Investigation of the Effect of Strength Exercise Program Applied on Unstable Grounds on Limb Symmetry Index After Anterior Cruciate Ligament Surgery of Female Athletes

Yıl 2021, , 22 - 30, 15.03.2021

Ayşenur Kurt , Atakan Çağlayan , Mustafa Erol , İbrahim Erdemir

https://doi.org/10.18826/useeabd.824013

Öz

Aim: The aim of this study is to examine the effect of the strength exercise program applied on unstable surfaces after anterior cruciate ligament surgery on limb symmetry index of female athletes.

Methods: Women aged between 18-32 years (n:50) undergoing anterior cruciate ligament (ACL) reconstruction using a hamstring autograft of 121.74±3.15 days ago participated in the study. Participants were divided into two groups as the study group (SG; n=25) who applied strength training program on unstable grounds and the control group (CG) that applied different return to sports programs. Individualized progressive exercises performed on unstable grounds during 12 weeks were applied to the athletes in the study group for a period of 90 days with 48 training sessions while the athletes in the control group will continue their classical rehabilitation programs. Single leg hop (SLH), Single leg Triple hop (STH), Single leg cross-over hop (SCH) and 6m Timed hop (6MT) tests were performed before and after the training program to determine the limb symmetry index (LSI) between the injured (I) and the noninjured (NI) legs of the athletes.

Results: When the pre- and post-test scores of the athletes were compared, a statistically significant improvement was observed in all parameters for both groups (p<0.05). When the improvemental differences of both groups were evaluated; LEFS, SL-A, SL-S, STH-A, STH-S, SCH-A and TOTAL hop scores showed a statistically significant difference in favour of SG (p <0.05).

Conclusion: The strength exercise program, which was applied on unstable ground, has positive effects on both functional field tests and LSI asymmetry in the return to sport phase of athletes who underwent ACL surgery.

Anahtar Kelimeler

anterior cruciate ligament, strenght, unstable,, LSI,

Kadın Sporcularda Ön Çapraz Bağ Cerrahisi Sonrası İnstabil Zeminlerde Uygulanan Kuvvet Egzersiz Programının Alt Ekstremite Simetrisi Üzerindeki Etkisinin İncelenmesi

Öz

Amaç: Bu çalışmanın amacı kadın sporcularda ön çapraz bağ cerrahisi sonrası instabil zeminlerde uygulanan kuvvet egzersiz programının alt ekstremite simetrisi üzerindeki etkisinin incelenmesidir. 

Materyal ve Metot: Çalışmaya 121,74±3,15 gün önce hamstring otogrefti ile ön çapraz bağ (ÖÇB) rekontrüksiyonu geçiren 18-32 yaşları arasında kadın (n:50) rekreatif sporcular katılmıştır. Katılımcılar instabil zeminlerde kuvvet antrenman programı uygulanan çalışma grubu (ÇG; n=25) ve farklı spora dönüş programları uygulayan kontrol grubu (KG; n=25) olarak ikiye ayrılmıştır. Çalışma grubundaki sporculara 12 hafta süresince instabil zeminlerde gerçekleştirilen bireyselleştirilmiş progresif egzersizler 90 gün süresince 48 antrenman oturumu olacak şekilde uygulanmıştır. Kontrol grubunda ki sporcular ise klasik spora dönüş programlarına devam etmişlerdir. Sporcuların ameliyatlı(A) ve sağlam (S) bacağı arasındaki simetri indeksini belirlemek üzere Tek bacak (TB), Tek bacak üçlü (TBÜ), tek bacak çapraz (TBÇ) ve 6 metre zamanlı (6MZ) sıçrama testleri antrenman programı öncesinde ve sonrasında uygulanmıştır. 

Bulgular: ÇG ve KG de yer alan sporcuların grup içi ön- ve son-test değerleri karşılaştırıldığında her iki grupta da tüm parametrelerde istatistiksel olarak anlamlı gelişim görülmüştür (p<0,05). Her iki grubun gelişim farkları değerlendirildiğinde ise; LEFS, TB-A, TB-S, TBÜ-A, TBÜ-S, TBÇ-A ve TOTAL sıçrama skorlarında ÇG lehinde KG sporcularına göre istatistiksel olarak anlamlı farklılık tespit edilmiştir (p<0,05). 

