Shoulder dislocations come to 31 - 75 per cent of the general number of large joints dislocations. Shoulder habitual dislocation (SHD) is a serious disease of a shoulder joint - complication of an initial dislocation. According to various data sources, 20 to 60 per cent of initial traumatic dislocations turn into habitual ones. If we group sport types based on the character of locomotor activity, SHD is more typical of single combats - 33.03 %, game sport type - 22.11 %, cyclic sport type – 16.96 %, technical sport type – 11.22 %, power-speed sport type - 3,53 %, multiathlon - 1,52 %.
Athletes’ SHD treatment is one of actual problems. Currently it is generally acknowledged, that the most effective method of SHD treatment is surgical operation. At the same time the operation itself does not solve all problems.
The quality of rehabilitation postsurgical actions are of great importance. Postsurgical therapy is even more valuable in patients for whom it is crucial to achieve shoulder joint stabilization ability through shoulder joint muscles strengthening, normal locomotor amplitude in joints of the upper extremity and regeneration of its muscle force. Other peculiarity of postsurgical therapy in athletes is the need to recover as soon as possible in order to restore the normal working capacity. The last stage of rehabilitation therapy includes recovery means for restoration of athletes’ specific locomotor abilities depending on the specific features of each individual sport type. Nevertheless athletic disability usually takes aroung 6-10 months after surgical operation.
The purpose of this clinical trial was to reduce the disability period in athletes by application of the most effective rehabilitation means suggested by various authors and introduction of new methods, such as «АLMAG-01» device travelling magnetic field magnetotherapy in particularly.
20 athletes have been divided into two groups - the basic group and the control group. Among the patients there were mainly wrestlers of various styles and sports and games athletes average age being about 21 years old, all of them male.
In the basic group in post-immobilization period the following practices were applied: therapeutic physical training, massage, thermotherapy, hydrotherapy; in control group - therapeutic physical training, massage, thermotherapy, hydrotherapy and magnetotherapy by «АLMAG-01» device’s "travelling magnetic field". Device emmiters were placed on a sick joint area. Magnetic field induction amplitude - 20±6 mTl, frequency - 6 Hz, procedure duration time - 20 minutes. Treatment rehabilitational course included 20 daily procedures.
1. 1. Dynamometry of operated arm various muscular groups (shoulder flexor –and- extensor muscular group, forearms flexor, outside and inside rotators).
2. Goniometry - operated shoulder joint motions range volume measurement (arm bending, moving aside, unbending, inside and outside rotation).
3. Measurement of shoulder girth in sm.
4. Shoulder muscles strength endurance loco-motor trials:
- pull-up test (number of pull-ups)
- press-up test on parallel bars (number of press-ups),
- shoulder joint passive flexibility test (the capture of fingers behind the back.)
5. Measurement results static processing. During the athletes’ rehabilitation period medical examination was carried out every 1,0-1,5 months.
In both groups rehabilitation included three stages: immobilization (1 month), post-immobilization (fr om 1 to 3-4 months after the surgery, training-regenerative (more than 3-4 months after the surgery). Within the first stage there were 10 magnetotherapy procedures carried out, during the second stage after one month interval - 10 magnetotherapy procedures, and during the third stage (1,5 months after the second one) - 10 magnetotherapy procedures.
For both groups a complex rehabilitation method was applied as follows. Immobilization period - massage, general complex of physical exercises for the healthy arm, legs, body cases, special exercises for operated hand, isometric muscle tension of the same arm, bicycle-ergometer training to keep the body’s general working capacity (30 minutes, pulse 150-160 beats/minutes). General duration of rehabilitation procedures (actions) within a day was 2-2,5 hours;
In the second stage the following was applied: different kinds of massage, thermotherapy, hydrotherapy, arm isometric muscle tension and further on arm dynamic muscle tension. At first physical exercises for shoulder girdle muscles were carried out in the benign conditions, and then various special gym apparatuses were used to load certain groups of the shoulder muscles. Power exercises for shoulder girdle muscles would start with small 0,5-1 kg load. Throughout power training the principle of repeated maximum was used. At the initial stage of muscle endurance training the weight was chosen according to an athlete’s personal capability to lift it 25-35 times. Starting from the first days of the second stage there were carried out medical and health-improving procedures, such as: magnetotherapy, massage, physical exercises and swimming in the swimming pool. General duration of physical procedures - 4-5 hours a day.
