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PHYSIOTHERAPY REHABILITATION OF ANTERIOR CRUCIATE LIGAMENT IN ATHLETES
No full textOzljede prednjeg križnog ligamenta (Anterior cruciate ligament - ACL) ubrajaju se među najčešće i najozbiljnije sportske ozljede koljena, s velikim utjecajem na funkcionalnu sposobnost sportaša i povratak profesionalnoj aktivnosti. U uvodnom dijelu rada naglašava se značaj problema kroz porast incidencije, složenost liječenja te visoke troškove rehabilitacije. Posebna pozornost usmjerena je na prevenciju i pravovremenu dijagnostiku, budući da neadekvatno liječenje povećava rizik od recidiva i razvoja sekundarnih ozljeda.
Sportske aktivnosti različitog intenziteta predstavljaju glavni rizični čimbenik za ozljede koljena. Epidemiološki podaci pokazuju veću učestalost ACL ozljeda u sportovima koji uključuju nagle promjene smjera, doskoke i kontaktne situacije, poput nogometa, rukometa i skijanja. Visokorizični sportovi povezani su s višestruko većom stopom ozljeda u usporedbi s niskorizičnim disciplinama. Mehanika i načini ozljeđivanja pokazuju kako su nagli pokreti s valgoznim koljenom i rotacijskim silama najčešći uzroci puknuća ligamenta, pri čemu važnu ulogu imaju i anatomske značajke koljena.
Analizom anatomije i biomehanike jasno se uočava da ACL ima ključnu stabilizacijsku funkciju te ograničava translaciju tibije i kontrolira rotaciju koljena. Razumijevanje tih mehanizama temelj je za planiranje učinkovitih preventivnih programa i rehabilitacijskih protokola. Biomehaničke studije potvrđuju da neravnoteža mišića, pogrešni obrasci doskoka i slabost propriocepcije značajno doprinose riziku ozljede.
Fizioterapijske intervencije uključuju konzervativne i operativne pristupe. Konzervativna rehabilitacija temelji se na individualiziranim programima koji obuhvaćaju jačanje mišića, neuromuskularni trening i postupno vraćanje sportskoj aktivnosti. Kod težih ozljeda ili kod sportaša s visokim zahtjevima prednost se daje kirurškoj rekonstrukciji ACL-a. Postoperativna rehabilitacija ima jasno definirane faze, od ranog postizanja pune ekstenzije i kontrole boli, do progresivnog opterećenja, funkcionalnih vježbi i testiranja spremnosti za povratak sportu.
Zaključno, ozljede prednjeg križnog ligamenta predstavljaju multidisciplinarni izazov koji zahtijeva integraciju epidemioloških spoznaja, biomehaničkih analiza, preventivnih programa i
personalizirane fizioterapije. Optimalni rezultati postižu se kombinacijom kirurških i konzervativnih metoda, uz naglasak na individualni pristup i dugoročnu prevenciju recidiva.Anterior cruciate ligament (ACL) injuries are among the most common and severe knee injuries in sports, significantly affecting athletes’ functional capacity and return to professional activity. The introduction highlights the increasing incidence, treatment complexity, and high rehabilitation costs associated with ACL injuries. Particular emphasis is placed on prevention and early diagnosis, as inadequate treatment increases the risk of recurrence and secondary injuries.
Sports activities of varying intensity represent the main risk factor for knee injuries. Epidemiological data show a higher prevalence of ACL injuries in sports involving sudden changes of direction, landings, and contact situations, such as football, handball, and skiing. High-risk sports are associated with a considerably higher injury rate compared to low-risk disciplines. The mechanics and mechanisms of injury demonstrate that sudden movements with valgus alignment and rotational forces are the most common causes of ligament rupture, with anatomical features of the knee playing an important role.
Analysis of knee anatomy and biomechanics reveals that the ACL serves as a key stabilizer, limiting tibial translation and controlling knee rotation. Understanding these mechanisms provides the foundation for effective preventive programs and rehabilitation protocols. Biomechanical studies confirm that muscle imbalances, faulty landing patterns, and poor proprioception substantially contribute to injury risk.
Physiotherapy interventions include both conservative and surgical approaches. Conservative rehabilitation is based on individualized programs encompassing muscle strengthening, neuromuscular training, and gradual return to sports activity. In more severe injuries, or in athletes with high performance demands, surgical reconstruction is preferred. Postoperative rehabilitation follows clearly defined stages, from early restoration of full extension and pain control to progressive loading, functional exercises, and return-to-sport readiness testing.
