Caution.
1.The methods and data provided in this plan are developed in accordance with the general routine, and the specific implementation needs to be completed under the guidance of a doctor depending on your own conditions and surgical conditions.
2.The pain that exists in the functional exercises is unavoidable. If the pain can subside to the original level within half an hour after the exercise stops, it will not cause damage to the tissue and should be tolerated.
3, muscle strength exercises should be concentrated until the muscle has a sense of soreness and fatigue, and then proceed to the next group after sufficient rest. The number of exercises, time, load, etc. must be completed according to the requirements, especially not to complete more times and increase the rest time, otherwise it is difficult to achieve the desired effect.
4, in addition to the surgical limb brake protection, the rest of the body parts should move as much as possible to improve the overall level of circulation and metabolism, to promote the recovery of the surgical local. Athletes should especially practice other parts of the body on their own to ensure basic physical fitness and early return to sports.
5. Early joint mobility exercises should be performed only 1-2 times a day to improve the angle and avoid swelling caused by repeated flexion and extension. If there is no progress in mobility for a long time (>2 weeks), there is a possibility of joint adhesions, so we should pay great attention to it, insist on completing the exercises and review them in time when necessary.
6.Ice packs should be given for 15-20 minutes immediately after the mobility exercise. If you usually feel swelling, pain and fever in the joint, you can apply ice again, 2-3 times a day.
7.The side with shadow in the illustration in the appendix is the affected side.
8. The swelling of the joint will continue throughout the exercise until the joint mobility is normal, muscle strength is restored, and the irritation factor disappears. However, the degree of swelling must be controlled and should not be continuously increased, and the general trend should be gradually decreasing. If the swelling increases, local redness, swelling, heat and pain are obvious, you must stop practicing, increase the number of ice packs, and seek medical attention in time!
9, weight-bearing and other exercises must be reviewed by a doctor and determined by taking X-rays before starting!
Correct postoperative position placement: the affected leg is elevated on a pillow, the toe is directly above, not crooked to the side, the knee joint should be vacated below, no pillow should be used to pad the leg into a slightly bent position. If the pain is unbearable, the leg is placed in a comfortable position under the guidance of the physician.
Begin as soon as anesthesia subsides.
Ankle pump: (see Appendix 1-Figure 1) Firm, slow, full range of flexion and extension of the ankle joint, 5 min/group, 1-2 groups/hour. (important to promote circulation, reduce swelling, and prevent deep vein thrombosis)
Quadriceps (anterior thigh muscle group) isometric contraction exercises: i.e. thigh muscle tensing and relaxation. Do as many as possible without increasing pain. (greater than 500-1000 reps/day)
First day to 1 week after surgery.
Straight leg raising exercises can be started to avoid too rapid atrophy of the leg muscles if pain is not significant, or postponed for several days if pain is significant.
Straight leg raise exercise: extend the knee and raise the leg straight up to 15M from the bed with the heel, and hold it until exhaustion. (See Appendix 1-Figure 4 for the method).
Lateral leg raise exercise, (See Appendix 1-figure 5 and 6 for method.) 10 times/set, 10-15 seconds hold/set, 5 seconds interval each time, 4-6 sets/day.
Posterior leg raising exercise, lying prone (face down on the bed), the affected leg is raised straight backward until the toe is 5 cm above the bed surface for 1 time, 30 times/group, 4-6 groups in a row, 30 seconds rest between groups, 4-6 exercises/day.
2 days after surgery
You can start to walk on the ground with the help of crutches, but the affected leg should never be put on the ground to bear weight! It is important to ensure safety and not to fall! At the same time, we should control the amount of activity and encourage only essential activities such as going to the toilet.
Start joint mobility exercises according to the surgeon’s opinion.
If you use CPM, you should start slowly (5 repetitions/minute), 1-2 hours/time, 1-2 times/day, and apply ice for 20-30 minutes immediately after the exercise.
If you use manual therapy or practice on your own, you must have a professional complete or instruct the method to be sure that the practice is correct.
