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    "titulo" => "<span class="elsevierStyleItalic">Return to play&#58;</span> Cap a on anem&#63; Aix&#242; no &#233;s un joc d&#8217;endevinalles"
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    "textoCompleto" => "<p class="elsevierStylePara"> </p><p class="elsevierStylePara"> Tenint en compte les darreres publicacions cient&#237;fiques&#44; l&#8217;estudi del <span class="elsevierStyleItalic">Return to play</span> &#40;RTP&#41; ha fet pocs progressos&#44; o fins i tot ha anat en una direcci&#243; equivocada<span class="elsevierStyleSup">1-3</span>&#46; Avui en dia&#44; tan sols un petit nombre d&#8217;estudis estan abordant el tema adequadament i centrant la seva atenci&#243; en la realitat del futbol<span class="elsevierStyleSup">4</span>&#46; Aix&#237;&#44; &#233;s necessari fer-se diverses preguntes&#46;</p><p class="elsevierStylePara"> &#8226; Com estem avaluant el RTP avui en dia&#63;</p><p class="elsevierStylePara"> &#8226; Com haur&#237;em d&#8217;entendre el proc&#233;s de RTP&#44; com un pas est&#224;tic integrat per una s&#232;rie de punts que cal realitzar quan el jugador lesionat ha arribat a la fase final de recuperaci&#243; o com un proc&#233;s constant de presa de decisi&#243;&#63;</p><p class="elsevierStylePara"> Francament&#44; les decisions que fem des del comen&#231;ament de la lesi&#243; afecten els criteris finals del RTP<span class="elsevierStyleSup">5</span>&#46; La primera decisi&#243; condiciona la seg&#252;ent i de seguida es desenvolupa una xarxa de decisions que impliquen un llarg proc&#233;s en qu&#232; diverses variables interactuen&#46; Quines s&#243;n&#44; m&#233;s espec&#237;ficament&#44; aquestes variables&#63;</p><p class="elsevierStylePara"> &#8226; Una diagnosi correcta&#46;</p><p class="elsevierStylePara"> &#8226; Un control estricte de la c&#224;rrega de treball durant el proc&#233;s de recuperaci&#243;&#46;</p><p class="elsevierStylePara"> &#8226; Una gesti&#243; intel&#183;ligent dels modificadors de risc de l&#8217;esport i dels modificadors de decisions&#46;</p><p class="elsevierStylePara"> Abans de descriure en profunditat aquestes variables&#44; &#233;s important constatar que el RTP ha de ser ent&#232;s com un proc&#233;s din&#224;mic i personalitzat&#46; El principal objectiu no ha de ser predir la durada del proc&#233;s de RTP&#44; sin&#243; evitar futures recaigudes&#59; no &#233;s un joc d&#8217;endevinalles&#46; Al llarg d&#8217;un proc&#233;s din&#224;mic hi ha molts factors que interactuen tot modificant el resultat final&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Una diagnosi correcta </span></p><p class="elsevierStylePara"> L&#8217;error m&#233;s greu que es pot cometre de cara al proc&#233;s de RTP &#233;s un diagn&#242;stic erroni&#46; Aix&#242; causar&#224; que les decisions que es prenguin sobre la lesi&#243; siguin incorrectes i mal plantejades&#44; i aquestes s&#243;n decisions que tenen una gran influ&#232;ncia sobre el resultat final<span class="elsevierStyleSup">6</span>&#46; Analitzem-ne alguns aspectes&#46;</p><p class="elsevierStylePara"> Quin &#233;s el paper de la resson&#224;ncia magn&#232;tica en el RTP&#63; Estem d&#8217;acord que la resson&#224;ncia magn&#232;tica no &#233;s una eina gaire &#250;til de cara als darrers criteris de decisi&#243; pel que fa al RTP<span class="elsevierStyleSup">7&#44;8</span>&#44; per&#242; &#233;s molt &#250;til a l&#8217;inici<span class="elsevierStyleSup">9</span>&#46; En relaci&#243; a la medicina de l&#8217;esport&#44; hi ha lesions que han de ser tractades quir&#250;rgicament de forma immediata i&#44; si els metges cl&#237;nics no tenen prou experi&#232;ncia a l&#8217;hora d&#8217;interpretar la resson&#224;ncia i els s&#237;mptomes cl&#237;nics&#44; no seran capa&#231;os de consolidar el tractament correcte&#44; de manera que la predicci&#243; final respecte el RTP no ser&#224; acurada<span class="elsevierStyleSup">10</span>&#46;</p><p class="elsevierStylePara"> Un bon diagn&#242;stic &#233;s el pas m&#233;s rellevant&#44; la veritable pedra angular&#44; de cara a un RTP adequat&#46; En la medicina de l&#8217;esport no &#233;s adequat considerar per separat les eines que utilitzem en el tractament d&#8217;una lesi&#243;&#46; No podem recolzar-nos &#250;nicament en la resson&#224;ncia magn&#232;tica&#44; els s&#237;mptomes cl&#237;nics o el GPS per separat&#59; per contra&#44; el que cal fer &#233;s considerar totes aquestes eines com una part fonamental en el proc&#233;s de presa de decisions&#46; Si no ho fem aix&#237; i treballem amb cadascuna d&#8217;elles per