Sonuç: İnstabil zemin de yapılan kuvvet egzersiz programının ÖÇB cerrahisi geçirmiş sporcuların spora dönüş evresinde hem fonksiyonel saha testleri üzerinde hem de LSI asimetrisi üzerinde olumlu etkileri vardır. 

Anahtar Kelimeler

ön çapraz bağ, kuvvet, İnstabil,, LSI,

Kaynakça

• Abrams, G.d, Haris, J.D., Gupta, A.K., McCormick, F.M., Bush-Joseph, C.A., Verma, N.N., Cole, B.J. & Bach, J.B.R. (2014). Functional performance testing after anterior cruciate ligament reconstruction The Orthopaedic Journal of Sports Medicine 2(1)
• Augustsson, J. (2013). Documentation of strength training for research purposes after ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, Volume 21, Issue 8, pp 1849–1855
• Baltacı, G. (2016) Diz Yaralanmalarında Rehabilitasyon, Hipokrat Kitabevi, Ankara.
• Barber-Westin, S.D. & Noyes, F.R. (2011). Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy - Journal of Arthroscopic and Related Surgery, 27(12), 1697-1705.
• Boden, B.P., Sheehan, F.T., Torg, J.S. & Hewett, T.E. (2010). Noncontact anterior cruciate ligament injuries: mechanisms and risk factors. J Am Acad Orthop Surg, 18 (9), 520-527.
• Brosky, J.J.A., Nitz, A.J., Malone, T.R., Caborn, D. N., & Rayens, M. K. (1999). Intrarater reliability of selected clinical outcome measures following anterior cruciate ligament reconstruction. Journal of Orthopaedic & Sports Physical Therapy, 29(1), 39-48.
• Citaker, S., Kafa, N., Kanik, Z.H., Ugurlu, M., Kafa B. & Tuna, Z. (2016). Translation, cross-cultural adaptation and validation of the Turkish version of the Lower Extremity Functional Scale on patients with knee injuries, Arch Orthop Trauma Surg. 136:389–395 DOI 10.1007/s00402-015-2384-6.
• Çağlayan, A., Karahan, M., Erdem, K. & Ökmen, A.Ş. (2015). Ön Çapraz Bağ Yaralanmalarını Engelleyici Antrenmanların Bayan Futbolcularda Yaralanma Sıklığı ve Fiziksel Parametreler Üzerindeki Etkisi. Uluslararası Spor, Egzersiz ve Antrenman Bilimi Dergisi. Cilt 1, Sayı 2, 104-113.
• Fischer, D.V. (2006). Neuromuscular Training to Prevent Anterior Cruciate Ligament Injury in the Female Athlete. Strength and Conditioning Journal, 28(5): 44-54.
• Garrison, J.C., Bothwell, J.M., Wolf, G., Aryal, S. & Thigpen, C.A. (2015). ‘Y balance test anterior reach symmetry at three month related to single leg functional performance at the time of return to sports following anterior cruciate ligament construction’. The international journal of sports physical therapy Vol:10 num:5 page:602
• Gokeler, A., Welling, W., Benjaminse, A., Lemmink, K., Seil, R. & Zaffagnini, S. (2017). A critical analysis of limb symmetry indices of hop tests in athletes after anterior cruciate ligament reconstruction: A case control study, Orthopaedics & Traumatology: Surgery & Research 103; 947–951
• Gustavson, A., Neeter, C., Thomee, P., Silbernagel, K.G, Augustsson, J., Thomee, R. & Karlsson, J. (2006). A test battery for evaluating hop performance in patients with ACL injury and patients who have undergone ACL reconstruction Knee Surgery Sports Travmatol Artrosc 14:778-788
• Hartigan, E.H., Axe, M.J. & Mackler, L.S. (2010). Time Line for Noncopers to Pass Return-to-Sports Criteria After Anterior Cruciate Ligament Reconstruction, Journal Of Orthopaedic & Sports Physical Therapy, volüme 40, number 3
• Hewett, T.E., Lindenfeld, T.N., Riccobene, J.V. & Noyes, F.R. (1999). The Effect of Neuromuscular Training on the Incidence of Knee Injury in Female Athletes: A Prospective Study. The American Journal of Sports Medicine, 27: 699-706.
