Uloga ISTEZANJA u prevenciji i lijeenju sportskih ozljeda

Uloga ISTEZANJA u prevenciji i liječenju sportskih ozljeda Dean Mistura Bacc. physio.

The Impact of Stretching on Sports Injury Risk: A Systematic Review of the Literature THACKER, S. B. et al. 2004. Senior Author (Country) Year Study Design Population Study Groups Outcomes Median Quality Score Andrish et al (US) 1974 Randomized trial 2777 male navy midshipmen in 8 wk basic training 1) 2) 3) 4) 5) foam heel pad heel stretching heel pad and heel stretching graduated running control 97 with shin splints 1)15/344 (4. 4%) 2)12/300 (4. 0%) 3)14/463 (3. 0%) 4)13/217 (6. 0%) 5)43/1, 453 (3. 0%) 31 Bixler and Jones (US) 1992 Prospective cohort study 5 Pennsylvania high school football teams: 28 games 1) 3 -min half-time warm-up/ stretch (3 teams) controls (2 teams) 27 with shin splints or tibial stress reaction 1)3 rd quarter a) total injuries 7 (0. 3 per game) b) sprains/strains 1 (0. 04 per game) 2)2) a) total injuries 22 (0. 8 per game) b) sprains/strains 13 (0. 46 per game) 32 Pope et al. (Australia) 1998 Randomized trial 1093 Army recruits in 26 platoons in 12 -wk basic training 1) 2, 20 -s stretches of calf before rigorous exercise (549 recruits in 13 platoons) 2, 20 -s stretches of wrist and triceps before rigorous, exercise (544 recruits in 13 platoons) 1) 2) 23 lower-extremity injuries 25 lower-extremity injuries 61 Retrospective cross-sectional series 195 college football players, 1994 and 1995 seasons 1) 1995 season—static stretching program—prior to conditioning training 1994 season-no stretching program 1) a) 153 injuries b) 21 lower-extremity injuries a) 155 injuries b) 43 lower-extremity injuries 29 Prospective cohort study 298 army recruits in two companies 1) 148 recruits—static hamstring stretch, 3 times daily 148 recruit controls—no stretching program 1) 25 lower-extremity overuse injuries (17%) 43 lower-extremity overuse injuries (29%) 34 Randomized tria 1538 army recruits in 39 platoons in 12 -wk basic training 1) 735 recruits in 19 platoons, 20 second supervised stretches of 6 major leg muscle groups before each physical training session 803 recruits in 20 platoons— no stretching Program 1) 158 lower-limb injuries (21%) 2) 175 lower-limb injuries (22%) Cross and Worrell (US) 1999 Hartig and Henderson (US) 1999 Pope et al. (Australia) 2000 2) 2) 60

Akutni efekti istezanja • Povećanje obima pokreta u zglobu koje traje 60 -90 min. (Moeller et al. , 1985; Kirsch et al. , 1995; Zito et al. , 1997) Najveći dio povećanja obima pokreta događa se kroz bolju tolerancije istezanja (Wiemann and Hahn, 1997; Magnusson, 1998)

Akutni efekti istezanja • Smanjenje pasivne tenzije mišića u mirovanju (tonusa) kroz stres relaksaciju. Najveći dio stres relaksacije događa se u prvih 20 sek. istezanja. (Mc. Hugh et al. , 1992; Magnusson, 1998; Mc. Nair et al. , 2000; Duong et al. , 2001) Stres relaksacija dovodi do 10 -30% smanjenja pasivne mišićne tenzije (Magnusson et al. , 1995; Magnusson et al. , 2000 b; Mc. Nair et al. , 2000)

Akutni efekti istezanja • Redukcija krutosti tetiva, konkretno ahilove za 8% (Kubo et al. 2002)

Akutni efekti istezanja • Smanjenje maksimalne statičke i dinamičke mišićne snage (Knudson et al. , 2000; Shrier, 2004; Weerapong et al. , 2004) Redukcija u testovima snage za 4 -30% (Kokkonen et al. , 1998; Avela et al. , 1999; Nelson and Kokkonen, 2001; Marek et al. , 2005) , redukcija skočnosti (Church et al. , 2001; Cornwell et al. , 2001; Mc. Neal and Sands, 2003: Young and Behm, 2003), redukcija brzine sprinta (Fletcher and Jones, 2004; Nelson et al. 2005), redukcija mišićne izdržljivosti (Nelson et al. , 2005).

