Dr.Med., Professor P.V. Rodichkin¹
N.S. Shalamanov²
PhD G.V. Buznik^3
1Herzen State Pedagogical University of Russia, St. Petersburg
²Clinic LLC "Advanced health technologies", St. Petersburg", St. Petersburg
³St. Petersburg State University, St. Petersburg

Keywords: musculoskeletal system health protection, dorsopathy and periarthritis in sports, orthopedic appliances, chondroprotectors.

Introduction. The authors’ practical medical experience shows that up to 30% of elite athletes are diagnosed with musculoskeletal disorders normally associated with the sport-specific physical activity. Most often, we deal with such diseases as chronic discogenic and vertebrogenic dorsopathies of cervical, thoracic and lumbar spine at the acute stage, as well as periarthrosis of major joints (shoulder, elbow, hip, knee, ankle).

The initial pathological changes caused by sport-specific physical loads occur in the soft tissues surrounding one or another working joint. Among the most frequent pathologies in sports is periarthritis (periarthrosis) – a periarticular tissue injury, when the joint itself is not involved in the pathological process. Joint functioning blocking due to the pain syndrome or contracture rapidly deteriorates the nutrition to the cartilage tissue [1].

All units of the musculoskeletal system are in close coordination with each other, they function as a single, finely tuned mechanism. Any violation in one link of this mechanism inevitably leads to changes in the entire system. The body tries to adjust to the changed conditions, compensate for the malfunction. Thus, in case of hypertension of the lumbar muscles, blockage of the lumbar spine occurs, due to which the spine shock-absorbing capacity decreases sharply. Accordingly, there is excessive load on the muscles of the overlying thoracic and cervical spine, which, with time, will lead to the mobility disorders in the latter [6]. All this can ultimately result in violation of the developed specific motor stereotype in athletes [3].

Therefore, in addition to the treatment itself, it is rather important for elite athletes to maintain own level of health for years, with no acute conditions, i.e. at the stage of long-lasting remission, to be in good physical condition and demonstrate high sports results.

To respond to these needs, the authors have designed and successfully tested and implemented an integrated rehabilitation concept for dorsopathy and periarthritis that includes the following four components:

• special physical exercises;
• special chondroprotectors administered as required by recommended procedure;
• special orthopedic appliances for quiescent and active service;
• dynamic health control component.

Objective of the study was to substantiate the implementation of the spinal and joint rehabilitation concept for athletes.

Methods and structure of the study. Subject to the study were 54 athletes (19 females, 25 males) aged 18 to 42 years, who underwent outpatient treatment in Clinic LLC "Advanced health technologies", St. Petersburg, in the period from 2012 to 2017. The athletes had different qualifications - from I senior degree to MSIC, and different sports experience - from 8 to 25 years. The testees’ sports specializations were as follows: track-and-field athletics (sprint, middle-distance running, high jumping), volleyball, basketball, hockey, football, tennis, judo, weightlifting, figure skating, competitive ballroom dancing, cross country skiing, mountain bike, wakeboard. The mandatory entry criteria were: active athletes, complaints included pains in one of the regions of the spine or major joints. The exclusionary criteria were: surgical treatment for the spine or joints, systemic connective tissue diseases, certain roentgen diagnosis of Stages 2-3 arthrosis, absence from the scheduled examination 3-6 months after treatment. The musculoskeletal system functionality was assessed using the developed 5-point idiopathic pain intensity scale (IPIS).

Results and discussion. Aiming at personal self-improvement, self-actualization and self-affirmation, social attitudes, satisfaction of spiritual and material needs are of greater or lesser importance for a particular athlete depending on his values-based orientations [2]. Therefore, restrict activity can turn into a psychological trauma for an athlete. Fear of exercise out of concern for a possible pain syndrome can significantly affect sporting achievements. In this regard, sports training was not prohibited during the outpatient treatment. In a certain number of cases, we provided recommendations on partial restriction of some physical exercises for a short period of time until the pain is relieved. The treatment itself was comprehensive and lasted on the average 5 to 8 days [5]. All the examined athletes were released from the hospital in a satisfactory condition and with absolutely no pain syndrome. The Reference and Experimental Groups of athletes were formed during the scheduled medical examination 3-6 months after their treatment in the clinic. The Experimental Group consisted of the patients who accurately followed medical advice on chondroprotectors taking, orthopedic appliances usage and introduction of the developed exercise sequences into their training process. There were 30 such athletes in the past five years of observations. The Reference Group was made of the patients who partially or completely ignored the medical recommendations – 24 people.

