The Swedish Journal of Scientific Research (sjsr)

ISSN: 2001-9211. Volume 1. Issue 3. August 2014

12
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THE EFFECT OF THE REHABILITATION APPROACH
ON THE INDICATORS OF PAIN AND SOME PHYSICAL
VARIABLES AFTER PARTIAL RESECTION OF MENIS-
CUS CARTILAGE OF THE KNEE JOINT
* Prof. Dr. Ammar Jassim , **Dr. Qusai Salih
*, ** Physical Education College, Basra Uniersity




















A!stract
The knee joint considered one of the important and large joints in the human body and a per-
centage of injury in this joint (70! of sports injuries" so it has become necessary to maintain
the integrity of this joint" where the things that called for the researcher to choose the problem
discussed although there are studies around is that the selection of the injured sample after do-
ing the procedure by endoscopic way. The study aimed to identify the impact of rehabilitati#e
approach proposed by the researcher for the rehabilitation of the injured (injury medial menis-
cus! of the knee joint. $dentify differences in painkiller and physical #ariables and range of mo-
tion before and after the endoscopic operation and after the rehabilitati#e curriculum " it is
found the presence of differences between the physical #ariables and determinants of mo#e-
ment before and after the endoscopic operation and after rehabilitati#e curriculum and in fa#or
of tests and measurements after the rehabilitati#e curriculum. There are differences in one of
the indicators of pain before and after the endoscopic operation and after rehabilitati#e curricu-
lum" tests and measurements after the rehabilitati#e curriculum. The researcher used the e%-
perimental method to fit the research problem and the selection of the sample by intentional
way which included patients with partial rupture in meniscus cartilage and was numbered (&!.
'esearcher begun his rehabilitation curriculum after endoscopic operation by (four weeks!. and
after the application of the curriculum"tests should be done and then do as before withdrawing
blood and after obtaining the data " (tatistical processor ha#e been done and the most im-
portant conclusions is that the rehabilitati#e curriculum has the impact of re-motor run of the
knee joint and get rid of muscle atrophy of femoral muscle and the de#elopment of some of
the physical #ariables and disposal of pain . the most important 'ecommendation of the re-
searcher is using the endoscopic processes instead of surgical procedures because of their ac-
ti#e role in the limitation of time and effort to return the patient to practice in the sports acti#-
ity" and an emphasis on the use of the curriculum prepared by the researcher because of its role
in the returning the indi#iduals of the sample to a le#el as close as possible to their natural pre-
injury.
)*+,-'.(/ "E#AB$%$&A&$'(. 01+($234. 03'T$34. 23'T$435*. )6**
The Swedish Journal of Scientific Research (sjsr)
ISSN: 2001-9211. Volume 1. Issue 3. August 2014


