AKE’nin PFA’lı hastalarda ağrı, alt ekstremite biyomekanisi ve fonksiyonelliği üzerine etkinliğini araştırmak amacıyla yaptığımız bu çalışmada, rastgele olarak iki gruba ayırdığımız PFA’lı hastalarımızdan birinci gruba dahil olanlar diz ve kalça egzersizlerinden oluşan bir egzersiz programı ile, ikinci grup diz ve kalça egzersizlerinden oluşan aynı egzersiz programına ek olarak AKE’nin yer aldığı egzersiz programı ile 6 hafta süresince haftada 2 gün takip edildiler.
Çalışmamızın sonucunda ulaştığımız sonuçlar ve öneriler şunlardır:
● Çalışmamızda hastalarımızda her iki grupta da ağrı açısından gözlemlediğimiz iyileşme egzersizin PFA rehabilitasyonunda en önemli yaklaşım olduğunu bir kez daha ortaya koymuştur.
● Çalışmamız sonucunda ağrının AKEP grubunda daha belirgin olarak azalmasının, AKE’nin ayak biyomekanisine etkisi aracılığıyla dizin dinamik ve statik stabilitesine olan desteğinden kaynaklandığını düşünmekteyiz. ● Ayak pronasyonuna yönelik uyguladığımız AKE’nin navikülanın pozisyonu,
Q açısı ve dize olan valgus stresini olumlu yönde etkileyeceğini söyleyebiliriz.
● Çalışmamızda temel amaçlarımız arasında yer almamasına ve bununla ilgili istatistiksel ilişki analizi yapmamış olmamıza karşın NDT ve KTA ile uyumlu olması açısından APİ, PFA’da kullanılabilir bir değerlendirme olarak akılda bulundurulmalıdır.
● Kalça ekstansör ve abduktör kaslarında kaydedilen kuvvet artışının AKE ile stabilizasyona olan ek destekten de kaynaklanabileceğini düşünmekteyiz. ● PFA’da egzersizin ağrıdaki iyileşmeye paralel olarak fonksiyon ve sağlık
düzeyine yansıdığı her iki grubumuzda da belirgin olarak görülmektedir. Ancak diğer bulgularımızın desteğiyle AKE, fonksiyonel ve sağlık düzeyinde daha belirgin iyileşmeye yol açmıştır.
● Bu çalışmada uygulanan egzersizlerin hepsi fizyoterapist tarafından hastanın eğitimi, yönlendirmesi ve gözetimi altında yapılmıştır. Bu detaylı egzersiz eğitimi yaklaşımının, hastaların egzersizleri net olarak anlamasını ve kompansasyonların önlenerek tam hedefe yönelik tedavinin
gerçekleştirilebilmesini sağlayarak sonuçta tedaviye artan uyum ve devamlılığın kazanılmasında etkili olmuştur.
● Bu çalışma AKE egzersizlerinin PFA’da kullanılabilirliğinin sunulduğu ilk çalışma olması nedeniyle özgündür.
● Bu çalışmayı takiben planlanacak çalışmalarda hastalar daha uzun dönem tedaviye alınabilir veya takipleri yapılabilir.
● Çalışmamızda AKE’yi 6 haftalık süreçte kademeli olarak ilerlettik. Daha uzun süreli tedaviyi içerecek programlar farklı zeminlerin kullanımı veya dinamik aktiviteler sırasında eğitimler şeklinde çeşitlendirilebilir.
● Hastaların uzun dönem takipleriyle AKE’nin uzun vadeli etkileri ve bu etkilerin kalıcılığı değerlendirilebilir.
● Hastaların ayak pronasyon oranları sınıflandırılarak, AKE ve ayak intrinsik kas eğitimi alan her sınıfın kendi içinde ve diğer sınıflara göre değişimleri değerlendirilebilir.
● PFA’lı hastalarda kullanılabiliecek diğer ayak egzersizlieri ile AKE karşılaştırılarak en etkin egzersiz veya egzersizler klinik kullanıma sunulabilir.
● PFA’nın sıklıkla görüldüğü koşucular başta olmak üzere çeşitli spor dallarındaki sporcuların antrenman programlarında koruyucu bir yaklaşım olup olmayacağı konusuna dikkat çekilebilir.
● Dinamik değerlendirmeler kapsamında enerji tüketim ölçümlerinin değerlendirilmesi de bu egzersiz programlarıyla meydana gelen fonksiyonel iyileşmeleri kas kuvveti, ayak biyomekanisi ve yürüyüş ilişkisi dahilinde daha nesnel olarak ifade edebilmesine yardımcı olabilir.
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