Vliv tréninkového programu na svalovou aktivitu svalů dolních končetin v souvislosti s rizikovými faktory zranění hamstringů u hráčů fotbalu.

• Název práce v češtině: Vliv tréninkového programu na svalovou aktivitu svalů dolních končetin v souvislosti s rizikovými faktory zranění hamstringů u hráčů fotbalu.
• Název v anglickém jazyce: The influence of the training program on muscle activity of lower limb muscles in relation to the risk factors of hamstring injury at soccer players
• Klíčová slova: Hamstringy, zranění, svalové poranění, prevence zranění, fotbal
• Klíčová slova anglicky: Hamstrings, injury, muscle injury, injury prevention, soccer
• Akademický rok vypsání: 2009/2010
• Typ práce: disertační práce
• Jazyk práce: čeština
• Ústav: Fyzioterapie (51-500400)
• Vedoucí / školitel: doc. PaedDr. Dagmar Pavlů, CSc.
• Řešitel: skrytý - zadáno vedoucím/školitelem
• Datum přihlášení: 11.12.2012
• Datum zadání: 11.12.2012
• Datum a čas obhajoby: 09.04.2013 00:00
• Místo konání obhajoby: UK FTVS
• Datum odevzdání elektronické podoby: 12.12.2012
• Datum odevzdání tištěné podoby: 12.12.2012
• Datum proběhlé obhajoby: 09.04.2013
• Oponenti: MUDr. David Pánek, Ph.D.