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1. $6T'-.82T$-6 36. $90-'T362* -: T1* '*(*3'21
The rehabilitation of sports injury became worried for specialists in therapeutic and sports medicine" and how to
return the injured people with less time and effort into an area of sports competitions and although both ha#e his
process of treatment methods but remains rehabilitati#e curriculum is the borderline in the healing of the players
and their return to their le#el of natural. knee joint considered one of the important and large joints in the human
body" whether in the practice of e#eryday business and sports acti#ity" in particular" the percentage of injury at this
juncture (70! of the injuries (;/ 2010! sports that affect athletes so it has become necessary to maintain the in-
tegrity of this joint in #arious sport acti#ities " where injury to any part of it cause stop athletes from participating
in the games and to drop their le#el because of the presence of pain in the area of injury which lead to lower their
technical le#el depending on the type and degree of injury " and since this joint considered an animate part of the
human body so it needs to diet and mo#ement as fle%ion and e%tension and the accompanying contraction and
rela%ation of the surrounding muscles as the basis for its ability to gi#e more and more " therefore its necessary to
focus on the therapeutic curriculum for this joint with the type of injury and the way of -pening of knee either
endoscopic or surgical " the indicators that can be inferred by the le#el of the change in the body of the patient
are biochemical #ariables and physical characteristics and the range of motion
2. '*(*3'21 -<=*2T$>*(
)* preparation a rehabilitati#e approach for the rehabilitation of the injured (injury medial meniscus! of the
knee joint to identify the differences between the physical #ariables and range of motion before and af-
ter the endoscopic operation and after rehabilitati#e approach
+* 8nderstand the differences between chemical indicators before and after the endoscopic operation and
after rehabilitati#e approach
7. '*(*3'21 1+0-T1*(*(
)* The e%istence of differences between the physical #ariables and range of motion before and after the en-
doscopic operation and after rehabilitati#e approach and in fa#or of tests and measurements after reha-
bilitati#e approach
+* There are differences between the chemical indicators before and after the endoscopic operation and
after rehabilitati#e approach
?. '*(*3'21 9*T1-.-4-5+
The researcher used the e%perimental method to sol#e the problem of his research and it is the nearest for sol#ing
problems by intentional way so the researcher and before doing the study should choose an e%perimental design
to test the #alidity of the results deri#ed from his hypothesis (2/ 1@77" p 2A;!
A. '*(*3'21 (3904*
$n order to access to accurate search results" the researcher must choose the sample by the intentional way . The
number of injured athletes with medial meniscus during that period (&! mathematically" where the researcher rule
out a number of respondents who ha#e other injuries in addition to the meniscus injury. The sample ranged in age
between (1&-2A! years
:or the diagnosis of injury" the researcher prepare a preliminary form contains a set of preliminary information
gi#es the initial idea to bring a sample of the patient and make some initial measurements (height and weight!. $n
order to #erify that the sample was distributed normally in some of the #ariables related to the topic of research
The Swedish Journal of Scientific Research (sjsr)
ISSN: 2001-9211. Volume 1. Issue 3. August 2014


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and that ha#e a clear impact on the #alidity and accuracy of the results" the researcher conducting homogeneity of
the sample and" as shown in table (1!.
Table 1 shows the mean" standard de#iation and coefficient of #ariation and coefficient of torsion of the research
sample
coefficient
of torsion
coefficient
of variation
Standard
deviation
The arith-
metic mean
Unit of measure-
ment
variables Sequence
0.801 2.953 5.15475 174.500 cm length 1
0.000 9.351 6.54654 70.000 kg weight 2
0.862- 14.414 0.99103 6.8750 year Training age 3
0.361 2.498 3.226 129.125 degree Flexion of
knee
4
0.479 1.771 2.878 162.500 degree Extension of
knee
5
0.294- 19.031 1.356 7.125 The number of
times
The rapid
force - belly
6
1.217- 18.036 1.488 8.250 The number of
times
The rapid
force -half
debna
7
0.304- 17.487 1.246 7.125 The number of
times
The rapid
force com-
plete debna
8
0.270 21.161 4.920 23.250 The number of
times
Endurance
force- belly
9
0.187- 10.921 3.181 29.125 The number of
times
Endurance
force half
debna
10
0.089 13.800 3.502 25.375 The number of
times
Endurance
force com-
plete debna
11
1.986 15.617 34.574 221.375 mili-
ter/pikogram
Pain killer-
beta endorphin
12

$n order to ensure that the research sample was distributed normally" the researcher conducting homogeneity of
the sample (meniscus cartilage! as in Table 2
Table (2) Shows arithmetic means and standard deviations and the values of the coefficient of variation and coeffi-
cient of torsion of a sample (meniscus cartilage) after the endoscopic procedure in research variables
coefficient
of torsion
coefficient
of varia-
tion
Standard
deviation
The arith-
metic
mean
Unit of measure-
ment
variables Sequence
0.733 1.905 2.549 133.750 Degree Flexion of
knee
1
0.069 2.360 4.0155 170.125 degree Extension of
knee
2
0.518 17.970 1.505 8.375 Number of times The rapid
force - belly
3
0.045 9.976 1.060 10.625 Number of times The rapid
force half
debna
4
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ISSN: 2001-9211. Volume 1. Issue 3. August 2014