separat&#44; perden el seu valor&#46;</p><p class="elsevierStylePara"> En refer&#232;ncia al diagn&#242;stic&#44; hi ha moltes variables que encara no es tenen en compte quan parlem d&#8217;aquestes lesions&#58; la variabilitat anat&#242;mica o els diversos processos de curaci&#243; dels teixits conjuntius<span class="elsevierStyleSup">11&#44;12</span> &#40;tend&#243;&#44; teixit miotendin&#243;s o f&#224;scies&#41;<span class="elsevierStyleSup">13</span> s&#243;n factors importants per definir una lesi&#243; muscular<span class="elsevierStyleSup">14</span>&#46;</p><p class="elsevierStylePara"> En aquest sentit&#44; cal fer notar que la recuperaci&#243; d&#8217;un tend&#243;<span class="elsevierStyleSup">15</span> &#233;s molt diferent que la reparaci&#243; muscular&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Control estricte de les c&#224;rregues de treball </span></p><p class="elsevierStylePara"> Per establir quan s&#8217;ha completat el RTP hi ha diverses definicions&#46; Algunes d&#8217;elles s&#243;n&#58;</p><p class="elsevierStylePara"> &#8226; Quan s&#8217;ha assolit el mateix nivell previ a la lesi&#243;&#46;</p><p class="elsevierStylePara"> &#8226; Quan s&#8217;ha finalitzat el programa de rehabilitaci&#243;&#46;</p><p class="elsevierStylePara"> &#8226; Quan s&#8217;ha retornat a l&#8217;activitat completa i hi ha disponibilitat per a l&#8217;entrenament&#46;</p><p class="elsevierStylePara"> Amb tot&#44; la m&#233;s acurada &#233;s la que diu que el RTP s&#8217;assoleix quan hi ha disponibilitat plena per disputar partits<span class="elsevierStyleSup">16</span>&#44; ja que cal entendre la fase d&#8217;entrenament com a part del proc&#233;s de recuperaci&#243;&#46;</p><p class="elsevierStylePara"> Si anem m&#233;s enll&#224;&#44; sorgeixen noves preguntes&#46;</p><p class="elsevierStylePara"> &#8226; Qu&#232; significa &#171;nivell previ a la lesi&#243;&#187;&#63; Hi ha un punt en el qual hom est&#224; completament sa&#63; Qui pot assegurar que el nivell d&#8217;abans de la lesi&#243; era totalment adequat<span class="elsevierStyleSup">17-19</span>&#63; Sovint&#44; abans de la lesi&#243; ja hi havia un proc&#233;s de mala adaptaci&#243;&#44; cosa que voldria dir que el jugador ja estava en risc&#46;</p><p class="elsevierStylePara"> &#8226; Ens lesionem per p&#232;rdua de for&#231;a&#63; Com t&#233; lloc aquesta p&#232;rdua&#63; Succeeix a causa d&#8217;un d&#232;ficit en l&#8217;entrenament&#44; per una mala adaptaci&#243; a la competici&#243; o per una sobrec&#224;rrega en els exercicis de gimn&#224;stica preventiva&#63;</p><p class="elsevierStylePara"> La segona pedra angular &#233;s la personalitzaci&#243; de les c&#224;rregues de treball<span class="elsevierStyleSup">20</span>&#46;</p><p class="elsevierStylePara"> El futbol ha evolucionat de manera extraordin&#224;ria en els darrers 6 anys&#44; i els jugadors s&#8217;han hagut d&#8217;adaptar al &#171;nou esport&#187; r&#224;pidament&#46; Algunes estrat&#232;gies han estat superades&#46; La majoria dels exercicis inclosos com a prevenci&#243; secund&#224;ria no tenen efectes preventius i la majoria de vegades sobrecarreguen els m&#250;sculs&#46; Hem de comen&#231;ar a canviar el concepte de prevenci&#243;&#58; el nou ha de ser el d&#8217;adaptaci&#243;&#46; Les lesions per distensi&#243; muscular no han de ser enteses com un trencament mec&#224;nic de teixit sa&#44; sin&#243; com una s&#232;rie de respostes adaptatives anormals que&#44; a la llarga&#44; no permetran que el teixit s&#8217;adapti a les creixents c&#224;rregues i tensions&#46;</p><p class="elsevierStylePara"> Una avaluaci&#243; est&#224;tica de les capacitats del jugador independentment de l&#8217;&#224;mbit esportiu &#233;s el nou repte a qu&#232; ens hem d&#8217;enfrontar&#46;</p><p class="elsevierStylePara"> A part de l&#8217;exploraci&#243; cl&#237;nica o la resson&#224;ncia magn&#232;tica&#44; els ex&#224;mens al camp amb el suport del GPS<span class="elsevierStyleSup">21-23</span> comencen a ser considerats importants pels equips m&#232;dics i t&#232;cnics a l&#8217;hora de personalitzar el progr&#233;s de la lesi&#243; i obtenir un marc de confian&#231;a en el qual donar validesa al RTP&#44; aix&#237; com en l&#8217;avaluaci&#243;&#44; monitoritzaci&#243; i gesti&#243; de les c&#224;rregues de treball&#46; L&#8217;&#250;s de la tecnologia per controlar les c&#224;rregues de treball ens forneix de gran quantitat de dades&#44; i hem d&#8217;avaluar quines s&#243;n &#250;tils a l&#8217;hora de definir el perfil adequat <span class="elsevierStyleItalic">&#40;fit profile&#41;</span>&#44; que &#233;s el perfil obtingut a