When building training and rehabilitation loads in football, in particular after injury of the ankle joint (AJ), special interest from coaches, doctors and physical therapists are athletes with hypermobility of the joints (HMJ), which may be a sign of connective tissue dysplasia (CDT). Systemic involvement of connective tissue in the dysplastic process in HMJ affects the state of the musculoskeletal system and cardiovascular system, which must be taken into account when applying rehabilitation loads.
Results. At the first stage, a study of the prevalence of external and cardiac signs of CTD among persons engaged in health and sports training. At this stage the study involved 247 people aged 7 to 40 years. At the II and III stages of the study to establish the morphological features and level of aerobic productivity and the impact of the physical therapy program included 46 football players who had acute damage to the ligamentous apparatus of the AJ. Patients in the main group were prescribed a 12-week program of physical rehabilitation depending on HMJ.
Among athletes dysplastic symptoms occurred in 23.9 %. It was found that the most common athletes are HMJ, flat feet, asthenic body structure, dolichostenomelia, posture disorders, wedge-shaped and funnel-shaped chest deformity. 56.5% of players had normal mobility in the joints, 30.4% moderate HMJ and 13.0% significant HMJ. A study of body composition distributed by HMJ level indicated that the lowest total fluid level was in the group with severe HMJ and was 41.1±2.3% (p<0.05).
Among athletes, the frequency of cardiac signs of CTD was 10.9%. Atypically located chords, additional chords and valve prolapses were the most common. Thus, statistically significant evidence was obtained for the relationship between the degree of HMJ and the diameter of the aortic root, and with increasing HMJ score, the diameter of the aorta decreased. It has also been found that as the degree of HMJ increases, the stroke volume of the left ventricle (LV) decreases statistically significantly. In addition, the posterior wall of the LV and the interventricular septum were thinner, significant increase in the E/e ratio.
It was found that in athletes with signs of CTD during exercise the level of LV ejection fraction decreased earlier at the third stage of load (p<0.05).
The level of PWC in athletes with CTD was statistically significantly lower (p<0.05).
With an increase in the level of HMJ there was a decrease in the level of PWC (p <0,05).
In football players with significant HMJ, the level of increase in aerobic productivity during the training cycle was lower by an average of 6.2±0.7 ml/min/kg.
At the beginning of the study, the indicators of daily activity were significantly reduced in both subgroups of observation and amounted to 62.8±1.5% in the main group and 64.3±1.3% in the control group. In addition, the decrease in the ability to perform sports activities was reduced in both the main and control groups even more and reached the level of 45.4±2.2% and 46.8±1.7%, respectively.
At 4 weeks of application of rehabilitation programs, the difference between the percentage of ability to perform household loads between the main and control groups reached an average of 8.4±0.1% and professional ability – 6.3±0.1% (p <0.05). It was obtained in the main group at 4 weeks higher results on the CAIT scale, in both static and dynamic balance and static and dynamic neuromuscular control (p<0.05).
The study of the dynamics of the amplitude of movements in the NHJ indicated the highest level in the main group.
The detailed analysis of the data indicated that there was a positive dynamics of physical working capacity in the main group (p<0.05).
Among athletes of the main group, cases of repeated injuries occurred in 21.7%, and in the control group in 73.9% (<0.05).
Scientific novelty of the results. For the first time the positive influence of the differentiated program of physical therapy taking into account the degree of HMJ was proved on the level of daily and sports activity, self-assessment of instability, static and dynamic balance, nervous muscle control in static and dynamic modes, the amplitude of dorsiflexion in the ankle joint, physical performance and preventive effect of the developed rehabilitation program on the frequency of recurrent injuries of the ankle joint for one year. It was first found that with increasing levels of HMJ there is a deterioration of diastolic function of the left ventricle. For the first time, the peculiarities of body composition in football players with HMJ.
Practical significance of the obtained results. The program of physical rehabilitation of ankle sprain in a football player with hypermobility of the joints has been developed, substantiated and implemented in health care practice.
Key words: soccer players, connective tissue dysplasia, hypermobility of joints, injuries, ankle joint, physical therapy.
