Before practicing knee mobility, patellar release (preparatory exercises) is usually done so that the practice of flexion and extension of the knee joint can be more effective. Pain and risk are also lower.
Patellar luxation (preparatory exercise).
The patella, commonly known as the kneecap, is a nearly circular “seed bone” directly in front of the knee joint. When the joint is not swollen, the outline of the patella can be seen when the leg is naturally stretched out on the bed. After injury or surgery, the outline of the patella may not be easy to find due to swelling of the knee joint. The trick is to place both legs side by side at the same angle and compare the position of the healthy leg to easily find the patella of the affected leg. (This method does not work well if both legs are injured or operated at the same time)
The role of the patella is very important to the knee joint and the movement of the patella during joint movement is very complex, so I won’t go into the details here. The point that must be made is that the mobility of the patella determines to a large extent the angle of flexion and extension of the knee joint, and if the patella cannot move freely, the angle of the knee joint will be very much restricted and affected!
The specific method is as follows.
Use your fingertips (pushing with your fingertips will pinch your flesh and is not good) to push on the edge of the patella and push the patella slowly and hard in each of the four directions, up, down, left and right, to the extreme position you can push to. Push in each direction 5-10 times and hold for 3-5 seconds when pushing to the maximum range of motion. Doing this before the knee flexion exercise can facilitate the sliding of the patella during knee flexion.
After doing the above preparatory exercises, do the following exercises.
A. Exercises for knee extension.
Leg compression exercises: Patients with knee flexion contracture deformity, take a standing or lying position, place the heel on a soft pad of about 30 cm, place your own or others’ hands on the distal end of the thigh, press evenly and continuously until there is a pulling and painful sensation at the back of the knee joint for 3 min, alternating between the two legs, 5 times a day.
B. Exercises for knee flexion.
1. Bedside leg drops.
The so-called bedside, because the early practice in the hospital was either practiced at the hospital bedside or at the treatment bedside. In fact, when you practice at home, the bed at home is relatively short, so your legs hang down and your feet touch the ground, so you can’t practice at the edge of the bed. So you can switch to table side leg draping, that is, you should sit on the table and let your feet off the ground, in order to facilitate the practice.
The specific method is.
Sitting on the edge of a table or a bed that is high enough. With the healthy leg under the injured or operated leg, hook your foot underneath the ankle of the affected leg, that is, hold the affected leg with the healthy leg. The muscles of the affected leg are completely relaxed and the entire weight of the leg is placed on the healthy leg. Then, slowly lower the leg with the strength of the healthy leg, the lower the leg, the greater the angle of knee flexion of the affected leg. After feeling significant pain, stop and hold still for 1-2 minutes as the tissues adapt and the pain may disappear or decrease, then lower the leg again.
This method is suitable for flexion exercises within 0-90°. Because of the protection of the healthy leg underneath, it will not be very nervous and afraid, especially suitable for the early exercise of flexion angle after injury or surgery, and the warm-up exercise before the larger angle bending.
The point is that the affected leg must be completely relaxed, the more afraid to relax, the more obvious the pain will be, the more difficult it will be to bend.
2, sitting chair “against the wall”.
Put the chair right up against the wall. People sitting on the chair, the toe of the affected leg against the wall or other fixed objects to prevent sliding.
After the body is seated, slowly move the body forward, as the body moves forward, the bending angle will also increase at the same time. After 1-2 minutes, the pain may disappear or decrease as the tissues adapt, and then move the body forward to the limit. You can indirectly measure the knee flexion angle by the distance of the knee joint from the wall. The smaller the distance between the knee and the wall, the greater the angle of flexion, provided that the height of the chair remains constant.
This method is suitable for flexion exercises in the range of 90-100°. If the chair is relatively short, the knee joint top to the wall, you can also reach an angle of about 110 °. This method is very safe, because people sitting on the chair, feet on the ground, very stable, as long as they are not suddenly forcefully and violently forward to the top, the angle will not change too much, there is basically no danger. (Except for the chair suddenly broken!)
The main point is that the body should sit upright, not because of pain on the crooked body or lift the hips. Otherwise, you will not be able to increase the angle and control the progress of the angle.
Need to be reminded: tibial plateau fracture, meniscus suture and other affected legs can not bear weight after surgery, can not use this method to practice the angle of flexion!
3. Supine leg draping.
Lie on your back and hold your hands on the back side of the knee joint of the thigh, so that the thigh is perpendicular to the bed, and if necessary, you can also have someone else help to fix the thigh to keep it stable.
You can have someone else hold the ankle joint of the affected leg for protection, or you can separate a hand to hold your heel. After this protection, completely relax the muscles of the thigh and let the lower leg drop naturally by gravity, gradually increasing the angle of knee flexion. After feeling significant pain, stop and hold still for 1-2 minutes as the tissues adapt, the pain may disappear or decrease, and then release to a greater angle.
This method is suitable for a flexion range of 100-120°. Some people with more flexible flexion angles can also rely on this method to practice to an angle of about 130°.