Adjunctive exercises for flexion: patellar release (start after stitch removal, not necessary for flexible patella): push the fingers against the edge of the patella and push the patella slowly and forcefully in the up and down direction to the limit position. 20 times in each direction, 2-3 times/day. This can be done before flexion exercises.
Sitting (or supine) position dropping leg: (for 0-95° range) Sitting on the edge of the bed with the knee hanging out below the bed. Relax the thigh muscles under protection and allow the calf to drop naturally to the limit and hold for 10 minutes. If necessary, add load at the ankle joint.
Supine leg drop: (after flexion angle greater than 90 ° to start) see Appendix 1 – Figure 9. supine on the bed, thighs perpendicular to the bed (hands hold the legs to fix), relax the thigh muscles, so that the calf drops naturally, if necessary, you can add load at the ankle joint (the load should not be too large, otherwise the muscle can not relax, that is, no effect). The requirements are the same as above.
Sitting leg hold: see Appendix 1 – Figure 11. sit on the bed, hold the ankle with both hands and make the heel slowly approach the buttocks. Measure the distance between the heel and the hip before starting, and gradually shorten the distance to the same angle as the healthy side of the leg. This exercise should be gradual, do not blindly adventurous or afraid of pain not to move forward.
The above exercises should be performed sequentially, with a slight improvement in the angle each time. Generally, the passive flexion angle of the knee joint should be exactly the same as that of the healthy leg 3 months after surgery. Pain during flexion exercises is normal, 30 minutes after the end of the exercise the pain subsides to the degree before the exercise that does not affect the tissue and must be overcome, the fear of pain does not front 2 weeks of angle without progress that may cause joint adhesions. Therefore must be gradual, gradually increase the angle of flexion.
Prone stretching: (start practicing when you feel difficulty in progressing the angle when holding the leg in a sitting position) in a prone position (face down on the bed) with the legs naturally extended, hold the ankle joint of the affected leg by yourself and make the knee joint flex (a long towel or a wide band can be tied around the ankle to facilitate the stretching). Or with the help of another person, but violent pushing is absolutely forbidden.
Active knee flexion and extension exercises (when the joint is not significantly painful at rest, you can start this exercise after passive flexion to improve knee flexibility): sitting position, with the foot not leaving the bed. Slow force, maximum knee flexion, followed by slow extension. 20-100 reps/set, 1-2 sets/day. See Appendix 1 – Figure 13.
After the knee is passively flexed at exactly the same angle as the healthy leg, and when the bones are healing well enough, you can start a protected full squat: full squat with hands on an object for protection, body upright, heels not leaving the ground, buttocks touching the heels as much as possible. 3-5 minutes/rep, 1-2 reps/day.
Knee extension exercises.
Stretching exercises in the muscles and the posterior joint capsule of the pulling sensation and slight pain is normal, do not contract the muscles against, should be completely relaxed, otherwise it will be ineffective. The weight of the load used in the exercise should not be too large, there should be no obvious pain, and the affected knee should be relaxed, and it is appropriate to continue until 30 minutes with a clear pulling sensation. No breaks should be taken in the middle of the exercise, otherwise the effect will be affected.
Seated knee extension: see Appendix 1 – Figure 14. sitting position, foot pads elevated, weighted above the knee joint. Relax the muscles completely and hold for 30 minutes. 30 minutes/time, 1-2 times/day.
Plyometric Exercises
Principles of plyometric exercises and selection of weights.
In the early and initial stages of plyometric exercises, because of the low level of muscle strength and the existence of more obvious inflammatory reactions in the tissues, static exercises (i.e., the practice method of maintaining a certain posture with weight until fatigue), 10 times/group, 10-15 seconds hold/time, 5 seconds interval each time, 4-6 groups of continuous exercises, 30 seconds rest between groups, 1-2 exercises/day. Or choose a light load (complete 30 movements that fatigue load), 30 times / group, 30 seconds of rest between groups, 4-6 groups of continuous exercises, 1-2 exercises / day.