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1.188 17.008 1.552 9.125 Number of times The rapid
force com-
plete debna
5
0.156 18.544 5.262 28.375 Number of times Endurance
force- belly
6
0.411 9.474 3.399 35.875 Number of times Endurance
force- half
debna
7
0.219 11.988 4.166 34.750 Number of times Endurance
force com-
plete debna
8
10.645 21.132 198.500 mili-
ter/pikogram
Pain killer-
beta endor-
phins
9
$t was used the coefficient of #ariation and coefficient of sprains as a means of statistical processing for treating
the physical #ariables and range of motion and atrophy of femoral muscle working on the affected knee and pain
killer after the endoscopic procedure" and .ue to the coefficient of #ariation not e%ceed of class (70!" and also
coefficient of torsion" which is limited to a #alue between (B - 7!" which reflects the homogeneity the sample in
those #ariables and it is distributed normally
;. T1* (855*(T*. '*13<$4$T3T$>* 28''$28489
The researcher prepared rehabilitati#e curriculum to de#elop some physical characters and range of motion" pain-
killer and for rehabilitation athletes injured with knee joint after the eradication of the medial meniscus. ,here
the researcher did the application of the curriculum (for the injured meniscus medial! of the injured athletes" be-
tween the day and the last" and the rehabilitati#e curriculum of the cartilage include on (2?! rehabilitati#e unit "
and the duration of each unit (A0-@0 minutes!" with the knowledge that the roll-out curriculum begins after four
weeks of the operation" after injured athlete finished the initial phase initial after the endoscopic operation which
are at the center of the martyr Cais 3bdul 9ajeed for medical rehabilitation and physical therapy through the use
of e%ercises of isometric and isotonic and with little weights and resistances through physiotherapist specialist for
the rehabilitation of injured athletes at this stage. the researcher 1as taken into account within the curriculum
easy to difficult and simple to comple% with the gradual increase weight" also taking into account the principle of
gradient in the training load " also the researcher took into account the intensities of e%ercises used as well as the
se#erity of the rehabilitati#e unit completely " the researcher also used in his curriculum the pressing bands to
pre#ent swelling (bloody effusion! in the knee joint and allow the tissue in the area of operation of the rapid heal-
ing . 3s a researcher used in his curriculum the stretch and at two periods before the start of the rehabilitati#e unit
3t the end of the unit " as well as the use of refresher warm-up e%ercises and abdominal e%ercises as well as the
use of e%ercises (winding running! and it is a good test for the mo#ement of the cartilage inside the joint and use
the e%ercises typical in the warm-up as well as the use of the bar and sticks and .umbbells and light weights be-
fore the start of the unit to prepare the injured for the performance of the rehabilitati#e unit and the ability to lift
weights in the rehabilitati#e unit" as the researcher using the bags and ice bottles after the end of each unit in the
curriculum for each injured.
7. 0'*(*6T3T$-6 36. .$(28(($-6 T1* '*(84T(
0resentation and discussion of analysis of #ariance (:! of the physical and biochemical #ariables (before and after
the operation and after the curriculum! of the medial meniscus
Table (7! shows the results of analysis of #ariance (:! between the measurements and tests of physical and bio-
chemical #ariables and determinants of mo#ement (before and after the operation and after the curriculum!
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ISSN: 2001-9211. Volume 1. Issue 3. August 2014