partir de la recollida de dades de cada entrenament i partit en qu&#232; el jugador es troba completament sa i en un estat &#242;ptim&#46;</p><p class="elsevierStylePara"> Hi ha diversos perfils en un equip&#58; acceleraci&#243; predominant&#44; desacceleraci&#243; o la combinaci&#243; d&#8217;ambdues&#46; Aix&#242; implica diferents RTP&#44; segons les qualitats espec&#237;fiques del jugador&#46;</p><p class="elsevierStylePara"> Entre les variables recollides di&#224;riament en els entrenaments i els partits que configuraran l&#8217;estat del jugador&#44; les m&#233;s importants s&#243;n les acceleracions&#44; les desacceleracions&#44; la cursa en alta velocitat &#40;<span class="elsevierStyleItalic">high speed running&#44; </span>HSR&#41;&#44; l&#8217;HML&#44; els esprints i l&#8217;equilibri de la petjada&#46;</p><p class="elsevierStylePara"> D&#8217;aquesta manera serem capa&#231;os de saber quines s&#243;n les caracter&#237;stiques individuals del jugador i assolirem el nostre objectiu principal&#58; un perfil adequat individualitzat&#46;</p><p class="elsevierStylePara"> Durant el proc&#233;s de recuperaci&#243; treballem amb circuits adaptats enfocats a aquest objectiu&#44; que diferiran segons el nostre objectiu sigui la velocitat o la for&#231;a&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Gesti&#243; intel&#183;ligent dels modificadors </span></p><p class="elsevierStylePara"> Les regles dels esports tenen una gran influ&#232;ncia i afecten el RTP&#46; No &#233;s el mateix jugar a handbol&#44; basquet o futbol&#44; perqu&#232; les regles de cada esport s&#243;n diferents i&#44; pel que fa al RTP&#44; poden retardar o avan&#231;ar la tornada o fins i tot ser utilitzades en favor nostre<span class="elsevierStyleSup">24&#44;25</span>&#46;</p><p class="elsevierStylePara"> Per aquesta ra&#243;&#44; podem assumir que els criteris del RTP podrien evolucionar en paral&#183;lel amb possibles noves regles en el futur proper&#46;</p><p class="elsevierStylePara"> Els metges han d&#8217;estar immersos en l&#8217;esport en qu&#232; treballen i han de tenir un coneixement profund del medi per tal de gestionar de manera intel&#183;ligent les decisions que prenen amb els jugadors&#44; l&#8217;equip t&#232;cnic i l&#8217;entrenador&#59; l&#8217;experi&#232;ncia adquirida pels metges dependr&#224; completament d&#8217;aquest coneixement&#46;</p><p class="elsevierStylePara"> Quin &#233;s el futur de la presa de decisions en relaci&#243; al RTP&#63; El concepte de <span class="elsevierStyleItalic">big data</span> ens ajudar&#224;&#44; ja que serem capa&#231;os de compartir l&#8217;experi&#232;ncia m&#232;dica entre metges de diversos pa&#239;sos i utilitzar-la per millorar el nostre coneixement&#44; particularment en els aspectes relatius als criteris del RTP&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions </span></p><p class="elsevierStylePara"> 1&#46; El proc&#233;s de presa de decisions en relaci&#243; al RTP ha de ser ent&#232;s com un proc&#233;s din&#224;mic focalitzat en evitar recaigudes i no en predir la durada del RTP&#46;</p><p class="elsevierStylePara"> 2&#46; La tecnologia ens ajuda molt avui dia personalitzant el proc&#233;s de presa de decisions i ho far&#224; m&#233;s en el futur&#44; per&#242; l&#8217;experi&#232;ncia cl&#237;nica&#44; aix&#237; com el coneixement del medi de l&#8217;esport en qu&#232; es treballa&#44; s&#243;n encara molt valuosos&#46;</p><p class="elsevierStylePara"> 3&#46; De la mateixa manera que considerem els modificadors&#44; hem de comen&#231;ar a considerar possibles noves regles en el futbol que podrien tenir influ&#232;ncia en el proc&#233;s de presa de decisi&#243; del RTP&#46;</p><hr></hr><p class="elsevierStylePara"> Rebut el 14 de desembre de 2015&#59; <br></br> acceptat l&#8217;11 de gener de 2016</p><p class="elsevierStylePara"> &#42; Autor per a correspond&#232;ncia&#46;<br></br><span class="elsevierStyleItalic">Correu electr&#242;nic&#58;</span><a href="mailto&#58;ricard&#46;pruna&#64;fcbarcelona&#46;cat" class="elsevierStyleCrossRefs">ricard&#46;pruna&#64;fcbarcelona&#46;cat</a></p>"
