the researcher have come to realize that one complaint exists with each and every patient under my care – pain. This was even more evident within the group of joint replacement patients. No two patients presented with the exact same pain profile or pain reports despite various commonalities such as anthropometric data (age, gender, length, mass), surgical procedure, attending physician, care facility, pathway exposure, diagnosis, radiographic findings and pharmaceutical intervention. If all the obvious factors were identical – what accounted for the different pain reports? This question is at the heart of the study – why do pain reports differ in the presence of so many similarities between patients? It soon became apparent that pain is recognized in the organic form. Organic pain can be measured and is expected with injury, illness or surgical intervention. The entire multi-disciplinary team is aware of organic pain and ready to intervene with medication, surgery and a pathway of care. All vigorously record organic pain and adapt treatment according to the pain levels as organic pain is real pain: real pain existing through exposure to real surgical intervention. Still the question remained: if all the factors prior to surgery, during surgery and after surgery were the same, why are patients experiencing and reporting very different pain levels? This question was the catalyst for the research and lead to keen focus during patient interviews. Every patient receiving an educational session prior to surgery had very vivid ideas about the pain they will experience post-operatively. The majority of patients formed pre-conceived notions about pain prior to undergoing surgery. They presented with a clear pain rating of what they expected to feel post-operatively. The pre-conceived pain rating was constructed in almost all the cases after some form of information obtained during consultation with their surgeon or a member of the multidisciplinary team. This pain notion existed as a tangible and measurable rating in the client’s mind prior to undergoing the knee replacement surgery. In select cases perceived pain was constructed as a result of information obtained from family or friends that underwent the same procedure while other clients constructed perceived pain due to a lack of information on the proposed surgery. It became evident that education or lack thereof on surgical interventions played a primary role in the construct of perceived pain. Patients were entering theatres for procedures and already experienced a form of perceived pain. If pain could be constructed prior to experiencing surgical intervention – can perceived pain then translate into actual organic pain and account for the variable pain reports post surgery? Against this backdrop, research was directed at understanding perceived pain and the factors that aid the construction of perceived pain. As education was found to be at the heart of every pain construct, the doctor-patient consultation was evaluated as a core component to ascertain the impact this relationship has on perceived pain. Measurement of perceived pain was also performed to conclude on the impact of this pain form on organic pain. The study is aimed at addressing the variant pain reports that no pathway or procedure can predict and provide for. It is an attempt to validate pain as constructed by the patient that impacts on their post-surgical pain ratings and behaviour. This research might contribute towards existing knowledge and understanding of the influence of doctor-patient interaction as well as the significance of this interaction on pain. As only scant research on perception of pain has been undertaken this research can prove insightful for further studies or as supplement to existing views and opinions. It can also serve as a foundation in developing practices that will manage pain by enhancing doctor-patient interaction in the health setting. / MA, Medical Sociology, North-West University, Vaal Triangle Campus, 2012

Bakgrund: Knäskador är vanligt bland fotbollsspelande flickor och kan avsluta en karriär i förtid. Studier har gjorts där skadeförebyggande träning visat på god effekt, dock saknas studier som följer upp användningen av träningsprogrammen. Syfte: Beskriva och utvärdera användandet av det skadeförebyggande träningsprogrammet Knäglädje. Metod: En deskriptiv, komparativ design. Totalt 37 fotbollstränare till flicklag i åldrarna 13-19 år svarade på en webbaserad enkät. Resultat: viktigaste faktorerna för användandet av träningsprogrammet var : minskad skaderisk för spelarna, enkelt att lägga in i ordinarie träning och det var kostnadsfritt. De viktigaste faktorerna för att inte använda programmet var: tid försvann från ordinarie träning, tog tid att lära sig programmet samt följde ett annat skadeförebyggande program. Ingen signifikant skillnad sågs vad gäller användandet av träningsprogrammet i förhållande till tränarerfarenhet och tränarutbildning. Tränare som fått utbildning i träningsprogrammet använde det i högre utsträckning än de som inte fått någon utbildning. Skillnaden var signifikant. Konklusion: Viktiga faktorer för användandet av Knäglädje var den minskande skaderisken, att det var kostnadsfritt samt enkelt att lägga in i träningen. Programmet användes i större utsträckning av tränare som fått utbildning i det. Det framkom i studien att de flesta tränare visade en medvetenhet om vikten av skadeförebyggande träning för att minska risken för skador.