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Předběžná náplň práce

Vymezení problému:
Zranění hamstringů je pro sportovce závažné zranění a vyžaduje dlouhodobou léčbu
a bohužel i velmi často recidivuje. Následkem tohoto zranění dochází k dlouhodobému výpadku ze sportovní přípravy, proto je nutná jeho prevence.
Mechanismus a příčina vzniku tohoto zranění je stále nejistá a neustále se o ní diskutuje,
ale obecně se hovoří o komplikované multifaktoriální etiologii.
Dle našeho názoru je pro sportovce nejvhodnější vytvoření programu, který je postaven na základě spolupráce fyzioterapeuta a trenéra. Cílem takového tréninku je primární prevence zranění, případně opětovné začlenění zraněného sportovce do tréninkového procesu a prevence recidivy zranění. Na základě této spolupráce by měl být trénink přizpůsoben tréninkovým, terapeutickým a léčebným potřebám. Základní komponentou celého tréninkového, případně terapeutického plánu, by měl být strečink, posilovací
a stabilizační cvičení. Tento trénink by měl být specifický pro ovlivnění případných rizikových faktorů zranění. Pro ovlivnění některých rizikových faktorů doporučují někteří autoři, například Best a Garret (1996), Carruthers, Sancturay (2006),
Kolt, Snyder-Mackler (2003), Tornese et al. (2000) cvičení typu „squat“ a jeho modifikace, „step-up“, „step-up“ laterálně, „step-down“, „cross-lift“, „leg-press“, „leg curls“, „benchpress“, „neckpress“, „dead lift“, posilování abduktorů kyčle a obecná posilovací cvičení, „pawback exercise“, „prone reverse hypers“ a „glute-ham-gastroc raises“. Brukner, Khan (2007) často doporučují využívání tzv. „Nordic eccentric exercise“.
My jsme pro tréninkový program vybrali strečink, squat a jeho dvě modifikace.
V rámci experimentu hodnotíme vliv sestaveného programu na zapojování svalů
po sedmi týdnech pravidelného provádění.
Cíle práce: Hlavním cílem této práce je vytvořit tréninkový program zaměřený
na prevenci zranění hamstringů a následně ohodnotit krátkodobý efekt tohoto programu na timing zapojování m. gluteus maximus, m. biceps femoris caput longum,
m. semitendinosus, m. adductor magnus, m. tensor fasciae latae, m. rectus femoris
při vyběhnutí z polovysokého startu. Dále ohodnotit vliv programu na koaktivaci těchto svalů. Dílčími cíli je sestavení dotazníku vztahujícího se na monitorování četnosti zranění hamstringů u hráčů fotbalu.
Metoda: Na základě literární rešerše je sestaven tréninkový program zaměřený
na prevenci zranění hamstringů. Tento program se podle rešerše zahraniční literatury jeví jako účinný. Vliv programu v praxi ověřujeme pomocí povrchového EMG. Pomocí povrchového EMG je hodnocen timing zapojení svalů m. gluteus maximus, m. biceps femoris caput longum, m. semitendinosus, m. adductor magnus, m. tensor fasciae latae, m. rectus femoris při vyběhnutí z polovysokého startu, zejména podle stanovených funkčních skupin. Funkčními skupinami jsou skupina svalů stabilizujících pánev, extensorů kyčle a flexorů kyčle. Experimentální skupiny tvoří hráči fotbalu České fotbalové ligy a Divize. Probandi jsou rozděleni do dvou skupin. U skupiny I (n=6) je hodnocen timing zapojení svalů, koaktivační poměr svalů a kokontrakční index.
U skupiny II (n=3) je hodnocen timing zapojení svalů a koaktivační poměr. Předintervenčního měření se zúčastnilo třináct hráčů. V průběhu experimentu, sedm týdnů, se dva hráči zranili a dva hráči onemocněli. Z tohoto důvodu je celkový počet hráčů zúčastněných v experimentu devět.
Výsledky: Na základě literární rešerše se jako účinná prevence zranění hamstringů jeví program složený ze zahřátí, strečinku a speciálního cvičení. My jsme pro toto zvolili rozběhání, statický strečink a tři varianty cviku squat. Na základě EMG měření je patrná značná individuální variabilita zapojování jednotlivých svalů při pohybovém stereotypu vyběhnutí z polovysokého startu. Efekt námi sestaveného programu je také individuální, ale je možné pozorovat některé podobné tendence jako je tomu u probandů 1 a 8, probandů 2 a 5, probandů 3 a 4 a probandů 6 a 7. Proband 9 nevykazuje významnější společné rysy s ostatními probandy. Pro statistické vyhodnocení efektu našeho programu je využito neparametrických t-testů. Změny koaktivace jsou hodnoceny
na hladině významnosti p<0.05. Statisticky významné zvýšení koaktivačního poměru
je možné sledovat v případě koaktivace mezi m. gluteus maximus a m. biceps femoris (GM/BF). Statisticky významné snížení pozorujeme u m. adductor magnus a m. biceps femoris (ADD/BF) a m. semitendinosus a m. biceps femoris (ST/BF). Na hladině významnosti p<0.05 došlo také k významnému snížení koaktivačního poměru
m. adductor magnus a m. gluteus maximus (ADD/GM), m. tensor fasciae latae
a m. gluteus maximus (TFL/GM), m. semitendinosus a m. gluteus maximus (ST/GM), m. rectus femoris a m. gluteus maximus (RF/GM) a skupiny hamstringů a m. gluteus maximus (HAM/GM). Snížení koaktivačního poměru m. biceps femoris a m. gluteus maximus (BF/GM) není na hladině významnosti p<0.05 signifikantní. Námi stanovený Hamstring index, poměr m. biceps femoris a m. semitendinosus (BF/ST),
je po intervenci signifikantně vyšší. Významné zvýšení koaktivačního poměru
také pozorujeme u skupiny hamstringů a m. gluteus maximus (GM/HAM). Výsledky
je možné označit za významné vzhledem ke skupině lidí, u které bylo šetření provedeno. Výsledky námi provedeného dotazníkového šetření v letech 2010-2012 poukazují na incidenci zranění hamstringů u fotbalistů 33,33 % z celkového počtu (n=75) hráčů napříč třemi výkonnostními úrovněmi.