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        "resumen" => "<p class="elsevierStylePara"> El retorn al terreny de joc &#233;s un dels aspectes m&#233;s importants dins del proc&#233;s de recuperaci&#243; del jugador lesionat&#46; &#201;s essencial comprendre aquest retorn com a un proc&#233;s constant de la presa de decisi&#243;&#46; Ha d&#8217;entendre&#8217;s com un proc&#233;s din&#224;mic i personalitzat&#46; El principal objectiu ha de ser l&#8217;abs&#232;ncia de noves lesions addicionals&#44; no predient de manera exacta el moment del retorn&#46; Existeixen una s&#232;rie de punts clau b&#224;sics&#44; que cal satisfer dins del proc&#233;s&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Diagn&#242;stic correcte&#58;</span> el bon diagn&#242;stic constitueix el pas m&#233;s important a l&#8217;hora del retorn&#44; i &#233;s el concepte b&#224;sic&#46; Actualment&#44; en la pr&#224;ctica de la medicina esportiva segueixen existint moltes variables que no es tenen en compte en parlar d&#8217;aquestes lesions&#46; <span class="elsevierStyleItalic">Control estricte de les c&#224;rregues de treball&#58;</span> els doctors en medicina esportiva continuen fent servir diferents conceptes per definir el retorn al terreny de joc&#44; sense cap consens&#44; encara que el concepte m&#233;s adequat &#233;s la plena disponibilitat per a la competici&#243;&#44; ja que la fase d&#8217;entrenament ha d&#8217;entendre&#8217;s com a part del proc&#233;s de recuperaci&#243;&#46; A part de l&#8217;exploraci&#243; cl&#237;nica o la RM&#44; l&#8217;equip m&#232;dic i el t&#232;cnic comencen a donar import&#224;ncia a la prova in situ dirigida per GPS&#44; per personalitzar el progr&#233;s de la lesi&#243; i obtenir un marc de confian&#231;a que validi el retorn al terreny de joc&#44; i avaluar&#44; supervisar i gestionar les c&#224;rregues de treball&#46; L&#8217;objectiu &#233;s adquirir el PERFIL INDIVIDUAL DE FORMA F&#205;SICA&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Gesti&#243; intel&#183;ligent dels modificadors&#58;</span> les regles esportives influeixen i afecten en gran mesura al retorn al terreny de joc&#46; Els doctors han d&#8217;involucrar-se en l&#8217;esport que manegen i tenir un ampli coneixement de l&#8217;entorn per poder gestionar amb intel&#183;lig&#232;ncia les decisions preses pel jugador&#44; l&#8217;equip t&#232;cnic i l&#8217;entrenador&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Cap a on ens dirigim&#63;</span> El concepte de GRANS DADES ens ajudar&#224; en el futur&#44; ja que podrem compartir l&#8217;experi&#232;ncia m&#232;dica entre doctors de diferents pa&#239;sos i fer-la servir per millorar el nostre coneixement&#44; especialment quant als criteris del retorn al terreny de joc&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"> Return to play &#40;RTP&#41; is one of the most important key points within the recovery process of the injured player&#46; It is essential to understand the RTP as a constant decision making process&#46; RTP has to be understood as a dynamic and personalised process&#46; The main objective has to be the absence of further re-injuries but not to exactly predict the RTP time&#46; There are a series of basic key points to fulfil within the process&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">A correct diagnosis&#58;</span> A good diagnosis is the most relevant step in getting a correct RTP&#44; it is really the first cornerstone&#46; Today in sports medicine practice many variables are still not taken into account when we talk about these injuries&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Strict control of workloads&#58;</span> Sport medicine doctors are still using different concepts to define the RTP&#44; without any consensus&#44; although the most appropriate concept is the full availability for matches&#44; because the training phase has to be understood as a part of the recovery process&#46; Apart from clinical exploration or MRI&#44; a test on field assessed by GPS starts to be considered important by the medical and technical staff in personalising the progress of the injury and obtaining a trusted framework to validate the RTP and in the assessment&#44; monitoring and management of workloads&#46; The objective is to acquire the INDIVIDUAL FIT PROFILE&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Intelligent management of modifiers&#58;</span> The rules of sports have a high influence and affect the return to play&#46; Doctors have to be involved in the sport they are working in and have a deep knowledge of the environment to be able to manage intelligently the decisions made with a player&#44; technical staff and coach&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Where are we going&#63;&#58;</span> The BIG DATA concept is going to help us in future&#44; because we will be able to share the medical experience between the doctors from different countries and use it to improve our knowledge specially in RTP criteria&#46;</p>"
      ]
    ]
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Return to play: Cap a on anem? Això no és un joc d’endevinalles