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(tatistical
signifi-
cance
The calcu-
lated #alue
of (:!
3#erage
sDuares
The de-
gree of
freedom
(um of
sDuares
(ources of
#ariation
>ariables seDuence
significant 2;.;7& 17A.7@2 2 7A1.A&7 <etween
groups
The range
motion of
the knee-
fle%ion
1
;.A&@ 21 17&.77A $nside
groups
significant 7;.&0? ?7A.2@2 2 &70.A&7 <etween
groups
'ange of
motion of
the knee -
e%tension
2
11.&27 21 2?&.77A $nside
group
significant 27.;22 77.1;7 2 1?;.777 <etween
groups
'apid force
of belly
7
2.;?@ 21 AA.;2A $nside
group
significant 2@.707 ?2.7@2 2 &A.A&7 between
groups
'apid force
E half
debna
?
1.?? 21 70.2A0 $nside
group
significant 2&.220 ?&.0?2 2 @;.0&7 <etween
groups
'apid force
E complete
debna
A
1.702 21 7A.7A0 $nside
group
significant 1A.A@1 ?1;.7@2 2 &&7.A&7 <etween
groups
*ndur-
ance
force -
belly
;
2;.772 21 A;1.77A $nside
group
significant 2A.;27 771.7@2 2 1?;7.A&7 <etween
groups
*ndur-
ance
force E half
debna
7
2&.A;0 21 A@@.7A0 $nside
group
significant ?1.A71 &A7.12A 2 170;.2A0 <etween
groups
*ndur-
ance
force E
complete
debna
&
20.A?2 21 ?71.77A $nside
group
significant 1;2.A?; @A22@.12
A
2 1@0?A&.7 <etween
groups
<eta en-
dorphins
@
A&A.&A@ 21 12707.07
0
$nside
group
&a!ulated f under the leel of significance ,.,- and degree of freedom .+*+)/ 0 1.23
Through the table (7! shows the results of the #alues of calculated : to measure the range of motion of the knee
(fle%ion - e%tension! 'eport (2;.;7& to 7;.&0?!" which is the more than the Tabulated #alue of : "the le#el of sig-
nificance (0.0A! and the degree of freedom (2-21!" demonstrating the presence of significant differences between
the results of tests of motion range of the knee (fle%ion - e%tension! (before and after the operation and after the
curriculum!. ,hile the results of calculated : in tests of physical #ariables of rapid *ndurance
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(of the abdomen - the two legs E half dbna " full .bna!" respecti#ely (27";22 - 2@.707 to 2&.220!" which is more
than the tabulated #alues of :
8nder the le#el of significance (0.0A! and the degree of freedom (2-21!" demonstrating the presence of significant
differences between the results of rapid *ndurance
Tests (of the abdomen - the two legs dbna " .bna full! (before and after the process and after the curriculum!" ha#e
reached results :!! . the results of calculated : in #ariable physical tests :or *ndurance force (of the abdomen - the
two legs half dbna" .bna full!" respecti#ely (1A"A@1 - 2A.;27 to ?1.A71!" which is more than the #alues of tabulated
: under the le#el of significance (0.0A! and the degree of freedom (2-21! which means that there are significant
differences between the results of stretch force tests (of the abdomen - the two legs half dbna" .bna full! (before
and after the process and after the curriculum! while the #alue of calculated (:! for the painkiller beta endorphins
(1;2.A?;!" which is greater than the #alue of Tabulated (:! below the le#el of significance (0.0A! and the degree of
freedom (2 - 21!" demonstrating the presence of significant differences between the results of measurements of
painkiller beta endorphins (before and after the operation and after the curriculum! for a medial meniscus.
$n order to find out which tests are better than the other" the researcher used the test with less significant differ-
ence (4(.! which is shown in Table ?.
(tatistical
significance
>alue of
4.(..
'esults of
differences
.eferens
between
means
groups #ariables seDuence
significant 2.20& 7.271 ?.;2A 12@.12A-
177.7A0
51-52 9otion range
of knee E fle%-
ion
2
significant @.77A 12@.12A-
17&.A00
51-57
significant ?.7A 177.7A0-
17&.A00
52-57
6ot signifi-
cant
2.@A& ?.72@ 7.;2A 1;2.A00-
170.12A
51-52 9otion range
of knee E e%-
tension
7
significant 1?.7A 1;2.A00-
177.2A0
51-57
significant 7.12A 170.12A-
177.2A0
52-57
significant 1.?00 2.0?& 1.2A0 7.12A-
&.77A
51-52 'apid force of
belly
?
significant A.7? 7.12A-
12.&7A
51-57
significant ?.?@ &.77A-
10.;2A
52-57
significant 1.072 1.A10 2.77A &.2A0-
10.;2A
51-52 'apid force of
legs E half
dbna
A
significant ?.;2A &.2A-
12.&7A
51-57
significant 2.2A 10.;2A-
12.&7A
52-57
6ot signifi-
cant
1.122 1.;?2 1.@@ 7.17A-
@.12A
51-52 'apid force of
legs E com-
plete dbna
;
significant ?.&;A 7.17A- 12 51-57
significant 2.&7A @.12A- 12 52-57
significant ?.??& ;.A0& A.12A 27.2A0-
2&.77A
51-52 *ndurance
force- belly
7
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significant 1?.2A 27.2A0-
77.A00
51-57
significant @.12A 2&.77A-
77.A00
52-57
significant ?.A@7 ;.727 ;.7A 2@.12A-
7A.&7A
51-52 *ndurance
force for legs E
half dbna
&
significant 1&.&7A 2@.12A-
?&.000
51-57
significant 12.12A 7A.&7A-
?&.000
52-57
significant 7.&@@ A.70A @.77A 2A.77A-
7?.7A00
51-52 *ndurance
force E full
dbna
@
significant 20.;2A 2A.77A-
?;.000
51-57
significant 11.2A 7?.7A00-
?;.000
52-57
significant 20.&2? 70.?;& ;?.77A 221.77A-
1A7
51-52 <eta endor-
phins
10
significant 212.7A 221.77A-
;2A.&
51-57
significant 1?&.77A 1A7-&.;2A 52-57
Through the presentation of the #ariables in Table ? note the de#elopment is clear in muscle power (speed-
strength! and in fa#or of the test after the curriculum and researcher attribute the reason for this de#elopment to
the nature of the curriculum and the therapeutic units in a scientific images of and how to manipulate with the
se#erity" siFe" and time where researcher began fi%ing time (70 seconds! when you get to the se#erity (7A! and
they arri#ed to the intensity of (100!" where the increase in weight and duplications which reach to (1A! recur-
rence and this led to a state of adaptation of the ner#ous system and the fle%ibility of the motor ner#es as a result
of duplications performed by the injured athlete which transfer ner#ous stimulations and the occurrence of the
process of muscle contraction of the muscle as well as acts of reflecti#ity and what the muscle contain of spindles
to reach the brain the limits of contraction and thereby increasing in the speed of muscle contraction as a result
of an increase greater number of muscle fibers by progression and o#erload .
the progression (or o#erload! states that the adjustment of output and hence the increase in the potential func-
tional ability are eDual to the siFe of the load while the second gradient base dictate to the practitioner to increase
the training load gradually" so as to ensure occurrence of adaptation in the muscle itself" and thus training e%er-
cise of muscle strength done at high speeds" in order to simulate what happens in most sports mo#ements on the
ground" which helps the occurrence of reDuired neuromuscular adjustment .
3s a rule known in regular training leads to prior ner#ous adaptation then muscular adaptation and this was con-
firmed (A/ 1@2! that the ner#ous system responds by type of contraction (0.7/ 2012 Gpp. @7-@&! and through the
display and analysis of stretch force "noticed the preference of tests after the curriculum and this is due to the na-
ture of the curriculum and its contents of therapeutic units and how to climb the duration of time of therapeutic
units" starting from (A& minutes to @1 minutes! which lead to the de#elopment of endurance strength as well as
the increase in the number of groups and duplicates the content of the e%ercises in the therapeutic unit and that
led to physiological changes in muscle and its ability to withstand fatigue as well as the e#olution in the circulatory
and respiratory systems as it is Hwhen you use a motor contraction must take muscle range of full motion" which
led to secure full ner#es of muscle" and thus muscular contraction by shortening and elongation work positi#ely to
stimulate and impro#e the functioning of the circulatory system and muscular system in the direction of endurance
The Swedish Journal of Scientific Research (sjsr)
ISSN: 2001-9211. Volume 1. Issue 3. August 2014