It´s important to consider all the risks that the players are exposed to and have a holistic view on the matter. The conclusions from my sponsor and looking through research in the area I came to the conclusion that surface and shoes have minimal consequences and are not an area of interest for me in this project.

Anterior cruciate ligament (ACL) ruptures are one of the most common knee ligament injuries suffered by both male and female athletes. These injuries are severe in nature and also have long-term impacts on activities of daily living. Significant research has been conducted utilizing a drop landing task to attempt to better understand the mechanics behind the injury and to help identify at-risk athletes for targeted intervention. However, there have not been any published standards for the height of the drop landing activity, and previous researchers have also raised some concerns about the ability of a drop landing task to replicate the landing mechanics of a sport-specific task. To examine possible differences in performance based on specific landing tasks, the first study compared the landing mechanics of male and female high school athletes in three different landing conditions (drop landing, DL; adjusted height drop landing, AHDL; and a vertical jump task, VJL) (Chapter 3). Thirty-seven (37) athletes completed bilateral landings in the three conditions, and their kinetic and kinematic landing mechanics were compared across conditions. For the male participants, maximum knee flexion during landing was greater in AHDL condition as compared to the DL and VJL conditions. Both male and female participants demonstrated greater hip adduction at impact and overall maximum value in the VJL condition as compared to the two drop landings. As drop landing tasks have been used to identify at-risk athletes, it was important to examine the three different tasks’ ability to predict lower extremity ligamentous injuries, and whether those 3D motion analysis predictors were more precise than a quick clinical symmetry screening tool (Chapter 4). One-hundred-and-sixty-five (165) athletes completed the clinical symmetry screen, and a subgroup of thirty-seven (37) athletes completed the 3D motion analysis. All of these participants were surveyed for lower extremity ligamentous injuries over the course of a season. Due to a small number of reported injuries, none of the injury predictor models based on 3D motion analysis landing mechanics or the clinical symmetry screening tool were able to produce accurate predictor models of injury. Knee abduction moment has been shown to be one of the strongest predictors of ACL injuries, and due to the collection of bilateral kinetics for a previous study (Chapter 3), there was a need to examine differences in KAM between the three different landing tasks (Chapter 5). Ten (10) recreational athletes completed bilateral landings in the three conditions, with foot placement relative to force plates to enable KAM calculation. The participants did not demonstrate any difference in KAM between the three landing conditions; however, a test for constant variance showed that the AHDL resulted in significantly less variance in KAM than DL or VJL. The results of these studies suggest that while easy to standardize, a set height drop landing task does not produce identical landing mechanics to those from an adjusted height drop landing task or a vertical jump task. Further research is needed to create or justify standardized landing tasks for researchers to utilize that produce consistent results that best duplicate the landing mechanics athletes performed during sporting activities. While the landing mechanics demonstrated in the three tasks and the results from the clinical screening were not able to predict injuries, future studies should examine quick clinical screening tools to identify athletes at a high risk of injury.

Articular cartilage lining joints, such as in the knee, functions to reduce friction and absorb shock. Collagen type II is the largest constituent in the extracellular matrix of articular cartilage and its restoration is of the highest interest to tissue engineers. Cartilage has little ability to naturally regenerate due to the absence of vascularity and the inability of the chondrocytes to proliferate at a high rate. It would be ideal to create a mimicking extracellular matrix/scaffold from type II collagen that could possibly be used to replace damaged articular cartilage that has the same function and morphology. Three different groups of cartilage chips were utilized to extract type II collagen. The yield of the three groups was compared. The extracted type II collagen from the three groups was electrospun at the concentrations of 0.06, 0.08, 0.10 and 0.12 g/mL. Both the pore size and fiber diameter were analyzed. A SDS-Page was performed on the material to assure it was pure type II collagen and that no collagen type I contamination was present.

PREVENTION OF KNEE JOINT INJURIES IN PROFESSIONAL WOMEN VOLLEYBALL OBJECTIVES Objective of this thesis is to explore whether the preventive actions, for elimination of factors that may cause knee joint injuries, are performed in professional junior women volleyball teams. In case of identified deficiencies specific program is created for coaches of junior women volleyball teams. The purpose of program is to act preventively and for that reason to eliminate referred factors. METHODS Data collection method of questionnaire with "open" and "closed" questions was used for field survey. RESULTS We have discovered that preventive actions are not performed in particular in area of knee-joint examination and regeneration. Also plyometric method, compensation exercise and exercise with balance equipment are neglected during workout. Key words: volleyball, injury, knee-joint, prevention