Plyometric exercises in the medium term are mainly endurance-strength exercises. Choose a medium load (the amount of load to complete 20 movements that feel fatigue), 20 times / group, 45 seconds of rest between sets, 4-6 sets of continuous exercises, 1-2 exercises / day.
In the late stage of plyometric exercises, the purpose is to improve the absolute strength, choose a large load (the amount of load to complete 12 movements that feel fatigue), 8-12 times / group, 90 seconds rest between sets, 4-6 sets of continuous exercises, 1-2 exercises / day.
□ immediate exercise □ day after exercise □ week after exercise □ month after exercise
Prone position “leg hook exercise”, 10 times / group, 10-15 seconds hold / time, each interval of 5 seconds, 4-6 sets of continuous exercises, 30 seconds rest between sets. (The method is as shown in Appendix 1 – Figure 18, with sandbag as the load, within the range of motion of the splint, and ice packs immediately after the exercise.)
□ immediate exercise □ day after exercise □ week after exercise □ month after exercise
Standing “leg hook” exercise. (See Appendix 1 – Figure 17, 18, 19), 30 times/group, 4-6 groups in a row, 30 seconds rest between groups, 4-6 exercises/day.
□ Immediate exercises □ Exercises after days □ Exercises after weeks □ Exercises after months
Resistance strengthening leg strength exercises, see Appendix 1-Figure 18, 19; Appendix 2-Figure 4, 5, 10, 11. 20 reps/set, 45 seconds rest between sets, 4-6 sets of continuous exercises, 2-4 exercises/day.
Exercises related to weight bearing.
Weight-bearing exercises are shown on the side page and are generally 1/4 to 1/3 weight-bearing starting at 6 weeks postoperatively, 1/3 at 8 weeks postoperatively, 1/2 weight-bearing at 10 weeks, and near full weight-bearing at 12 weeks. However, the decision must be based on the doctor’s review results!
□ Immediate exercises □ Days later exercises □ Weeks later exercises □ Months later exercises
Weight bearing and balance: separate the feet under protection, alternate shifting the center of gravity from side to side within the range of slight pain, and strive to achieve full weight bearing standing on the affected side of one leg. (See appendix 1-figure 7), 5 minutes/time, 2 times/day.
Separate the feet anteriorly and posteriorly and move the center of gravity to achieve full weight-bearing standing on the affected side. (See Appendix 1-figure 22), 5 points/time, 2 times/day.
□ Immediate exercise □ Post-day exercise □ Post-week exercise □ Post-month exercise
Forward-backward and side-to-side straddle exercises. (See appendix 1-figure 21 and 23) 20 times/set, 45 seconds rest between sets, 4-6 sets of continuous exercises, 2-4 exercises/day.
□ immediate exercise □ post-day exercise □ post-week exercise □ post-month exercise
Heel lifting exercises: stand on your toes, including standing with your feet shoulder-width apart, with your toes facing forward; stand in the “outer eight”; stand in the “inner eight” three positions to practice different muscles and different parts of the muscles. 2 minutes / time, rest for 5 seconds, 10 times / group, 2-3 groups / day. -3 sets/day.
□ immediate exercise □ after days □ after weeks □ after months
Silent squat exercises. (See Appendix 2 – Figure 1, 2) back against the wall, feet shoulder-width apart, toes and knees are forward, not “inside and outside the eight”, gradually increase the angle of squatting (less than 90 °) with increasing strength, 2 minutes / time, interval of 5 seconds, 5-10 consecutive / group. 2-3 groups / day.
□ immediate exercise □ day after exercise □ week after exercise □ month after exercise
Exercise with the affected leg in a 45° position with a half squat and knee extension. Stand with the affected leg on one leg, straighten the upper body, slowly squat down to 45° of flexion and then slowly pedal until fully extended.
Then slowly pedal until fully straightened. The requirement is slow, hard and controlled (no swaying). 20-30 times/group, interval between groups
30 seconds between sets, 2-4 times/day.