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for the understanding of factors that are complementary to each other. (?/ 1@@ Gp. 122!" and when analyFing the
results (4(.! to identify significant differences in arithmetic means for the #ariable of painkiller (beta endorphin!
offered by the table (@!" showing that the results of the differences between tests before and after the process was
(;?.77A!" which is greater than the #alue of 4(. under the le#el of significance (0.01! and adult (70.?;&!" which in-
dicates the presence of significant differences between the two tests before and after the process and in fa#or of
the test after the operation
$t turns out that the results of the differences between the two tests before the operation and after the curriculum
was (212.7A0!" which is greater than the #alue of 4(. under the le#el of significance (0.01! and adult (70.?;&!"
which indicates the presence of significant differences between the two tests before the operation and after the
curriculum and in fa#or of the test after the curriculum" and show that the results of the differences between the
two tests after the operation and after the curriculum was (1?&.77A!" which is greater than the #alue of 4(. under
the le#el of significance (0.01! and adult (70.?;&!" which indicates the presence of significant differences between
the two tests after the operation and after the curriculum and in fa#or of the test after the curriculum" and also
noted from this that the test after the curriculum to the #ariable painkiller (beta-endorphin! was the best. the re-
searcher 3ttributed this de#elopment which happened to members of injured athletes by detecting the e%tent of
their arri#al to the healing phase or the closest to heal by the pain e%pressed by the painkiller (beta endorphins!
which the pituitary gland responsible of it " where secreted when there is pain in the body in order to try to curb
this pain when e%creted significantly demonstrates the presence of pain and this is what we ha#e obser#ed in
measurements before and after the operation and after the curriculum where it began after the curriculum se-
crete a few amounts which demonstrates the arri#al of injured athletes to the stage of healing <y strengthening
the muscles and ligaments surrounding them and increase their efficiency and thus stopping pain and decrease
secretion of endorphins. (&/ 200@" p 170!
&. 2-6248($-6(
)* rehabilitati#e approach has effect in returning the motion range of knee joint and get rid of muscular atro-
phy of femurs and reduce pain
+* There are differences between the physical #ariables addressed by the research between the three tests
(before the operation and after the operation and after the curriculum! and in the fa#or of after the cur-
riculum which demonstrates the impro#ed neural signal and increase the number of operating motor
units
1* There are differences between the range of motion in the three measurements (before the operation and
after the operation and after the curriculum! and in the fa#or of the after curriculum and it refers to the
return of the safety of the affected joint and remo#e the motor range
2* The results of some of the physical #ariables and range of motion refers to some e#olution after the endo-
scopic operation (meniscus cartilage! resulting from the therapeutic curriculum
-* drop out of training before the endoscopic procedure due to injury showed the results of weakness and
atrophy of muscle groups working on the knee joint as well as to determine the $dentification of the joint
'*:'*62*(
)* 3bul-*la 3hmed 3bdel :attah/ training sports and physiological bases" .ar 3l- :ikr 3l- 3rabi i 1" 1elwan
8ni#ersity" 2airo" 1@@7
+* 3hmed <adr/ -rigins of scientific research and its methods" i 1" )uwait" agency of publications 0.1@77 m"
The Swedish Journal of Scientific Research (sjsr)
ISSN: 2001-9211. Volume 1. Issue 3. August 2014