Author: Bc. Eva Kurková Title: Knee osteoarthritis: a biological response to medication class SYSADOA Problem definition: Knee osteoarthritis is a degenerative joint disease which belongs to the most common musculoskeletal diseases. The disease is associated with pain of the knee joints, which causes patients' limitations in activities of daily living. Therefore, the objective of the treatment of osteoarthritis is to reduce the pain and a progression of the disease. To achieve these aims, conservative or surgical methods are used. The conservative methods include, among others, the pharmacological treatment. Since the medicaments from the class SYSADOA are easily available we can use them during treatment. Aim of the thesis: The aim of the thesis is to determine the effect of SYSADOA medication on the 2nd and 3rd degree of the knee osteoarthritis. The effect is determined by patients' subjective evaluations and by the changes of the rheological properties of the knee joint. Method: The survey contains an anamnesis questionnaire and the clinical examination of the knee joint. The rheological properties of the knee joint are evaluated by a special device - knee rheometer that non-invasively and painlessly measures the dependence of the passive resistance of the knee joint on its bending angle. To...

Title: The effect of alcohol drinking on the isokinetic knee strength Objectives: The objective of this thesis is to assess the effect of alcohol on isokinetic knee strength during extension and flexion. Methods: Fifteen volunteers participated in this study. Their age was 23,9 ± 1,9 years, height 179,5 ± 7,2cm and weight 78,5 ± 7,95kg. They were all students from sports faculty. One group of volunteers was given alcohol with juice (0,8g of alcohol to 1kg of fat-free mass), the second group drank only juice. We used the switch design study. We measured isokinetic knee strenght on dynamometer Cybex Humac Norm (Cybex NORM ®, Humac, CA, USA) in three types of angular velocity (6Oř/s, 180ř/s, 240ř/s). The parametrs were peak torque, muscular work, average muscular power and time to peak. Results: We registered statistically significant increase of peak torque, muscular work and average muscular powers when measuring flexion in all the three angular velocities (60ř/s, 180ř/s, 240ř/s). We did not register statistically or effect size significant diference readings of time needed for maximal peak torque when measuring flexion and extension. The only exception was angular speed 240ř/s where we registered a factually significant change in time needed for extensors to reach the maximal peak torque....

Abstract Introduction: The prevalence of anterior cruciate ligament tear is around 7000 every year within the swedish population and 95% of reconstructive surgery was with a hamstring tendon graft. Six months post surgery a 13% decrease in knee flexion strength compared to non injured side. The need for a study that determine the role of gastrocnemius and foot position in knee flexion is lacking in the litterature and could benefit Physiotheraphy ACL rehabilitation. Purpose: of his study was to investigate M gastrocnemius medialis (MGM) activation in the ipsilateral knee after removal of hamstring tendon for ACLR, and se if ankle position alter knee flexion outcomes. Method: 3 women, mean age 24 years who underwent ACL reconstruction with hamstring graft on one leg was tested. The time since injury was 3, 6 and 7 years respectively with an mean ,5 years wait until surgery. Isokinetic knee flexion and extension testing was done in the Biodex system 3 pro. EMG electrodes measured medial gastrocnemius activation with and without ankle in dorsiflexion. Results: Knee flexion peak strength was higher by a mean of 3 Nm (3,5%) with dorsiflexed foot. Mean (MGM) activation remained the same with or without dorsiflexion. Overall knee flexion strength was higher by a mean of 5 Nm compared to the injured side. Conclusion: Knee flexion in the biodex with foot in dorsiflexion could allow for isometric plantarflexion and increas power output. Certain changes in inclusion criteria and methodology as well more studies is needed to come to a given conclusion. / nej