In conclusion, ACL injuries represent a multidisciplinary challenge requiring the integration of epidemiological insights, biomechanical analysis, preventive strategies, and personalized physiotherapy. Optimal outcomes are achieved through a combination of surgical and
conservative methods, with a strong emphasis on individualized care and long-term recurrence prevention
REHABILITATION OF THE FIFTH METATARSAL BONE FRACTURE
No full textFrakture pete metatarzalne kosti česte su ozljede stopala koje se javljaju kod profesionalnih sportaša, rekreativaca, ali i u općoj populaciji uslijed traumatskih ili stresnih mehanizama. Njihova učestalost povezana je s anatomsko-biomehaničkim značajkama ove kosti, koja sudjeluje u održavanju stabilnosti lateralnog svoda stopala i prijenosu tjelesne težine. Zbog svoje pozicije peta metatarzalna kost izložena je povećanim opterećenjima, a njezina slabija vaskularizacija u određenim zonama može otežati proces cijeljenja. Klasifikacija fraktura prema zonama (1, 2 i 3) omogućuje preciznije planiranje liječenja. Zona 1 najčešće obuhvaća avulzijske frakture s povoljnom prognozom, zona 2 ili Jonesova fraktura karakterizirana je otežanim cijeljenjem i češće zahtijeva operativni pristup, dok zona 3 obuhvaća stresne frakture proksimalne dijafize koje predstavljaju najveći rehabilitacijski izazov. Dijagnostika uključuje klinički pregled i radiološke metode, pri čemu MRI može otkriti frakture koje nisu vidljive na RTG-u. Liječenje može biti konzervativno, s imobilizacijom i postupnim vraćanjem funkcije, ili operativno, što se preferira kod nestabilnih fraktura, sporog cijeljenja i sportaša s visokim zahtjevima. Rehabilitacija je ključna za povrat pune funkcionalnosti, a uključuje fizikalnu terapiju: ultrazvuk, TENS, magnetoterapiju, krioterapiju, manualne tehnike za vraćanje pokretljivosti, te kinezioterapiju za jačanje muskulature, propriocepciju i prevenciju recidiva. Ovaj rad daje sveobuhvatan prikaz anatomije, biomehanike, dijagnostike, terapijskih mogućnosti i rehabilitacijskih protokola za frakture pete metatarzalne kosti. Naglašava se važnost multidisciplinarnog pristupa, individualizacije terapije te edukacije pacijenata, čime se osigurava brži i sigurniji povratak svakodnevnim i sportskim aktivnostima uz minimalan rizik od komplikacija.The fifth metatarsal fractures are common foot injuries occurring in professional athletes, recreational sports participants, and the general population as a result of traumatic or stress-related mechanisms. Their high incidence is linked to the anatomical and biomechanical characteristics of the bone, which plays a vital role in maintaining the stability of the lateral foot arch and transmitting body weight. Due to its position, the fifth metatarsal is subjected to increased loads, and its reduced vascularization in certain zones may complicate healing. Fractures are classified into three zones to guide treatment more precisely. Zone 1 usually involves avulsion fractures with a favorable prognosis, Zone 2 or Jones fracture is known for its delayed healing and frequently requires surgical intervention, while Zone 3 involves stress fractures of the proximal diaphysis, presenting the greatest rehabilitation challenge. Diagnosis is based on clinical examination and imaging, with MRI useful in detecting fractures not visible on plain radiographs. Treatment may be conservative, involving immobilization and gradual restoration of function, or surgical, which is preferred in unstable fractures, delayed healing, and for athletes with high performance demands. Rehabilitation plays a central role in restoring full function, incorporating physical therapy modalities (ultrasound, TENS, magnetotherapy, cryotherapy), manual techniques to regain mobility, and kinesitherapy to strengthen muscles, improve proprioception, and prevent re-injury. This paper provides a comprehensive overview of the anatomy, biomechanics, diagnosis, therapeutic options, and rehabilitation protocols for fifth metatarsal fractures. It emphasizes the importance of a multidisciplinary approach, individualized therapy, and patient education to ensure a faster and safer return to daily and sporting activities with minimal risk of complications
REHABILITATION OF “PECTORALIS MAJOR” MUSCLE INJURY
No full textOzljede m. pectoralis major predstavljaju relativno rijetke, ali klinički značajne traume koje se
javljaju najčešće kod aktivnih sportaša i osoba koje se bave fizički zahtjevnim aktivnostima.
Rehabilitacija nakon rupture zahtijeva multidisciplinarni pristup koji uključuje dijagnostiku,
fizikalne metode i kinezioterapiju. Cilj ovog rada je prikazati proces rehabilitacije pacijenta s
parcijalnom rupturom miotendinoznog dijela m. pectoralis major, s naglaskom na terapijske
postupke i funkcionalni ishod.