The third stage included the following the basic therapy means: physical exercises in the gym, in the swimming pool and in the park, massage, magnetotherapy. All physical exercises can be divided into three groups: 1. local and power exercises of submaximal intensity for shoulder girdle muscles, 2. exercises designed in accordance with and imitating a particular sport type, 3. general physical development exercises and exercises that help increase athletes’ work capacity. Physical exercises total duration in training-regenerative stage came up to 5 - 5,5 hours.
In the basic group as it has been said travelling magnetic field emitted by ALMAG®-01device was applied on a joint area for 20 minutes once a day, the course of treatment - 10 daily procedures. Besides in post-immobilization period to make action on injured upper extremity muscles the following were used: drum-type vibrator to influence all muscles of operated upper extremity (2-3 exercises a day) and manually operated stimulator.
During the therapy process the regeneration rate and final results of active movements in shoulder joint and the strength of muscular groups were obviously higher in the experimental group (see Table 1).
Muscular strength endurance motorial tests (10 pull-ups and 10 press-up on parallel bars without rest) were gone through by the patients of the basic group on the average after 4,2 months after the surgery, and by the patients of the control group after 5,4 months. Passive flexibility motorial test (finger capture behind the back) of the operated upper extremity shoulder joint was gone through by the patients of the basic group on the average after 4,8 months after the surgery, and by the patients of control one after 5,9 months.
Based on the above presented data and motorial trials results there was taken an expert decision to allow the athletes their pre-surgical training intensit. Taking into consideration the trial’s results athletes of both groups (basic and control) made a decision to start normal training in the following period of time (see Table 2).
As it is shown above, according to an expert assessment, all athletes of the basic group were allowed to start training at the initial level not later than 5 - 5,5 months after the surgical operation.
In the control group only three of the athletes (a football player, 2 wrestlers) were allowed to resume their normal training at the same terms (5 - 5,5 month after the surgical operation). Five athletes of the control group were allowed to resume trainings in 6-6,5 months, and two - in 7 and more months.
1. Athletes’ physical rehabilitation after shoulder dislocations surgical operation is one of the most complicated, not sufficiently investigated actual issues.
2. Athletes’ successful physical rehabilitation after shoulder dislocations surgical operation is possible provided all medical rehabilitation requirements are met, as follows:
- early beginning, complexity, continuity and succession, individual approach.
- medicinal agent and physical exercises timely application, dose progressive increase, physical activity complexification.
- in immobilizing period duration of all rehabilitation actions should be 2 - 2,5 hours per day, in post immobilizing period - 4-5 hours, in training- recovery period - 5 - 5,5 hours.
3. The developed physical rehabilitation complex technique with travelling magnetic field magneto-therapy involvement proved to be more effective one as final results of both joint mobility, muscles strength and special locomotor tests turned out to be authentically the best in the basic group wh ere this technique had been applied.
4. On the basis of expert assessment athletes of the basic group experienced ALMAG®-01device travelling magnetic field magnetotherapy (8 of 10 athletes were engaged in sport demanding humeral joint maximal involvement) went back to their initial training intensity on average in 4,5 months after surgical operation, while control group athletes being engaged in the same kinds of sport respectively resumed their normal training intensity on the average in 6 months.
5. Based on the results of the conducted clinical trials, it is necessary to recommend the application of developed rehabilitation complex including ALMAG®-01device travelling magnetic field magnetotherapy in clinic traumatology departments, sport prophylactic centers, polyclinics for athletes after surgical operations .