Return to Play: Where are we going? It is not a guessing game
Ricard Prunaa
a Serveis Mèdics del F.C. Barcelona, Barcelona, Espanya
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    "textoCompleto" => "<p class="elsevierStylePara"> </p><p class="elsevierStylePara"> Tenint en compte les darreres publicacions cient&#237;fiques&#44; l&#8217;estudi del <span class="elsevierStyleItalic">Return to play</span> &#40;RTP&#41; ha fet pocs progressos&#44; o fins i tot ha anat en una direcci&#243; equivocada<span class="elsevierStyleSup">1-3</span>&#46; Avui en dia&#44; tan sols un petit nombre d&#8217;estudis estan abordant el tema adequadament i centrant la seva atenci&#243; en la realitat del futbol<span class="elsevierStyleSup">4</span>&#46; Aix&#237;&#44; &#233;s necessari fer-se diverses preguntes&#46;</p><p class="elsevierStylePara"> &#8226; Com estem avaluant el RTP avui en dia&#63;</p><p class="elsevierStylePara"> &#8226; Com haur&#237;em d&#8217;entendre el proc&#233;s de RTP&#44; com un pas est&#224;tic integrat per una s&#232;rie de punts que cal realitzar quan el jugador lesionat ha arribat a la fase final de recuperaci&#243; o com un proc&#233;s constant de presa de decisi&#243;&#63;</p><p class="elsevierStylePara"> Francament&#44; les decisions que fem des del comen&#231;ament de la lesi&#243; afecten els criteris finals del RTP<span class="elsevierStyleSup">5</span>&#46; La primera decisi&#243; condiciona la seg&#252;ent i de seguida es desenvolupa una xarxa de decisions que impliquen un llarg proc&#233;s en qu&#232; diverses variables interactuen&#46; Quines s&#243;n&#44; m&#233;s espec&#237;ficament&#44; aquestes variables&#63;</p><p class="elsevierStylePara"> &#8226; Una diagnosi correcta&#46;</p><p class="elsevierStylePara"> &#8226; Un control estricte de la c&#224;rrega de treball durant el proc&#233;s de recuperaci&#243;&#46;</p><p class="elsevierStylePara"> &#8226; Una gesti&#243; intel&#183;ligent dels modificadors de risc de l&#8217;esport i dels modificadors de decisions&#46;</p><p class="elsevierStylePara"> Abans de descriure en profunditat aquestes variables&#44; &#233;s important constatar que el RTP ha de ser ent&#232;s com un proc&#233;s din&#224;mic i personalitzat&#46; El principal objectiu no ha de ser predir la durada del proc&#233;s de RTP&#44; sin&#243; evitar futures recaigudes&#59; no &#233;s un joc d&#8217;endevinalles&#46; Al llarg d&#8217;un proc&#233;s din&#224;mic hi ha molts factors que interactuen tot modificant el resultat final&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Una diagnosi correcta </span></p><p class="elsevierStylePara"> L&#8217;error m&#233;s greu que es pot cometre de cara al proc&#233;s de RTP &#233;s un diagn&#242;stic erroni&#46; Aix&#242; causar&#224; que les decisions que es prenguin sobre la lesi&#243; siguin incorrectes i mal plantejades&#44; i aquestes s&#243;n decisions que tenen una gran influ&#232;ncia sobre el resultat final<span class="elsevierStyleSup">6</span>&#46; Analitzem-ne alguns aspectes&#46;</p><p class="elsevierStylePara"> Quin &#233;s el paper de la resson&#224;ncia magn&#232;tica en el RTP&#63; Estem d&#8217;acord que la resson&#224;ncia magn&#232;tica no &#233;s una eina gaire &#250;til de cara als darrers criteris de decisi&#243; pel que fa al RTP<span class="elsevierStyleSup">7&#44;8</span>&#44; per&#242; &#233;s molt &#250;til a l&#8217;inici<span class="elsevierStyleSup">9</span>&#46; En relaci&#243; a la medicina de l&#8217;esport&#44; hi ha lesions que han de ser tractades quir&#250;rgicament de forma immediata i&#44; si els metges cl&#237;nics no tenen prou experi&#232;ncia a l&#8217;hora d&#8217;interpretar la resson&#224;ncia i els s&#237;mptomes cl&#237;nics&#44; no seran capa&#231;os de consolidar el tractament correcte&#44; de manera que la predicci&#243; final respecte el RTP no ser&#224; acurada<span class="elsevierStyleSup">10</span>&#46;</p><p class="elsevierStylePara"> Un bon diagn&#242;stic &#233;s el pas m&#233;s rellevant&#44; la veritable pedra angular&#44; de cara a un RTP adequat&#46; En la medicina de l&#8217;esport no &#233;s adequat considerar per separat les eines que utilitzem en el tractament d&#8217;una lesi&#243;&#46; No podem recolzar-nos &#250;nicament en la resson&#224;ncia magn&#232;tica&#44; els s&#237;mptomes cl&#237;nics o el GPS per separat&#59; per contra&#44; el que cal fer &#233;s considerar totes aquestes eines com una part fonamental en el proc&#233;s de presa de decisions&#46; Si no ho fem aix&#237; i treballem amb cadascuna d&#8217;elles per separat&#44; perden el seu valor&#46;</p><p class="elsevierStylePara"> En