I. Early – inflammatory response period (0-1 week)
Purpose: To reduce pain, swelling; early muscle strength exercises; early weight bearing; early mobility exercises to avoid adhesions and muscle atrophy.
In the early and initial stages of functional exercises, the tissue has a more obvious inflammatory response due to the low muscle strength level. Therefore, static exercises and endurance exercises with small loads are the main focus. Choose a light load (30 times the amount of fatigue to complete the movement), 30 times / group, 2-4 groups of continuous exercises, 30 seconds rest between groups, until fatigue.
Do not walk too much in the early stage and should not use walking as an exercise method. Otherwise, it is very likely to cause joint swelling and fluid accumulation, which will affect functional recovery and tissue healing.
(i) On the day of surgery.
1. Ankle pump – forceful, slow, full range of flexion and extension of the ankle joint, the more the better.
2. Quadriceps isometric exercises – i.e. thigh muscle tensing and relaxation. Should be done as much as possible without increasing pain.
3, N rope muscle isometric exercises – the affected leg force down the padded pillow, so that the back of the thigh muscle tense and relaxed. The requirements are the same as above. All exercises are done as much as possible without increasing pain!
4. 24 hours after surgery, you can walk on the ground with the help of crutches, but only to go to the toilet and other necessary activities.
(II) 1 day after surgery.
1.Continue the above exercises. Change the ankle pump to anti-gravity exercises (you can be assisted by others or hold the thigh with your hand).
2.Start straight leg raise – straight leg raise after knee extension to heel 15M from bed, hold for 5 seconds. 30 times/group, 3-4 groups/day.
3.Weight-bearing and balance (postpone for 3-5 days for patients with combined cartilage injury)-separate the feet under protection and move the center of gravity alternately from side to side within the range of slight pain. 5 min/set, 2 sets/day.
(iii) Flexion exercises are started 3-7 days after surgery depending on the situation.
Flexion exercises are performed to the extent of slight pain, up to the largest possible angle to avoid re-adhesion at the release.
(iv) 1 week postoperatively.
1. Continue the above exercises. Start single-leg standing balance exercises. 5 minutes/time, 2-3 times/day.
2.Start prone “leg hook exercise”, 10 times/group, 2-4 groups/day.
3. Active knee flexion greater than 90 degrees.
(v) 5 days after surgery.
Continue and strengthen the above exercises. Start active extension and flexion exercises in the range of 0-45 degrees with weight in standing position. 30 times/group, 2-3 groups/day, and apply ice for swelling and pain after the exercises.
(vi) 1 week after surgery.
Active flexion greater than 100°. 2 Can stand on one foot, can walk short distances without crutches.
II. Initial period: (2 weeks-1 month)
Purpose: To strengthen mobility and muscle strength exercises: improve joint control and stability; start to resume daily activities.
With the improvement of muscle strength level, the exercises to improve absolute strength are the main focus in this period. Choose a medium load (the amount of load to complete 20 movements that is fatigue), 20 times / group, 2-4 groups of continuous exercises, rest 60 seconds between groups, until fatigue.
Care should be taken to control the amount of exercise to avoid joint swelling and fluid accumulation. If the joints feel swollen and hot after the exercise, ice should be applied promptly!
(I) 2 weeks after surgery.
1.Flexion to 120-130°.
2.Intensive muscle strength exercises. (One straight leg raise up to 6 minutes)
3.No significant swelling or pain in the joint, then you should walk with a normal gait as much as possible.
4.Start to instruct the various muscle exercises, the load, angle, number of times and time of the exercises, according to their own conditions. Generally 30 times/group, 2-4 groups/day.
(II) 3 weeks after surgery.
1.Passive flexion to 140°.
2.Intensive muscle strength exercises.
3.Start anterior-posterior and lateral straddle exercises. 30 reps/group, 4 groups/day. (Ice pack after exercise!)
III. Mid-term: (1 month-2 months)
Purpose: Strengthen joint mobility to the same level as the healthy side. Strengthen muscle strength and improve joint stability. Restore the ability to perform all activities of daily life, and light exercise.
(i) 4-5 weeks after surgery.
1.Active flexion up to 150° (full range, same as the healthy leg), and basically pain-free.
2.Start static squatting exercises against the wall. Squatting exercises: back against the wall, feet shoulder-width apart, toes and knees are forward, no “internal and external eight”, with the power to gradually increase the squatting angle (less than 90 °), 2 minutes / time, interval of 5 seconds, 5-10 consecutive / group. 2-3 groups / day.
3, the beginning of the standing position “hook leg” exercise. Resistance flexion to the maximum pain-free angle for 10-15 seconds. 30 times/group, 4 groups/day.
(II) 6-8 weeks after surgery.
1.Active flexion and extension angle reach the same as the healthy side, and no pain.
2.Start single leg 45 degree position half squat exercise on the affected side. 5 minutes/set, 4 times/day.
IV. Late stage: (2 months – 3 months)
Purpose: Full restoration of all activities of daily life. Strengthen muscle strength and joint stability. Gradually resume exercise. Increase the maximum strength, choose a large load (the amount of load to complete 12 movements that feel fatigue), 8-12 times / group, 2-4 groups of continuous exercises, rest 90 seconds between groups, until fatigue.
V. Recovery exercise period: (3 months later)
Purpose: Full return to sports or strenuous activities.
Knee pads can be worn for protection if necessary, but are only advocated for use during strenuous exercise.
1. Gradually resume strenuous activities or special training.
2.Strengthen the muscle strength and the stability of the joint during running and jumping.
3. If the strength of the affected muscles reaches 85% or more of the healthy side, there is no pain and no obvious swelling during the exercise, then the exercise can be fully resumed.
Flexion exercise methods.
Choose any one of the following methods. Once a day, strive for a slight increase in angle can be. If there is any special discomfort during or after the exercise, promptly inform the doctor. Exercise process shall not be straightened rest, repeated flexion and extension, otherwise it will affect the effect, and very easy to cause swelling.
1, sitting (or supine) position hanging leg: sitting on the edge of the bed lying down, below the knee hanging outside the bed. Relax the thigh muscles under protection, so that the calf drops naturally, to the limit of protection for 10 minutes. If necessary, you can add load at the ankle joint.
2.Supine draped leg: supine on the bed, thighs perpendicular to the bed, under the protection of relaxed thigh muscles, so that the calf natural drooping, the requirements of the same as above.
3.Sitting knee: sitting position, the foot does not leave the bed, hands clasped at the ankle joint, slowly, hard, maximum knee flexion, and hold for 10 seconds. 10 minutes / time, 2-3 times / day.
Exercise method of extension and flexion: ( If preoperative extension disorder exists, it must be practiced carefully )
1. Seated knee extension: Sitting position with foot pads elevated and weighted above the knee joint. Relax the muscles completely and hold for 30 min. 30 min/time, 1-2 times/day.
2. Prone suspension: prone, hanging below the knee outside the bed, with a weight at the ankle joint. Same requirements as above.