From time to time in clinical work, patients ask questions about methods of lower extremity muscle training and joint mobility exercises. I think this is very important for knee lesions, both preoperatively and postoperatively. Good knee function is about movement under stable conditions, which means that the joint should be able to move (i.e., the joint should be mobile enough) and that the joint should be stable enough.
Many knee injuries destroy stability, and over time, joint adhesions can occur, resulting in decreased mobility. Surgery after a knee injury is usually performed to restore joint stability, such as cruciate ligament reconstruction and lateral collateral ligament repair. After surgery, the knee joint is not able to move normally in the early stages to protect the surgical result and post-operative pain, which can result in joint adhesions and a decrease in joint mobility.
After knee injury or early surgery, the muscles of the lower extremity, especially the muscles in front of the thigh (that is, the quadriceps), will atrophy quickly because the lower extremity cannot move with normal force and full joint range of motion. Usually one month after injury or surgery, the quadriceps muscle atrophies significantly if effective functional exercise is not performed. Normal muscle function is very important to maintain the stability of the knee joint, especially during sports. Therefore, proper muscle strength and joint mobility exercises are exceptionally important for restoring joint function, both after injury and after surgery.
Regarding quadriceps muscle strength training.
For plyometric training, we attach great importance to strength and frequency, which means that we should exert enough force each time until the muscles are sore and enough times in order to achieve the purpose of training plyometric strength.
The methods of quadriceps muscle strength training are.
1, leg tensing exercises.
Knee straight case, force the quadriceps muscle tense, for 5 to 10 seconds to feel muscle soreness and then relaxation is counted once a day, 3 to 5 sets of practice, each group of practice 15 to 50 times.
This is the first level of muscle strength training exercises, anesthesia can be carried out after waking up, can be throughout the rehabilitation period.
2. Straight leg raise exercise.
Lie flat, knee straight, lower limb elevation, about 40 ° with the bed, for 5-10 seconds to feel muscle swelling and then relaxation is counted once, 3-5 groups per day, each group of 15-50 times. This is the second level of muscle strength training exercises, the second day after surgery, muscle strength recovery level 3 or more to carry out.
Precautions are.
Lower limbs should be lifted quickly and slowly, not suddenly fall down; lower limbs should not be lifted too high, not to mention the knee extension and flexion movements in the air.
3. Single-leg standing exercises.
Straighten the knee joint as much as possible, stand with the affected limb, 1~3 minutes each time, practice 3~5 times a day. This is a tertiary exercise of muscle strength training, which must be performed only if the patient can easily complete straight leg raising exercises, requiring the muscle strength of quadriceps muscle to recover to grade 4+. Patients with fork ligament reconstruction usually start this exercise 1 week after surgery.
Precautions are.
Patients with fork ligament reconstruction and meniscal sutures should wear the brace securely before getting out of bed to do this exercise, and should not do knee flexion during early single-leg stance.
Regarding knee mobility exercises.
For joint mobility exercises, we place a lot of emphasis on improving the mobility of each exercise rather than the number of times and the speed of the joint movement.
Knee mobility exercises include
1. Patellar pushing exercises.
Avoiding patellar adhesions is important for the prevention of knee adhesions. The patient himself or a chaperone should pinch the patella with both hands and do activities in four directions: up and down, inside and outside, with the range of patellar activity on the opposite side as a reference, 3 to 5 groups of activities per day, 5 to 15 times per group.
2. Bedside leg dropping exercise.
Patients do bedside, the affected limb naturally relaxed down, adhere to 1 ~ 3 minutes count once, 3 ~ 5 times a day practice. This exercise is the first level of joint mobility exercise, which is a passive knee activity and is suitable for use in the early postoperative period when the joint mobility is not yet greater than 90°. Note: Patients should be protected from lying down to the bedside, and the patient’s heel should be protected after reaching the bedside to gradually make the affected limb droop, and patients should not move to the bedside unprotected to do droop exercises in the early stage.
3. Knee lift exercises in bed.
In the bed by the escort with both hands to hold the N fossa will lift the knee joint upward, so that the knee joint flexion, let go and slowly straighten the knee joint. 3~5 sets per day, 5~10 times per set. This exercise is a level 1 exercise for joint mobility, which is a passive knee activity and is suitable for application within 2~4 weeks after fork ligament reconstruction and meniscus suture surgery.
4. Prone position pull-back exercise.
With the patient in prone position, use a wide cloth belt or elastic band to pocket the back of the foot, and the patient himself pulls the foot of the affected lower limb toward the hip to flex the knee joint. Each time the knee joint is flexed to the maximum degree, so that the patient has a sore feeling in the knee joint, hold for about 1 minute. Perform 3 to 5 sets of 1 to 3 times per day. This exercise is a secondary exercise for joint mobility, which is a passive knee activity and is suitable for patients whose knee mobility is already greater than 90°.