• Hopper, D.M., Goh, S.C., Wentworth, L.A., Chan, D.Y.K., Chau, J.H.W., Wootton, G.J., Strauss, G.R. & Boyle, J.J. W. (2002). Test–retest reliability of knee rating scales and functional hop tests one year following anterior cruciate ligament reconstruction. Physical Therapy in Sport, 3(1), 10-18.
• Jacopetti, M., Pasquini, A. & Costantino, C. (2016). Evaluation of strength muscle recovery with isokinetic, squat jump and stiffness tests in athletes with ACL reconstruction: a case control study. Acta Biomed;87(1):76–80.
• Jacopetti, M., Pasquini, A. & Costantino, C. (2016). Evaluation of strength muscle recovery with isokinetic, squat jump and stiffness tests in athletes with ACL reconstruction: a case control study. Acta Biomed;87(1):76–80.
• Johnston, W., Dolan, K., Reid, N., Coughlan, G.F. & Caulfield B. (2017). Investigating the effects of maximal anaerobic fatigue on dynamic postural control using the Y-Balance Test. Journal of Science and Medicine in Sport 21- 103–108
• Kayıtken, B., Yücel, S.B. & Dinç, N. (2012). ‘Benzer Şiddet Düzeyindeki Egzersizlerde Farklı Kas Katılım Modellerinin Fizyolojik Parametrelere Olan Etkileri’ Spor Bilimleri Dergisi Hacettepe Journal of Sport Sciences, 23 (3), 77–88.
• Kınıklı, G.I., Yüksel, I., Baltacı, G. & Atay, O.A. (2014). Hemstring Otogrefti ile Ön Çapraz Bağ Rekonstrüksiyonu Sonrası Progresif Eksentrik ve Konsentrik Egzersiz Programının Fonksiyonel Performansa Etkisi. Acta Orthop Traumatol 48(3): 283-289.
• Markatos, K., Kaseta, M.K., Lallos, S.N., Korres, D.S. & Efstathopoulos, N. (2013). The anatomy of the ACL and its importance in ACL reconstruction. European Journal of Orthopaedic Surgery & Traumatology, Volume 23, Issue 7, pp 747–752.
• Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE., (2006), ‘Rehabilitation After Anterior Cruciate Ligament Reconstruction: Criteria-Based Progression Through The Return-To-Sport Phase’. J Orthop Sports Phys Ther. 36:385-402.
• Myer, G.D., Ford, K.R., Paterno, M.V., Nick, T.G. & Hewett, T.E. (2008). The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes. Am J Sports Med 36:1073–1080
• Myer, G.D., Schmıtt, L.C., Brent, J.L., Ford, K.R., Barber Foss, K.D., Scherer, BJ., Heıdt Jr. RS., Dıvıne, JG. & Hewett TE. (2011) ‘Utilization of modified NFL Combine testing to identify functional deficits in athletes following ACL reconstruction’ J Orthop Sport PHYS Ther. 41(6):377-387
• Noyes, F.R. & Barber-Westin, S.D. (2012). Sportsmetrics ACL intervention training program: Components, results. ACL Injuries in the Female Athlete: Causes, Impacts, and Conditioning Programs. Orthopedics, Springer-Verlag, Berlin Heidelberg 275-308.
• Paterno, M.V. & Greenberger, H.B. (1996). The test-retest reliability of a one legged hop for distance in young adults with and without ACL reconstruction. Isokinetics and Exercise Science, 6(1), 1-6.
• Pişirici, P., Çağlayan, A., Karahan, M. & Hantes M. (2018). Return to Play in Football, On Field Testing After Anterior Cruciate Ligament Reconstruction, Springer, 559-567.
• Reid, A., Birmingham, T., Stratford, P., Alcock, G. & Giffin, J. (2007). Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther 87: 337-349.
• Sandrey, M.A. (2006). The Comparative Effects Of A Six-Week BalanceTraining Program, Gluteus Medius Strength Training Program, and Combined Balance Training/Gluteus Medius StrengthTraining Program On Dynamic Postural Control, West Virginia.
• Schmitt, L.C., Paterno, M.V. & Hewett., T.E. (2012). The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 42:750–9.
• Wellsandt, E., Failla, M.J. & Mackler, L.S. (2017). Limb Symmetry Indexes Can Overestimate Knee Function After ACL Injury, J Orthop Sports Phys Ther. May; 47(5): 334–338. doi:10.2519/jospt.2017.7285.