Ozljede „m. pectoralis major najčešće nastaju tijekom sportskih aktivnosti koje uključuju nagle
pokrete, podizanje velikih opterećenja ili traumu izravnim udarcem. U literaturi se navodi da do
rupture često dolazi kod bench pressa ili kontaktnog sporta. Terapijski pristupi mogu biti
konzervativni i kirurški. Konzervativni uključuju imobilizaciju, fizikalnu terapiju i progresivnu
kinezioterapiju. Kirurški pristup rezerviran je za potpune rupture ili za pacijente s visokim
funkcionalnim zahtjevima. Ishod ovisi o pravovremenoj dijagnostici i kvaliteti rehabilitacijskog
protokola.
U navedenom slučaju ozljede prsnog mišića, pratit će se događaj rehabilitacije realnog slučaja kod
pacijenta srednjih godina.
Rana intervencija prvi je preduvijet za brži i povoljniji ishod svake traumatske ozljede, pogotvo
mišičnih i tetivnih dijelova. Pri ranoj inetrvenciji prije svega podrazumijevamo sve radnje koje će
spriječiti veća ili sekundarna oštečenja tkiva, te minimizirati hemoragiju koja predstavlja veliki
problem pri ponovnom „spajanju“ tkiva.Injuries to the pectoralis major muscle are relatively rare but clinically significant traumas that
occur most often in active athletes and people who engage in physically demanding activities.
Rehabilitation after rupture requires a multidisciplinary approach that includes diagnostics, physical
methods and kinesiotherapy. The aim of this paper is to present the rehabilitation process of a
patient with a partial rupture of the myotendinous part of the pectoralis major muscle, with an
emphasis on therapeutic procedures and functional outcome.
Injuries to the pectoralis major muscle most often occur during sports activities that involve sudden
movements, lifting heavy loads or trauma from a direct blow. The literature states that rupture often
occurs in bench press or contact sports. Therapeutic approaches can be conservative and surgical.
Conservative approaches include immobilization, physical therapy and progressive kinesiotherapy.
Surgical approach is reserved for complete ruptures or for patients with high functional demands.
The outcome depends on timely diagnosis and the quality of the rehabilitation protocol.
In the above case of a pectoral muscle injury, the rehabilitation event of a real case in a middle-aged
patient will be followed.
Early intervention is the first prerequisite for a faster and more favorable outcome of any traumatic
injury, especially of the muscle and tendon parts. Early intervention primarily means all actions that
will prevent major or secondary tissue damage, and minimize hemorrhage, which is a major
problem when reconnecting tissue
EFFECTIVENESS OF EXOSKELETON USE IN NEUROREHABILITATION AFTER SPINAL CORD INJURY
No full textOzljede leđne moždine predstavljaju značajan medicinski problem, uzrokujući dugotrajne
fizičke, psihološke i socijalne posljedice te narušavajući motoričke funkcije donjih ekstremiteta.
Takve ozljede često zahtijevaju intenzivnu i dugotrajnu rehabilitaciju, a klasične metode poput
fizioterapije i radne terapije ponekad nisu dovoljne za potpun oporavak, osobito kod težih
neuroloških oštećenja. Napredak robotskih sustava u rehabilitaciji donjih ekstremiteta omogućuje
izvođenje preciznih, ponovljivih i ciljano prilagođenih pokreta koji potiču neuroplastičnost.
Sustavi poput Lokomata, EksoGT-a i Andago robota pomažu u ponovnom opterećenju donjih
ekstremiteta i obnovi hodnih sposobnosti, čime se poboljšavaju funkcionalni ishodi, ravnoteža i
kvalitetu života, a istovremeno se smanjuje fizičko opterećenje terapeuta. Integracija dodatnih
tehnologija, uključujući funkcionalnu elektrostimulaciju, virtualnu stvarnost i biofeedback,
dodatno povećava učinkovitost terapije. Unatoč brojnim prednostima, primjena robotske
rehabilitacije suočava se s izazovima, uključujući visoke troškove, tehnička ograničenja i potrebu
za specijaliziranom edukacijom terapeuta. Na temelju dosadašnjih istraživanja može se zaključiti
da korištenje egzoskeleta u rehabilitaciji donjih ekstremiteta nakon ozljede leđne moždine
značajno poboljšava funkcionalne ishode, skraćuje vrijeme oporavka i povećava motivaciju
pacijenata, te predstavlja perspektivan smjer u razvoju neurorehabilitacijskih metoda.
Cilj ovog rada je analizirati učinkovitost i kliničku primjenjivost robotski potpomognutih
sustava u rehabilitaciji donjih ekstremiteta nakon ozljede leđne moždine, s naglaskom na njihove
prednosti, ograničenja i potencijal u unapređenju neurorehabilitacijskih postupaka.Spinal cord injuries pose a significant health challenge, causing long-term physical,
psychological, and social impairments and severely affecting motor function in the lower limbs.