refer&#232;ncia al diagn&#242;stic&#44; hi ha moltes variables que encara no es tenen en compte quan parlem d&#8217;aquestes lesions&#58; la variabilitat anat&#242;mica o els diversos processos de curaci&#243; dels teixits conjuntius<span class="elsevierStyleSup">11&#44;12</span> &#40;tend&#243;&#44; teixit miotendin&#243;s o f&#224;scies&#41;<span class="elsevierStyleSup">13</span> s&#243;n factors importants per definir una lesi&#243; muscular<span class="elsevierStyleSup">14</span>&#46;</p><p class="elsevierStylePara"> En aquest sentit&#44; cal fer notar que la recuperaci&#243; d&#8217;un tend&#243;<span class="elsevierStyleSup">15</span> &#233;s molt diferent que la reparaci&#243; muscular&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Control estricte de les c&#224;rregues de treball </span></p><p class="elsevierStylePara"> Per establir quan s&#8217;ha completat el RTP hi ha diverses definicions&#46; Algunes d&#8217;elles s&#243;n&#58;</p><p class="elsevierStylePara"> &#8226; Quan s&#8217;ha assolit el mateix nivell previ a la lesi&#243;&#46;</p><p class="elsevierStylePara"> &#8226; Quan s&#8217;ha finalitzat el programa de rehabilitaci&#243;&#46;</p><p class="elsevierStylePara"> &#8226; Quan s&#8217;ha retornat a l&#8217;activitat completa i hi ha disponibilitat per a l&#8217;entrenament&#46;</p><p class="elsevierStylePara"> Amb tot&#44; la m&#233;s acurada &#233;s la que diu que el RTP s&#8217;assoleix quan hi ha disponibilitat plena per disputar partits<span class="elsevierStyleSup">16</span>&#44; ja que cal entendre la fase d&#8217;entrenament com a part del proc&#233;s de recuperaci&#243;&#46;</p><p class="elsevierStylePara"> Si anem m&#233;s enll&#224;&#44; sorgeixen noves preguntes&#46;</p><p class="elsevierStylePara"> &#8226; Qu&#232; significa &#171;nivell previ a la lesi&#243;&#187;&#63; Hi ha un punt en el qual hom est&#224; completament sa&#63; Qui pot assegurar que el nivell d&#8217;abans de la lesi&#243; era totalment adequat<span class="elsevierStyleSup">17-19</span>&#63; Sovint&#44; abans de la lesi&#243; ja hi havia un proc&#233;s de mala adaptaci&#243;&#44; cosa que voldria dir que el jugador ja estava en risc&#46;</p><p class="elsevierStylePara"> &#8226; Ens lesionem per p&#232;rdua de for&#231;a&#63; Com t&#233; lloc aquesta p&#232;rdua&#63; Succeeix a causa d&#8217;un d&#232;ficit en l&#8217;entrenament&#44; per una mala adaptaci&#243; a la competici&#243; o per una sobrec&#224;rrega en els exercicis de gimn&#224;stica preventiva&#63;</p><p class="elsevierStylePara"> La segona pedra angular &#233;s la personalitzaci&#243; de les c&#224;rregues de treball<span class="elsevierStyleSup">20</span>&#46;</p><p class="elsevierStylePara"> El futbol ha evolucionat de manera extraordin&#224;ria en els darrers 6 anys&#44; i els jugadors s&#8217;han hagut d&#8217;adaptar al &#171;nou esport&#187; r&#224;pidament&#46; Algunes estrat&#232;gies han estat superades&#46; La majoria dels exercicis inclosos com a prevenci&#243; secund&#224;ria no tenen efectes preventius i la majoria de vegades sobrecarreguen els m&#250;sculs&#46; Hem de comen&#231;ar a canviar el concepte de prevenci&#243;&#58; el nou ha de ser el d&#8217;adaptaci&#243;&#46; Les lesions per distensi&#243; muscular no han de ser enteses com un trencament mec&#224;nic de teixit sa&#44; sin&#243; com una s&#232;rie de respostes adaptatives anormals que&#44; a la llarga&#44; no permetran que el teixit s&#8217;adapti a les creixents c&#224;rregues i tensions&#46;</p><p class="elsevierStylePara"> Una avaluaci&#243; est&#224;tica de les capacitats del jugador independentment de l&#8217;&#224;mbit esportiu &#233;s el nou repte a qu&#232; ens hem d&#8217;enfrontar&#46;</p><p class="elsevierStylePara"> A part de l&#8217;exploraci&#243; cl&#237;nica o la resson&#224;ncia magn&#232;tica&#44; els ex&#224;mens al camp amb el suport del GPS<span class="elsevierStyleSup">21-23</span> comencen a ser considerats importants pels equips m&#232;dics i t&#232;cnics a l&#8217;hora de personalitzar el progr&#233;s de la lesi&#243; i obtenir un marc de confian&#231;a en el qual donar validesa al RTP&#44; aix&#237; com en l&#8217;avaluaci&#243;&#44; monitoritzaci&#243; i gesti&#243; de les c&#224;rregues de treball&#46; L&#8217;&#250;s de la tecnologia per controlar les c&#224;rregues de treball ens forneix de gran quantitat de dades&#44; i hem d&#8217;avaluar quines s&#243;n &#250;tils a l&#8217;hora de definir el perfil adequat <span class="elsevierStyleItalic">&#40;fit profile&#41;</span>&#44; que &#233;s el perfil obtingut a partir de la recollida de dades de cada entrenament i