A literatura tem dado evidências de que uso de um calçado flexível e desprovido de salto que reproduza as características cinemáticas e cinéticas da marcha descalça poderia reduzir as cargas articulares e a progressão da osteoartrite (OA) de joelho. Assim, o propósito deste estudo foi avaliar e comparar a influência do uso agudo de um calçado flexível, desprovido de salto e de baixo custo (Moleca®), de um calçado moderno de salto e da condição descalça sobre os padrões cinéticos e cinemáticos do membro inferior durante a marcha de idosas com e sem OA de joelho. Foi avaliada a marcha de 45 idosas: 21 com OA (GOA) grau 2 ou 3 pelos critérios de Kellgren e Lawrence e 24 assintomáticas como grupo controle (GC) entre 60 e 75 anos. Foram adquiridas a força reação do solo vertical e horizontal e a variação angular sagital do tornozelo, joelho e quadril nas condições: descalça, Moleca® e salto alto. Também foram calculados, para as mesmas condições, os picos e o impulso dos momentos de força de adução do joelho por dinâmica inversa. As comparações inter-grupos e intercondições foram realizadas por ANOVAs dois fatores, sendo as três condições de marcha, medidas repetidas. Em ambos os grupos, o uso agudo da Moleca® impôs ao tornozelo uma variação angular sagital semelhante à condição descalça. Observou-se também que, em ambos os grupos, o uso agudo da Moleca® e do salto, gerou um aumento da amplitude de movimento sagital e da flexão final do joelho. No GOA, o salto impôs maior flexão de quadril que a condição descalça. Em ambos os grupos, o salto e a Moleca® apresentaram aumento do 1º pico da força vertical em relação à marcha descalça. Por outro lado, a magnitude dessa variável foi ainda maior com o uso do salto em relação à Moleca®. No GOA, o uso agudo da Moleca® comparado à marcha descalça proporcionou maior atenuação da força vertical durante o médio apoio. Ainda no GOA, a Moleca® em relação ao salto proporcionou maior capacidade de desaceleração e aceleração. Em ambos os grupos, o uso da Moleca® proporcionou momento de adução do joelho semelhante à marcha descalça. A Moleca®, porém, foi ainda mais efetiva que a marcha descalça na diminuição do momento de adução do joelho durante o médio apoio. Conclui-se que o calçado flexível, desprovido de salto e de baixo custo (Moleca®), em idosas com OA de joelho, devido à associação das características cinemáticas dos membros inferiores e da força reação do solo, proporciona momentos de força resultantes no joelho semelhantes à marcha descalça e uma efetiva redução de sobrecarga em relação ao calçado de salto. O uso agudo da Moleca® permitiu também, em algumas fases do apoio, uma redução ainda maior do momento de força do joelho em relação à marcha descalça, com a vantagem, porém, de proporcionar proteção externa aos pés durante a locomoção. / The literature has been given evidences that the use of flexible and non-heeled footwear that reproduces the kinematic and kinetic characteristics of barefoot gait may reduce the joint loads and the progression of the knee osteoarthritis (OA). The purpose of this study was to evaluate and compare the influence of the acute use of flexible, non-heeled and inexpensive footwear (Moleca®), with a modern heeled shoe and barefoot condition on the lower limb kinetic and kinematic patterns during gait in elderly women with and without knee OA. The gait of 45 elderly women was evaluated: 21 with OA grade 2 or 3 (OAG) according to Kellgren and Lawrence´s criteria and 24 asymptomatic control group (CG) between 60 and 75 years. Vertical and horizontal ground reaction force, ankle, knee and hip sagittal angular variation were acquired in the follow conditions: barefoot, Moleca® and heeled shoe. Knee adduction moments and angular impulse were also calculated by inverse dynamics. Comparisons intergroups and inter-conditions were performed by two-way ANOVAs, and the three gait conditions were within factors. In both groups, the acute use of Moleca® produced ankle sagittal angular variation similar to barefoot condition. In the sagittal plane, the use of Moleca® and heeled shoe generated an increased knee range of motion and increased knee final flexion in both groups. In the OAG, the heeled shoe imposed an increased hip flexion compared to the barefoot condition. In both groups, the heeled shoe and Moleca® increased the 1st vertical force peak in comparison to barefoot condition. Moreover, the magnitude of this variable was even greater when using the heeled shoe compared to the Moleca®. In the OAG, the acute use of Moleca® provided greater attenuation of the vertical force in midstance. Also in the OAG, the Moleca® provided greater capacity of deceleration and acceleration in comparison to the heeled shoe. In both groups, the Moleca® provided joint loads to the knee medial compartment similar to barefoot gait. Moleca®, however, was even more effective than barefoot gait in reducing the knee loads during midstance. We conclude that flexible, nonheeled and inexpensive footwear (Moleca®), in elderly women with knee OA, due to the association of the lower limb kinematics and ground reaction force characteristics, provides loads on the knee joint similar to barefoot gait and a significant reduction of overloads in comparison to the heeled shoe. The Moleca® also allows, in some gait support phases, a greater reduction in the knee joint load compared to the barefoot gait; however, with the advantage of providing external protection to the feet during gait.