Such injuries often require intensive, prolonged rehabilitation, and conventional methods like
physiotherapy and occupational therapy may not always lead to full recovery, especially in
severe neurological deficits. The development of robotic systems for lower limb rehabilitation
allows precise, repeatable, and customized movements that promote neuroplasticity. Devices
such as the Lokomat, EksoGT, and Andago robots facilitate weight-bearing and walking
recovery, improving functional outcomes, balance, and quality of life, while reducing physical
strain on therapists. Additional technologies, including functional electrical stimulation, virtual
reality, and biofeedback, further enhance therapeutic effectiveness. Despite the advantages,
challenges remain, including high costs, technical limitations, and the need for specialized
therapist training. Available evidence suggests that exoskeleton-assisted rehabilitation of lower
limbs after spinal cord injury significantly enhances functional outcomes, shortens recovery
time, and increases patient motivation, representing a promising direction for the future
development of neurorehabilitation strategies.
The aim of this paper is to analyze the effectiveness and clinical applicability of robot-assisted
systems in lower limb rehabilitation after spinal cord injury, with an emphasis on their
advantages, limitations, and potential in advancing neurorehabilitation procedures
PHYSIOTHERAPY APPROACHES TO ANKLE DISTORTION
No full textDistorzija gležnja, odnosno uganuće, česta je akutna ozljeda lokomotornog sustava. Nastaje
iznenada tijekom nagle promjene smjera kretanja ili kretanja po neravnoj podlozi, a uzrokuje
istegnuće ili puknuće ligamenta. Najčešće uganuće gležnja je lateralno uganuće do kojeg dođe
prilikom pretjerane inverzije stopala gdje dolazi do pucanja prednjeg talofibularnog ligamenta.
S obzirom na učestalost ozljede važna je pravovremena i pravilna dijagnostika. U uvodnom
dijelu rada detaljnije je opisana distorzija gležnja, njezina podjela i mehanizam nastanka
pojedinog uganuća. Zatim slijedi anatomija i biomehanika gležnja koja daje osnove za
razumijevanje funkcije gležnja i održavanja stabilnosti i pokretljivosti. Liječenje uganuća može
biti konzervativno ili kirurško, ovisno o stupnju ozljede, a često započinje primjenom RICE ili
PRICE metode (zaštita, odmor, led, kompresija, elevacija), kao prvotnom mjerom za smanjenje
otekline i boli. Nakon toga slijedi fizioterapijska procjena koja uključuje subjektivni pregled i
objektivni pregled pacijenta. Koriste se testovi za procjenu subjektivnih sposobnosti, mjere
cirkularnosti, mjere opsega pokreta, manualni mišićni test te razni funkcionalni i klinički
testovi. Nakon detaljne procjene započinje planiranje fizioterapijske intervencije. Rehabilitacija
nakon uganuća gležnja obuhvaća terapijske vježbe istezanja, pasivne i aktivne vježbe povećanja
opsega pokreta, vježbe jačanja pojedinih skupina mišića te najvažnije, vježbe koordinacije,
ravnoteže i propriocepcije. Uz razne vježbe provode se i različite elektroterapijske procedure,
a to su TENS, interferentne struje (IFS) i laser koje služe za ublažavanje boli i poticanje
cijeljenja oštećenog tkiva. Rehabilitacija uganuća gležnja se može još poboljšati tehnikama
bandažiranja i kinesiotapinga. Edukacija pacijenta o prevenciji ozljeda i pravilnom provođenju
vježbi ključni su aspekti završnog dijela fizioterapijskog procesa.Ankle sprain, or sprain, is a frequent acute injury of the locomotor system. It occurs suddenly
during a sudden change in the direction of movement or movement on an uneven surface, and
causes stretching or rupture of the ligament. The most common ankle sprain is a lateral sprain
that occurs during excessive inversion of the foot where the anterior talofibular ligament tears.
Given the frequency of the injury, right time and correct diagnosis are important. In the
introductory part of the paper, the distortion of the ankle, its division and the mechanism of
occurrence of each sprain is described in more detail. Then follows the anatomy and
biomechanics of the ankle, which provides the basis for understanding ankle function and
maintaining stability and mobility. Treatment of sprains can be conservative or surgical,
depending on the degree of injury, and often begins with the application of the RICE and PRICE
method (protection, rest, ice, compression, elevation), as an initial measure to reduce swelling
and pain. This is followed by a physiotherapy assessment that includes a subjective examination
and an objective examination of the patient. Tests are used to assess subjective abilities,
circularity measures, range of motion measures, manual muscle testing, and various functional
and clinical tests. After a detailed assessment, physiotherapy intervention planning begins.