partit en qu&#232; el jugador es troba completament sa i en un estat &#242;ptim&#46;</p><p class="elsevierStylePara"> Hi ha diversos perfils en un equip&#58; acceleraci&#243; predominant&#44; desacceleraci&#243; o la combinaci&#243; d&#8217;ambdues&#46; Aix&#242; implica diferents RTP&#44; segons les qualitats espec&#237;fiques del jugador&#46;</p><p class="elsevierStylePara"> Entre les variables recollides di&#224;riament en els entrenaments i els partits que configuraran l&#8217;estat del jugador&#44; les m&#233;s importants s&#243;n les acceleracions&#44; les desacceleracions&#44; la cursa en alta velocitat &#40;<span class="elsevierStyleItalic">high speed running&#44; </span>HSR&#41;&#44; l&#8217;HML&#44; els esprints i l&#8217;equilibri de la petjada&#46;</p><p class="elsevierStylePara"> D&#8217;aquesta manera serem capa&#231;os de saber quines s&#243;n les caracter&#237;stiques individuals del jugador i assolirem el nostre objectiu principal&#58; un perfil adequat individualitzat&#46;</p><p class="elsevierStylePara"> Durant el proc&#233;s de recuperaci&#243; treballem amb circuits adaptats enfocats a aquest objectiu&#44; que diferiran segons el nostre objectiu sigui la velocitat o la for&#231;a&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Gesti&#243; intel&#183;ligent dels modificadors </span></p><p class="elsevierStylePara"> Les regles dels esports tenen una gran influ&#232;ncia i afecten el RTP&#46; No &#233;s el mateix jugar a handbol&#44; basquet o futbol&#44; perqu&#232; les regles de cada esport s&#243;n diferents i&#44; pel que fa al RTP&#44; poden retardar o avan&#231;ar la tornada o fins i tot ser utilitzades en favor nostre<span class="elsevierStyleSup">24&#44;25</span>&#46;</p><p class="elsevierStylePara"> Per aquesta ra&#243;&#44; podem assumir que els criteris del RTP podrien evolucionar en paral&#183;lel amb possibles noves regles en el futur proper&#46;</p><p class="elsevierStylePara"> Els metges han d&#8217;estar immersos en l&#8217;esport en qu&#232; treballen i han de tenir un coneixement profund del medi per tal de gestionar de manera intel&#183;ligent les decisions que prenen amb els jugadors&#44; l&#8217;equip t&#232;cnic i l&#8217;entrenador&#59; l&#8217;experi&#232;ncia adquirida pels metges dependr&#224; completament d&#8217;aquest coneixement&#46;</p><p class="elsevierStylePara"> Quin &#233;s el futur de la presa de decisions en relaci&#243; al RTP&#63; El concepte de <span class="elsevierStyleItalic">big data</span> ens ajudar&#224;&#44; ja que serem capa&#231;os de compartir l&#8217;experi&#232;ncia m&#232;dica entre metges de diversos pa&#239;sos i utilitzar-la per millorar el nostre coneixement&#44; particularment en els aspectes relatius als criteris del RTP&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions </span></p><p class="elsevierStylePara"> 1&#46; El proc&#233;s de presa de decisions en relaci&#243; al RTP ha de ser ent&#232;s com un proc&#233;s din&#224;mic focalitzat en evitar recaigudes i no en predir la durada del RTP&#46;</p><p class="elsevierStylePara"> 2&#46; La tecnologia ens ajuda molt avui dia personalitzant el proc&#233;s de presa de decisions i ho far&#224; m&#233;s en el futur&#44; per&#242; l&#8217;experi&#232;ncia cl&#237;nica&#44; aix&#237; com el coneixement del medi de l&#8217;esport en qu&#232; es treballa&#44; s&#243;n encara molt valuosos&#46;</p><p class="elsevierStylePara"> 3&#46; De la mateixa manera que considerem els modificadors&#44; hem de comen&#231;ar a considerar possibles noves regles en el futbol que podrien tenir influ&#232;ncia en el proc&#233;s de presa de decisi&#243; del RTP&#46;</p><hr></hr><p class="elsevierStylePara"> Rebut el 14 de desembre de 2015&#59; <br></br> acceptat l&#8217;11 de gener de 2016</p><p class="elsevierStylePara"> &#42; Autor per a correspond&#232;ncia&#46;<br></br><span class="elsevierStyleItalic">Correu electr&#242;nic&#58;</span><a href="mailto&#58;ricard&#46;pruna&#64;fcbarcelona&#46;cat" class="elsevierStyleCrossRefs">ricard&#46;pruna&#64;fcbarcelona&#46;cat</a></p>"