If the joint adhesions and other conditions, the weight of the leg can not increase the angle. Then you can add a load at the ankle joint, but the load should never be too heavy, otherwise the muscles can not relax, but also prone to danger.
It is important to find the right weight for you by trying. It is best not to feel significant pain in the beginning 3-5 minutes, and the calf dares to relax and sag naturally. 3-5 minutes later the pain starts. The last 3-5 minutes of pain reaches the level of need to insist on endurance, can barely hold on to 10-15 minutes as appropriate.
The main point is to fix the thighs and not to move. At the same time, learn to relax the muscles and do not extend the knee to fight the pain. Also master the weight of the load. The trick is not to use a sandbag, use a bag tied to the ankle, add something to the bag, lighter, add a little more, heavier, take at a little, it will be very convenient to adjust the weight at any time!
4, sitting position holding knees.
Sit on the bed, first actively bend the knee to the maximum angle. After holding their hands around their ankles, pull hard to this side of the body, so that the heel slowly and gradually approach the hip to increase the angle of knee flexion. After feeling significant pain, stop and hold still for 1-2 minutes as the tissues adapt, the pain may disappear or decrease, and then hold the leg at a greater angle.
This method is suitable for 110-130 ° flexion range, some flexion angle is more flexible, can also rely on this method to practice to about 130-140 ° angle, or even reach normal.
The advantage of this exercise method is that you can indirectly measure the degree of knee flexion angle by measuring the distance between the heel and the hip.
5. Prone traction knee flexion.
Prone, that is, face down on the bed, the affected leg first straight, then active force bending, flexion to the maximum angle after the help of others or their own grip on the affected side of the ankle, after pulling closer to the direction of the hip, so as to passively make the knee joint to increase the angle of flexion. If the angle does not reach the point where you can grip your ankle, you can find a non-elastic band or your own pants to put around your ankle to facilitate pulling harder at a greater angle. After feeling significant pain, stop and hold still for 1-2 minutes to allow the tissues to adapt, the pain may disappear or decrease, and then pull at a greater angle.
This method is suitable for 120-135 ° flexion range, some flexion angle is more flexible, can also rely on this method of practice to about 140-150 ° angle. Even to the heel next to the hip, to achieve the full range of flexion angle.
The advantage of this method is that when practicing knee flexion you will feel a significant pull on the anterior thigh muscles, which is very good for increasing the extension and flexibility of the antagonist muscles of the flexed knee, the quadriceps, and can help improve the flexibility of knee flexion. The specific mechanism is written in “Principles of rehabilitation of joint adhesions (after release surgery)”, so I will not repeat it here.
The point is that violence should never be used to suddenly increase the angle, especially when others are helping!
6. Protected kneeling sitting.
The angle is close to normal at this time. You can hold something to protect, with the weight of the gradual downward kneeling, to increase the angle of knee flexion. After feeling obvious pain stop and keep still, 1-2 minutes after the tissue has adapted, the pain may disappear or reduce, then kneel at a greater angle.
Be careful to keep your body square and distribute your weight equally between your legs. A crooked body may cause knee flexion with rotation or inversion, which may be dangerous!
The point is also absolutely not to use violence to suddenly increase the angle, while there must be a large angle as a basis to start this exercise, otherwise it may be very dangerous!
7. Full squat under protection.
After the knee flexion angle is basically close to normal. You can hold on to something to protect the squat and use your weight to gradually squat down to increase the angle of knee flexion. After feeling significant pain stop and keep still, 1-2 minutes after the tissue has adapted, the pain may disappear or reduce, then squat to a greater angle.
The important thing to note is that the body should be square and the weight should be equally distributed between the legs. A crooked body may cause knee flexion with rotation or inversion, which may be dangerous!
The point is also that you should never use violence to suddenly increase the angle, and you must have a large angle as a base before you can start this exercise, otherwise it can be very dangerous!
Summarize.
These are the methods of practicing knee flexion at different angles and in different situations. Generally speaking, no matter which method is used to bend the leg, the whole process should be controlled within 30 minutes. Too long and repeated flexion can overstimulate the joint, causing increased swelling and inflammation in the knee joint, which is detrimental to the recovery of joint function!
When practicing knee flexion, it is important to stick to the end of each exercise and not relax in the middle. In other words, do not “repeat” the whole process. Do not relax and rest when you feel pain, and then practice and bend again. You should slowly advance the angle and hold it for 1-2 minutes after the pain starts, so that the pain is relieved after the tissues adapt, and then hold it in a little bit to gradually increase the angle. Otherwise, you are repeating the knee flexion and extension movements, which will likewise stimulate the joint and cause increased swelling and inflammation in the knee joint.
The most important point: although the above-mentioned are methods that can be practiced at home without special equipment, due to the different injuries and surgeries and different tissue conditions of each person, the exercises must still be evaluated and guided by a professional physician therapist, who thinks you are suitable for a certain exercise before you can do it. Own blind practice one-sided pursuit of angle, will only cause danger!