Rehabilitation after an ankle sprain includes therapeutic stretching exercises, passive and active
exercises to increase the range of motion, exercises to strengthen individual muscle groups, and
most importantly, coordination, balance, and proprioception exercises. In addition to various
exercises, various electrotherapeutic procedures are also performed, such as TENS,
interferential currents (IFS), and laser, which serve to relieve pain and promote healing of
damaged tissue. Ankle sprain rehabilitation can be further improved with bandaging and kinesio
taping techniques. Patient education on injury prevention and proper exercise performance are
key aspects of the final part of the physiotherapy process
PHYSIOTHERAPEUTIC INTERVENTION AFTER TOTAL HIP REPLACEMENT
No full textUgradnja totalne endoproteze zgloba kuka je ortopedski i operativni zahvat te sve češći način
liječenja određenih stanja tog zgloba, a osobito kod pacijenata s uznapredovalim
osteoartritisom. Nakon zamjene cijelog zgloba, cilj je ublažavanje boli, poboljšanje funkcije te
kvalitete života pacijenta. Uspješan ishod zahvata i ove vrste liječenja značajno ovisi o pravilno
provedenoj fizioterapiji i rehabilitaciji koja mora biti individualno prilagođena pacijentu i
njegovim potrebama. Fizioterapijska intervencija započinje svega nekoliko sati nakon samog
zahvata i ima ključnu ulogu u povratku najveće moguće funkcionalnosti kuka te prevenciji
komplikacija. Rehabilitacija se provodi kroz više faza te uključuje raznovrsne terapijske metode
i pristupe. Najprije je naglasak na respiratornim vježbama, vježbama za poticanje cirkulacije te
izometričkim vježbama. Navedenim se metodama, odmah nakon operativnog zahvata,
smanjuje rizik od tromboze i potiče se cijeljenje. Također, provode se vježbe za stopala, vježbe
opsega pokreta i vježbe za jačanje mišića. Kasnije, tijekom rehabilitacije uvode se vježbe
ravnoteže, koordinacije i propriocepcije. Pravilno korištenje ortopedskih pomagala, poput
štaka, sastavan je i vrlo važan dio svake fizioterapijske intervencije. Uloga je fizioterapeuta da
educira pacijenta o pravilnom kretanju tijekom obavljanja aktivnosti svakodnevnog života, ali
i o pokretima koje bi pacijent trebao izbjegavati jer mogu dovesti do ozbiljnih komplikacija i
dislokacije umjetnog zgloba. Nadalje, koriste se metode poput krioterapije i elektroterapije koje
imaju pozitivan učinak na smanjenje boli i upale te pospješuju cjelokupan proces oporavka.
Česta je primjena transkutane električne živčane stimulacije, elektrostimulacije i interferentnih
struja. Pravilno provedena fizioterapijska intervencija te suradnja između pacijenta i
fizioterapeuta ključna je za uspješan oporavak i povratak svakodnevnim aktivnostima, kao i za
značajno poboljšanje kvalitete života pacijenta.Total hip replacement is an orthopedic and surgical procedure, and it is used as an increasingly
common method of treating certain conditions of this joint, especially in patients with advanced
osteoarthritis. After replacing the entire joint, the goal is to relieve pain, improve function, and
improve the patient's quality of life. The successful outcome of the procedure and this type of
treatment significantly depends on properly performed physical therapy and rehabilitation,
which must be individually tailored to the patient and their needs. Physiotherapy intervention
begins just a few hours after the procedure itself and plays a key role in restoring the highest
possible functionality of the hip and preventing complications. Rehabilitation is carried out in
several phases and includes a variety of therapeutic methods and approaches. The first emphasis
is on breathing exercises, exercises to stimulate circulation, and isometric exercises. These
methods, immediately after the surgery, reduce the risk of thrombosis and promote healing.