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        "resumen" => "<p class="elsevierStylePara"> El retorn al terreny de joc &#233;s un dels aspectes m&#233;s importants dins del proc&#233;s de recuperaci&#243; del jugador lesionat&#46; &#201;s essencial comprendre aquest retorn com a un proc&#233;s constant de la presa de decisi&#243;&#46; Ha d&#8217;entendre&#8217;s com un proc&#233;s din&#224;mic i personalitzat&#46; El principal objectiu ha de ser l&#8217;abs&#232;ncia de noves lesions addicionals&#44; no predient de manera exacta el moment del retorn&#46; Existeixen una s&#232;rie de punts clau b&#224;sics&#44; que cal satisfer dins del proc&#233;s&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Diagn&#242;stic correcte&#58;</span> el bon diagn&#242;stic constitueix el pas m&#233;s important a l&#8217;hora del retorn&#44; i &#233;s el concepte b&#224;sic&#46; Actualment&#44; en la pr&#224;ctica de la medicina esportiva segueixen existint moltes variables que no es tenen en compte en parlar d&#8217;aquestes lesions&#46; <span class="elsevierStyleItalic">Control estricte de les c&#224;rregues de treball&#58;</span> els doctors en medicina esportiva continuen fent servir diferents conceptes per definir el retorn al terreny de joc&#44; sense cap consens&#44; encara que el concepte m&#233;s adequat &#233;s la plena disponibilitat per a la competici&#243;&#44; ja que la fase d&#8217;entrenament ha d&#8217;entendre&#8217;s com a part del proc&#233;s de recuperaci&#243;&#46; A part de l&#8217;exploraci&#243; cl&#237;nica o la RM&#44; l&#8217;equip m&#232;dic i el t&#232;cnic comencen a donar import&#224;ncia a la prova in situ dirigida per GPS&#44; per personalitzar el progr&#233;s de la lesi&#243; i obtenir un marc de confian&#231;a que validi el retorn al terreny de joc&#44; i avaluar&#44; supervisar i gestionar les c&#224;rregues de treball&#46; L&#8217;objectiu &#233;s adquirir el PERFIL INDIVIDUAL DE FORMA F&#205;SICA&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Gesti&#243; intel&#183;ligent dels modificadors&#58;</span> les regles esportives influeixen i afecten en gran mesura al retorn al terreny de joc&#46; Els doctors han d&#8217;involucrar-se en l&#8217;esport que manegen i tenir un ampli coneixement de l&#8217;entorn per poder gestionar amb intel&#183;lig&#232;ncia les decisions preses pel jugador&#44; l&#8217;equip t&#232;cnic i l&#8217;entrenador&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Cap a on ens dirigim&#63;</span> El concepte de GRANS DADES ens ajudar&#224; en el futur&#44; ja que podrem compartir l&#8217;experi&#232;ncia m&#232;dica entre doctors de diferents pa&#239;sos i fer-la servir per millorar el nostre coneixement&#44; especialment quant als criteris del retorn al terreny de joc&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"> Return to play &#40;RTP&#41; is one of the most important key points within the recovery process of the injured player&#46; It is essential to understand the RTP as a constant decision making process&#46; RTP has to be understood as a dynamic and personalised process&#46; The main objective has to be the absence of further re-injuries but not to exactly predict the RTP time&#46; There are a series of basic key points to fulfil within the process&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">A correct diagnosis&#58;</span> A good diagnosis is the most relevant step in getting a correct RTP&#44; it is really the first cornerstone&#46; Today in sports medicine practice many variables are still not taken into account when we talk about these injuries&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Strict control of workloads&#58;</span> Sport medicine doctors are still using different concepts to define the RTP&#44; without any consensus&#44; although the most appropriate concept is the full availability for matches&#44; because the training phase has to be understood as a part of the recovery process&#46; Apart from clinical exploration or MRI&#44; a test on field assessed by GPS starts to be considered important by the medical and technical staff in personalising the progress of the injury and obtaining a trusted framework to validate the RTP and in the assessment&#44; monitoring and management of workloads&#46; The objective is to acquire the INDIVIDUAL FIT PROFILE&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Intelligent management of modifiers&#58;</span> The rules of sports have a high influence and affect the return to play&#46; Doctors have to be involved in the sport they are working in and have a deep knowledge of the environment to be able to manage intelligently the decisions made with a player&#44; technical staff and coach&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Where are we going&#63;&#58;</span> The BIG DATA concept is going to help us in future&#44; because we will be able to share the medical experience between the doctors from different countries and use it to improve our knowledge specially in RTP criteria&#46;</p>"
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Article information
ISSN: X8866581
Original language: Català
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