Předběžná náplň práce v anglickém jazyce

Objective:
Hamstring strain is a serious injury and requires long-term treatment. Hamstring strain has a high risk of recurence. As a result of this injury is long-term lost of competition and training. Prevention is necessary because of this.
The mechanism and etiology of this type of injury is still uncertain and still under discussion. Multifactorial etiology is commonly discussed.
In our opinion, the best solution is the training program, which is made on the basis
of cooperation the physiotherapists and coaches. The goal of this training program should be primary prevention of injury or reintegration of injured athlete in the training program or the prevention of reccurenc of injury. As the result of this cooperation should be training program with all aspects of training, therapy and treatment. The basic of such training program should be muscle strengthening, core training and stretching. This training should be specific to the elimination of risk factors of injury. Recommendation by some authors, for example Best a Garret (1996), Carruthers, Sancturay (2006), Kolt, Snyder-Mackler (2003), Tornese et al. (2000) is squat and its modifications, step-up, step-up lateraly, step-down, cross-lift, leg-press, leg curls, benchpress, neckpress, dead lift, hip abduktor strengthening, general strengthening exercises, pawback exercise, prone reverse hypers and glute-ham-gastroc raises. Brukner, Khan (2007) usually recommend the Nordic eccentric exercise. We have chosen for our training program stretching, squat and its two modification.
In our study we evaluate the influence of such program on musle timing after seven weeks of regular application.
Aim: The main aim of this study is make a hamstring injury prevention training program and evaluate the short-time effect of this program on timing of m. gluteus maximus, m. biceps femoris caput longum, m. semitendinosus, m. adductor magnus,
m. tensor fasciae latae, m. rectus femoris in running. Also to evaluate the effect of our program on muscle coactivation. Next aim is to make a questionare about the incidence of hamstring injury in Czech football players.
Methods: Literary review is the basic of our training program focusing on hamstring injury prevention. This program is according to the review effective. For the evaluation of this program we use the surface EMG. We have observed the timing of muscles:
m. gluteus maximus, m. biceps femoris caput longum, m. semitendinosus, m. adductor magnus, m. tensor fasciae latae, m. rectus femoris, mainly according to functional muscle groups at the soccer players in running starting position. Functional muscle groups are muscles stabilizing the pelvis, hip extensors and flexors. The experimental group is made by Czech soccer players at the level Czech soccer league and Division. The participants are separated into two groups. In group I (n=6) we evaluate the timing of muscles, coactivation rate and cocontraction index. In group II (n=3) we evaluate
the timing of muscles and coactivation rate. In preintervention measurement took part thirteen players, but during seven weeks of intervention, two of them have injured
and two have got ill. Because of this is the total number of participants nine.
Results: On the literary review it seems that an effective prevention of hamstring injury is program composed of warm-up, stretching and special exercise. Because of this
we have chosen low intensity running, static stretching and three modifies of squat. According to EMG we can see individual variability of muscle timing during semihalf starting position in running. Effect of our program is also very individual, but we can see some similarities like in probands 1 and 8, probands 2 and 5, probands 3 and 4, probands 6 and 7. Proband 9 has no significant similarities with the others.
For statistical assessment are used nonparametric t-tests. The changes in coactivation are evaluated on the significance level level p<0.05. Statistically significant increasing of coactivation rate is in case of m. gluteus maximus and m. biceps femoris (GM/BF). Statistically significant decreasing we can see in m. adductor magnus and m. biceps femoris (ADD/BF), m. semitendinosus and m. biceps femoris (ST/BF), also m. adductor magnus and m. gluteus maximus (ADD/GM), m. tensor fasciae latae and m. gluteus maximus (TFL/GM), m. semitendinosus and m. gluteus maximus (ST/GM), m. rectus femoris and m. gluteus maximus (RF/GM), hamstring group and m. gluteus maximus (HAM/GM). Decreasing of coactivation rate of m. biceps femoris and m. gluteus maximus (BF/GM) is not significant on the significance level level p<0.05. We have established Hamstring index. Hamstring index is rate of m. biceps femoris
and m. semitendinosus (BF/ST). Hamstring index is after seven weeks of intervention significantly higher. Significantly higher coactivation index we can see also in case
of hamstring group and m. gluteus maximus (GM/HAM). The results are significant due to the group of soccer players who were participated in the study. The results
of our questionare conducted in years 2010-2012 show the 33,33% incidence
of hamstring injury at soccer players of the total amount (n=75) players across three performance levels.