□ immediate exercise □ after days □ after weeks □ after months
The “step front down” exercise: face the ground, stand on the first floor of the step with your back to the step, your upper body is straight, the affected leg stands on one leg and the healthy leg is extended forward. The affected leg slowly squats until the healthy leg follows the ground, and then slowly stretches until it is completely straight. 20 times/group, 30 seconds between groups, 2-4 groups in a row, 2-3 times/day.
The affected leg stands on one leg, the healthy leg is straight, the toe is supported on the step, the body weight is leaned forward and falls completely on the affected leg, 0-30° range, slowly squat down to 30° of flexion, then slowly pedal until fully straightened. 20 times/group, 30 seconds interval between groups, 2-4 groups in a row, 2-3 times/day.
Adjunctive therapy
1.□ Immediately □ After days □ After weeks □ After months
Immediately after the exercise of mobility and other joint activities, apply ice for about 20 minutes, and if there is a feeling of obvious heat and swelling in the joint after the usual (standing and walking), apply ice again 3-5 times/day.
2.□ Immediately □ After days □ After weeks □ After months
Heat therapy (herbal fumigation, wax therapy, infrared therapy, etc.); low and medium frequency electrotherapy; ultrasonic therapy
Purpose of rehabilitation treatment
1. To promote the absorption of hematoma and exudation as soon as possible and to relieve pain.
2.To accelerate the formation of fibrous joints and bone scabs at the fracture ends.
3.Prevent muscle atrophy and joint stiffness.
4. Prevent complications when patients with severe fractures are bedridden 。。。。
Rehabilitation treatment methods for different stages of fracture
1. Traumatic inflammatory phase
The purpose is ① to promote the absorption of hematoma, inflammatory exudate and necrotic tissue to prevent adhesions ② to improve blood circulation and accelerate fiber connection at the severed end ③ to prevent muscle costal atrophy ④ to improve the patient’s physical and mental status
(1) Exercise therapy should be started 1-2 days after the first aid, and the principle is to combine movement and static, local and whole body
① Isometric contraction training of the affected limb muscles, at least 3 times a day, each time to not cause excessive muscle fatigue, usually 5-10 minutes or longer
② Active and passive activities of the affected limb of the non-fixed joint, note that the amount of activity should be gradually increased to avoid affecting the stability of the broken end
(3) Maintain normal activities of the able-bodied limbs: patients with upper limb fractures should be moved to the ground as early as possible, and those with lower limb fractures, if the situation permits, should also be moved early
(2) Physiotherapy: Start 1-2 days after the first aid
① Thermal therapy: Conduction heat therapy (waxing, Chinese medicine ironing), radiation heat therapy (infrared, radiofrequency, light bath) can improve the blood circulation of the affected limb, promote absorption and accelerate healing, 1-2 times a day, 10 times a course of treatment
②Magnetic therapy: helps the formation of bone scabs. 1 time per day, 30-60 minutes each time.
(3) Massage: doing centripetal massage at the proximal end of the fixed part can promote blood flow back and reduce edema, and prevent muscle cost atrophy and joint spasm.
2.Scab formation period
The main purpose is to promote the formation of bone scab, other purposes as above
① Exercise therapy During this period, the fracture end scab is formed, the fracture is more stable, and the amount of exercise should be gradually increased. In addition to prolonging the isometric contraction time and increasing the strength of the affected limb, active exercises of non-fixed joints and resistance training of related muscles should be done.
②Physical therapy as before
③ Occupational therapy and daily living activities training The upper limb is mainly functional training, while the lower limb is for standing and weight-bearing.
3 Scab maturation and plasticity period
① Exercise therapy After the removal of external fixation, the original braked joint stiffens, the range of motion decreases, and the corresponding muscle atrophy, which is the focus of treatment. Gradually increase the amount of exercise, mainly active exercise, if necessary, supplemented by passive and resistance exercise
②Physical therapy
For scarring and adhesions, direct current ionization, ultrasound, audio and thermal therapy can be used.
Joint contracture with exercise therapy, can be in warm therapy, passive arithmetic, hydrotherapy. For more severe contracture, do joint domestic traction therapy.