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1* 1aFFa <in 9ohd 3l-1aFFa / (elected Topics in physiology of acti#ity and physical performance" i 1" 'iyadh"
2012
2* <astawisi 3hmad/ principles and theories of training sports" .ar el :ikr al 3rabi" 2airo" 1@@;
-* 4ouay )aFim/ the effect of rehabilitati#e curriculum on according to the bio- rhythm in some physical at-
tributes and range of motion and bio-chemical #ariables after the eradication of the cartilage of the knee
joint" doctoral thesis" 2010
4* 9arwan 3bdel 9ajid $brahim/ descripti#e statistics and inferential" i 1" -man" .ar el fikr for printing and
publishing" .istribution 0.2000 m

3* 9ajid 3l 9ajali" Iiad *rmala/ The effect of using bullet massage and therapeutic e%ercise in the rehabilita-
tion of injured with disc in the cer#ical #ertebrae of the spine. (cientific 2onference of the si%th athlete.
3mman. =ordan. 200@ pp. 170
5* )omip >. (trcnyht and power in sport the -lympic book of sport medicint. <lake werll scientific publica-
tion 5ermany. 1@@2








Address for corres6ondence7
Author: Dr.Qusai Salih , inst.Assistant , collage of physical education , basrah university
E-mail: qusaimallah@yahoo.com