Kronični efekt istezanja • Povećanje fleksibilnosti (obima pokreta) za 531%, odnosno 6 -12° (Knudson et al. , 2000; Harvey et al. 2002; Guissard and Duchateau, 2004; Decoster et al. 2005)

Hipoteza No 1 • Povećanjem fleksibilnosti dolazi do manjeg stresa na dijelove lokomotornog sustava, te potom i do smanjnog rizika od ozljeda, odnosno smanjenja njihove pojave u sportaša.

Hipoteza No 2 • Smanjenjem mišićnog tonusa u mirovanju i tetivne tenzije skraćuje se “fiziološko” trajanje treninga i “kupuje” dodatno vrijeme za oporavak.

Pet

Kremšnitin poučak • • • Jaja Mlijeko Brašno Šećer Masalac

Pravila statičkog istezanja • • • Isključivo nakon treninga Izdržaj u poziciji najmanje 20 sek. Istezanje više (ili svih) mišićnih skupina

The Impact of Stretching on Sports Injury Risk: A Systematic Review of the Literature THACKER, S. B. et al. 2004. Senior Author (Country) Year Study Design Population Study Groups Outcomes Median Quality Score Andrish et al (US) 1974 Randomized trial 2777 male navy midshipmen in 8 wk basic training 1) 2) 3) 4) 5) foam heel pad heel stretching heel pad and heel stretching graduated running control 97 with shin splints 1)15/344 (4. 4%) 2)12/300 (4. 0%) 3)14/463 (3. 0%) 4)13/217 (6. 0%) 5)43/1, 453 (3. 0%) 31 Bixler and Jones (US) 1992 Prospective cohort study 5 Pennsylvania high school football teams: 28 games 1) 3 -min half-time warm-up/ stretch (3 teams) controls (2 teams) 27 with shin splints or tibial stress reaction 1)3 rd quarter a) total injuries 7 (0. 3 per game) b) sprains/strains 1 (0. 04 per game) 2)2) a) total injuries 22 (0. 8 per game) b) sprains/strains 13 (0. 46 per game) 32 Pope et al. (Australia) 1998 Randomized trial 1093 Army recruits in 26 platoons in 12 -wk basic training 1) 2, 20 -s stretches of calf before rigorous exercise (549 recruits in 13 platoons) 2, 20 -s stretches of wrist and triceps before rigorous, exercise (544 recruits in 13 platoons) 1) 2) 23 lower-extremity injuries 25 lower-extremity injuries 61 Retrospective cross-sectional series 195 college football players, 1994 and 1995 seasons 1) 1995 season—static stretching program—prior to conditioning training 1994 season-no stretching program 1) a) 153 injuries b) 21 lower-extremity injuries a) 155 injuries b) 43 lower-extremity injuries 29 Prospective cohort study 298 army recruits in two companies 1) 148 recruits—static hamstring stretch, 3 times daily 148 recruit controls—no stretching program 1) 25 lower-extremity overuse injuries (17%) 43 lower-extremity overuse injuries (29%) 34 Randomized tria 1538 army recruits in 39 platoons in 12 -wk basic training 1) 735 recruits in 19 platoons, 20 second supervised stretches of 6 major leg muscle groups before each physical training session 803 recruits in 20 platoons— no stretching Program 1) 158 lower-limb injuries (21%) 2) 175 lower-limb injuries (22%) Cross and Worrell (US) 1999 Hartig and Henderson (US) 1999 Pope et al. (Australia) 2000 2) 2) 60

Intenzitet istezanja • • • Mišićno istezanje Tetivno istezanje Zglobno istezanje

Vrste istezanja • • Statičko Dinamičko Intermitentno Balističko Izolirana ekscentrična kontrakcija Postizometrička relaksacija (PIR) PNF

Addendum • Istezanje poslije treninga kao postupak autodijagnostike i terapije.

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