The patients’ physical condition was evaluated based on the idiopathic pain intensity (IPS) index: 1 point –no pain either at rest or under load; 2 points –no pain at rest, but pain in the spine or joint during active movements; 3 points –no pain at rest, but back or joint pain during regular actions; 4 points – pain at rest; 5 points – pain at rest, constrained posture, sleep disturbance.

The IPI index in the Experimental Group was 1.35±0.15, which was significantly lower (p<0.05) than in the Reference Group - 2.74±0.25. It should be emphasized that all the Experimental Group athletes came to the hosoital for the check-up examination as planned, 6 months after treatment. Their IPI rates were as follows: 1 point - 83%, 2 points - 10% and 3 points - 7% of the subjects. Only 65% of the Reference Group athletes came to the clinic for the follow-up examination 6 months after treatment. Their IPI rates were, respectively: 1 point - 60% and 2 points - 5%. The remaining 35% of the Reference Group athletes came to the clinic for the check-up 3-5 months after treatment due to the severity of the pain syndrome: 3 points - 15%, 4 points - 20%, respectively. The number of manual therapy sessions, conducted for prophylactic purposes, in the Experimental Group equaled 2.1±0.1, which was significantly lower (p<0.05) than in the Reference Group, –e 2.94±0.25. Therefore, the findings obviously demonstrate that the athletes accurately following medical advice have significantly higher level of functioning of the musculoskeletal system.

Therefore, our concept is based on the idea of devising a versatile approach to the prevention of destructive and dystrophic spinal and articular disorders. To achieve the primary goal – preservation and promotion of athletes’ health – the following components were used as a single system:

• compulsory special physical exercises to strengthen the musculoskeletal system. The developed exercises series was in order with the classical sports training system and could be easily integrated into the training process for athletes of any specialization;
• supportive chondroprotectors taking (once-twice a year) is a powerful motivator for regular performance of special physical exercises; besides, it provides a structural-modifying effect on the cartilaginous tissue (pathogenetic therapy), as well as a symptom-modifying impact in the form of a pain alleviating effect (symptomatic therapy);
• regular use of orthopedic appliances during active physical activity (joint stabilizers, orthopedic corsets). It is nothing but orthoses, i.e. functional fittings that change the structural and functional characteristics of the musculoskeletal system. They take away a portion of the workload and thereby create more comfortable conditions for that area of the joint or region of the spine that have indications for therapy;
• dynamic health control is a well-structured system of doctor-patient relationships. Especially when the patients are active athletes. According to the developed concept of musculoskeletal system health protection, after the basic treatment each patient was recommended to visit the clinic every 6-12 months and undergo short treatment-and-prophylactic courses of manual therapy (2-4 sessions), agree on a unified position of the doctor and a specific patient in adjusting the special physical exercises for musculoskeletal system, chondroprotectors taking and use of orthopedic appliances.

Conclusion. The spinal and articular disorders prevention concept was found beneficial as verified by its practical contributions to the professional sport longevity and compliance with the healthy lifestyle.

References

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5. Rodichkin P.V., Shalamanov N.S., Golubev V.N. Kompleksny podkhod k lecheniyu zabolevaniy oporno-dvigatelnogo apparata u sportsmenov [Integrated Approach to Treatment of Musculoskeletal Disorders in Athletes]. Teoriya i praktika fiz. kultury, 2014, no. 10, pp. 53-55.
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Corresponding author: rodichkin.pavel@gmail.com

Abstract

The study analyzes an idea of universal spinal and articular disorders prevention concept for elite sports. The authors’ practical medical experience shows that up to 30% of elite athletes are diagnosed with musculoskeletal disorders normally associated with the sport-specific physical activity. The elite athletes not only strive to have cured the disorders and diseases but also maintain their health in the long-term remission phase to secure good physical shape and competitive accomplishments. To respond to these needs, the authors have designed and successfully tested and implemented an integrated rehabilitation concept for dorsopathy and periarthritis that includes the following four components: special physical exercises; special chondroprotectors administered as required by recommended procedure; special orthopedic appliances for quiescent and active service; and dynamic health control component. The spinal and articular disorders prevention concept was found beneficial as verified by its practical contributions to the professional sport longevity and compliance with the healthy lifestyle.