Foot exercises, range of motion exercises, and muscle strengthening exercises are also
performed. Later during rehabilitation, balance, coordination, and proprioception exercises are
introduced. The correct use of orthopedic aids, such as crutches, is an integral and very
important part of any physiotherapy intervention. The role of the physiotherapist is to educate
the patient about proper movement during activities of daily living, but also about movements
that the patient should avoid because they can lead to serious complications and dislocation of
the artificial joint. Furthermore, methods such as cryotherapy and electrotherapy are used,
which have a positive effect on reducing pain and inflammation and promoting the overall
recovery process. Transcutaneous electrical nerve stimulation, electrostimulation, and
interferential currents are often used. Properly performed physiotherapy intervention and
cooperation between the patient and physiotherapist are key to successful recovery and return
to daily activities, as well as to significantly improve the patient's quality of life
THE ROLE OF PHYSIOTHERAPY IN THE TREATMENT OF NEURODEGENERATIVE DISEASES
No full textNeurodegenerativne bolesti predstavljaju ozbiljan medicinski i socijalni problem zbog progresivnog gubitka neuronske funkcije i strukture, što dovodi do smanjenja funkcionalne sposobnosti i kvalitete života oboljelih. Najčešće neurodegenerativne bolesti uključuju Parkinsonovu bolest, Alzheimerovu bolest i multiplu sklerozu. Zbog složenosti patofizioloških mehanizma i neizlječive prirode ovih bolesti, pristup liječenju zahtijeva multidisciplinarnu suradnju, pri čemu fizioterapija ima ključnu ulogu. Fizioterapija u liječenju neurodegenerativnih bolesti usmjerena je na očuvanje mobilnosti, održavanje mišićne snage, poboljšanje ravnoteže i koordinacije te smanjenje rizika od komplikacija kao što su kontrakture i padovi. Primjena različitih fizioterapijskih tehnika, uključujući kineziterapiju, proprioceptivnu neuromuskularnu facilitaciju (PNF), hidroterapiju i korištenje asistivnih uređaja, pomaže u očuvanju funkcionalne nezavisnosti pacijenata. Individualizirani fizioterapijski programi temeljeni su na procjeni motoričkih i kognitivnih sposobnosti te prilagođeni stupnju progresije bolesti. Edukacija pacijenata i njihovih obitelji također je važna komponenta terapije, jer potiče aktivno sudjelovanje u procesu rehabilitacije i pridonosi boljoj kontroli simptoma. Brojna istraživanja potvrđuju pozitivne učinke fizioterapije na smanjenje simptoma i poboljšanje kvalitete života oboljelih od neurodegenerativnih bolesti. Redovita terapija ne samo da ublažava motoričke poremećaje, već i pridonosi očuvanju mentalnog zdravlja i socijalne uključenosti pacijenata. Zaključno, fizioterapija ima nezamjenjivu ulogu u holističkom pristupu liječenju neurodegenerativnih bolesti, pomažući pacijentima da zadrže što veću razinu funkcionalne neovisnosti i kvalitete života unatoč progresiji bolestiNeurodegenerative diseases represent a significant medical and social problem due to the progressive loss of neuronal function and structure, leading to a reduction in functional ability and quality of life for affected individuals. The most common neurodegenerative diseases include Parkinson’s disease, Alzheimer’s disease and multiple sclerosis. Due to the complexity of pathophysiological mechanisms and the incurable nature of these diseases, the treatment approach requires multidisciplinary collaboration, with physiotherapy playing a crucial role. Physiotherapy in the treatment of neurodegenerative diseases is focused on maintaining mobility, preserving muscle strength, improving balance and coordination, and reducing the risk of complications such as contractures and falls. The application of various physiotherapeutic techniques, including kinesiotherapy, proprioceptive neuromuscular facilitation (PNF), hydrotherapy, and the use of assistive devices, helps maintain the functional independence of patients. Individualized physiotherapy programs are based on the assessment of motor and cognitive abilities and are adapted to the stage of disease progression. Patient education, as well as the education of their families, is also an important component of therapy, as it encourages active participation in the rehabilitation process and contributes to better symptom management. Numerous studies confirm the positive effects of physiotherapy on symptom reduction and the improvement of quality of life in patients with neurodegenerative diseases. Regular therapy not only alleviates motor disorders but also contributes to the preservation of mental health and social inclusion of patients. In conclusion, physiotherapy plays an irreplaceable role in a holistic approach to the treatment of neurodegenerative diseases, helping patients maintain the highest possible level of functional independence and quality of life despite disease progression
PHYSIOTHERAPY MANAGEMENT OF GROIN PAIN SYNDROME
No full textSindrom bolne prepone, poznat i kao sportska hernija ili atletska pubalgija, predstavlja jedan od češćih uzroka kronične boli u preponskoj regiji, osobito kod profesionalnih i rekreativnih sportaša koji se bave sportovima s visokim intenzitetom. Ovaj sindrom najčešće se javlja kod aktivnosti koje uključuju eksplozivne pokrete, nagle promjene smjera, skokove, udarce te snažne rotacije trupa. Unatoč nazivu, ne uključuje stvarnu herniju, već se radi o složenom mišićno-tetivnom disbalansu, najčešće između trbušne muskulature i aduktora natkoljenice, što rezultira bolom, funkcionalnim ograničenjima i smanjenjem sportske izvedbe. Dijagnostika sindroma bolne prepone iznimno je zahtjevna zbog preklapanja simptoma s brojnim drugim stanjima u području zdjelice, kukova i donjeg abdomena. Ključnu ulogu u pravilnoj identifikaciji problema ima fizioterapijska procjena, koja uključuje temeljitu analizu posture, obrasca kretanja, mišićne snage, fleksibilnosti te biomehaničkih odstupanja. Osim toga, važno je procijeniti neuromišićnu kontrolu i stabilnost trupa. Rehabilitacija se provodi individualizirano, kroz progresivni fizioterapijski program koji uključuje vježbe mobilnosti, istezanja, stabilizacije i jačanja ciljanih mišićnih skupina. Suradnja više stručnjaka – fizioterapeuta, liječnika sportske medicine i trenera – od iznimne je važnosti za uspješan oporavak i prevenciju ponovne pojave simptoma. Cilj ovog rada je prikazati važnost precizne fizioterapijske procjene, kao i ulogu rehabilitacijskog procesa u liječenju i povratku sportaša svakodnevnim i sportskim aktivnostima.Groin pain syndrome, also known as sports hernia or athletic pubalgia, is one of the most common causes of chronic pain in the groin region, especially among professional and recreational athletes engaged in high-intensity sports. This syndrome typically occurs during activities that involve explosive movements, sudden changes of direction, jumping, kicking, and powerful trunk rotations. Despite the name, it does not involve a true hernia but rather a complex musculo-tendinous imbalance, most often between the abdominal muscles and the adductors of the thigh, resulting in pain, functional limitations, and reduced athletic performance. Diagnosing groin pain syndrome is particularly challenging due to the overlap of symptoms with numerous other conditions in the pelvic, hip, and lower abdominal areas. A key role in correctly identifying the problem lies in physiotherapeutic assessment, which includes a thorough analysis of posture, movement patterns, muscle strength, flexibility, and biomechanical deviations. In addition, it is important to evaluate neuromuscular control and trunk stability. Rehabilitation is carried out through an individualized, progressive physiotherapy program that includes mobility exercises, stretching, stabilization, and strengthening of targeted muscle groups. The collaboration of multiple professionals - physiotherapists, sports medicine doctors, and coaches - is essential for a successful recovery and prevention of symptom recurrence. The aim of this paper is to highlight the importance of precise physiotherapeutic assessment and the role of the rehabilitation process in the treatment and return of athletes to daily and sports activities
THE ROLE OF POSTURE AND FUNCTIONAL MOVEMENT IN SNAPPING SCAPULA SYNDROME
No full textGlenohumeralni zglob jedan je od najpokretljivijih u ljudskom tijelu, a njegova stabilnost ovisi o pravilnom funkcioniranju mišićno-koštanih struktura, pri čemu lopatica ima središnju ulogu. Poremećaji u biomehanici ramenog kompleksa mogu dovesti do sindroma pucketave lopatice, koji se očituje bolnošću i pucketanjem pri pokretima lopatice preko prsnog koša. Etiološki čimbenici uključuju neuromuskularni disbalans, disfunkciju scapulothorakalnog spoja, lošu posturu i preopterećenje stabilizatora lopatice. Sindrom se učestalije javlja kod sportaša s ponavljanim pokretima iznad glave, ali sve češće i u općoj populaciji, osobito među uredskim radnicima. Za stabilnost ramenog pojasa ključni su mehanizmi međudjelovanja mišićnih sila, čija disfunkcija rezultira povećanim trenjem, upalnim promjenama i funkcionalnim ograničenjem. Rehabilitacija zahtijeva multidisciplinaran i individualiziran pristup. Fizioterapijski plan uključuje edukaciju o pravilnoj posturi, ergonomske prilagodbe, specifične vježbe za stabilizaciju lopatice te manualne i miofascijalne tehnike. Dodatno se primjenjuju metode proprioceptivne neuromuskularne facilitacije (PNF) i dinamičke neuromuskularne stabilizacije (DNS), koje potiču pravilnu aktivaciju dubokih stabilizatora trupa i ramenog kompleksa. Rezultati istraživanja potvrđuju učinkovitost navedenih intervencija kroz smanjenje boli, pucketanja i povećanje snage stabilizatora lopatice. Ipak, potrebna su daljnja klinička istraživanja s većim brojem ispitanika i dugoročnim praćenjem funkcionalnih ishoda. Sveobuhvatan fizioterapijski pristup doprinosi smanjenju simptoma, poboljšanju funkcionalne stabilnosti te unapređenju kvalitete života oboljelih.The glenohumeral joint is one of the most mobile joints in the human body, with its stability depending on the coordinated function of musculoskeletal structures, in which the scapula plays a central role. Disruptions in shoulder biomechanics can lead to Snapping Scapula Syndrome (SSS), characterized by pain and audible snapping during scapular movement over the thoracic wall. The most common etiological factors include neuromuscular imbalance, dysfunction of the scapulothoracic articulation, poor posture, and overload of scapular stabilizers. The syndrome is more prevalent among athletes performing repetitive overhead movements, yet it is increasingly observed in the general population, particularly among office workers.Shoulder stability relies on force-couple mechanisms of interacting muscle groups, whose dysfunction results in increased friction, inflammation, and functional limitations. Rehabilitation requires a multidisciplinary and individualized approach. Physiotherapy management includes patient education on posture, ergonomic adjustments, specific scapular stabilization exercises, as well as manual therapy and myofascial release techniques. Additionally, proprioceptive neuromuscular facilitation (PNF) and dynamic neuromuscular stabilization (DNS) methods are applied to promote proper activation of deep stabilizers of the trunk and shoulder girdle. Recent studies confirm the effectiveness of such interventions, demonstrating pain reduction, decreased snapping, and improved scapular stabilizer strength. However, further clinical research with larger and more diverse populations and long-term follow-up is needed to evaluate functional and subjective outcomes. A comprehensive physiotherapy approach contributes to symptom reduction, improved functional stability, and enhanced quality of life in patients with Snapping Scapula Syndrome
MOTOR DEVELOPMENT OF A CHILD IN THE FIRST TWO YEARS OF LIFE
No full textMotorički razvoj djeteta predstavlja proces usvajanja i usavršavanja pokreta kojima dijete ovladava vlastitim tijelom s ciljem učinkovite interakcije s okolinom i predmetima. Ovaj aspekt razvoja neraskidivo je povezan s emocionalnim, socijalnim, somatskim i kognitivnim razvojem te u ranoj dobi može poslužiti kao pokazatelj ukupnog psihičkog sazrijevanja. Razvoj motorike moguće je klasificirati kroz četiri osnovna područja: kontrolu glave, pokrete trupa, pokrete gornjih i donjih ekstremiteta. Ključni motorički događaji, poznati kao razvojni miljokazi, individualno su uvjetovani i ne odvijaju se istovremeno kod sve djece. Kako bi se pravodobno uočila potencijalna odstupanja od tipičnog motoričkog razvoja, uobičajena je podjela razvoja u tromjesečne faze života djeteta. Ova klasifikacija omogućava identifikaciju očekivanih vještina i njihovu usporedbu s aktualnim motoričkim postignućima. Kašnjenje od tri mjeseca ili više može ukazivati na potrebu za dodatnom procjenom, osobito ako su prisutni znakovi rizika po mjesecima života. Jedan od češćih pokazatelja odstupanja je promjena mišićnog tonusa, koji može biti snižen (hipotonija), povišen (hipertonija) ili kombiniran (distoni sindrom). Ova stanja zahtijevaju ranu intervenciju stručnjaka unutar multidisciplinarnog tima, u kojem ključnu ulogu ima fizioterapeut. Osim procjene neuromotoričkog statusa i provođenja individualizirane terapije, fizioterapeut ima važnu edukacijsku ulogu u radu s roditeljima, posebice u kontekstu pravilnog postupanja s djetetom (tzv. baby handling) i provođenja vježbi za poticanje motoričkog razvoja. Aktivna uključenost roditelja značajno doprinosi uspješnosti rehabilitacijskog procesa i osigurava optimalne uvjete za napredovanje djeteta.A child's motor development is the process of acquiring and perfecting movements that a child uses to control his or her own body in order to effectively interact with the environment and objects. This aspect of development is inextricably linked to emotional, social, somatic and cognitive development and at an early age can serve as an indicator of overall psychological maturation. Motor development can be classified into four basic areas: head control, trunk movement, and upper and lower limb movement. Key motor events, known as developmental milestones, are individually conditioned and do not occur simultaneously in all children. In order to timely detect potential deviations from typical motor development, it is common to divide development into three-month stages of a child's life. This classification allows for the identification of expected skills and their comparison with current motor achievements. A delay of three months or more may indicate the need for additional assessment, especially if there are signs of risk by month of life. One of the more common indicators of deviations is a change in muscle tone, which can be reduced (hypotonia), increased (hypertonia) or combined (dystonia syndrome). These conditions require early intervention by experts within a multidisciplinary team, in which the physiotherapist plays a key role. In addition to assessing the neuromotor status and implementing individualized therapy, the physiotherapist has an important educational role in working with parents, especially in the context of proper handling of the child (so-called baby handling) and implementing exercises to stimulate motor development. The active involvement of parents significantly contributes to the success of the rehabilitation process and ensures optimal conditions for the child's progress