Points to note before rehabilitation.
1. The presence of anterior knee pain during functional exercises is unavoidable. If the pain can subside to its original level within half an hour of stopping the exercise, it will not cause damage to the tissue and should be tolerated.
2, plyometric exercises should be concentrated until the muscles feel sore and fatigued, and then proceed to the next group after sufficient rest. The number of exercises, time, load depending on their own situation, and should be practiced at the same time the healthy side. The improvement of muscle strength and muscle capacity is the key factor of joint stability, and it is expected to be practiced carefully.
3, in addition to the surgical limb brake protection, the rest of the body parts (such as the upper limb, waist and abdomen, the healthy side of the leg, etc.) should be practiced as much as possible to ensure physical quality, improve the overall level of circulation and metabolism, and promote the recovery of the surgical local.
4, early joint mobility (flexion, extension) exercises, only once a day, and strive to improve the angle can be, avoid repeated flexion and extension, multiple exercises. If the flexion angle does not progress for a long time (>2 weeks), there is a possibility of joint adhesions, so we should pay great attention to it and consult the attending physician in time.
5. Apply ice for 20~25 minutes each time, 4~6 times a day. If the joint is swollen and hot, the number of ice packs can be increased. It can be increased 1 time after exercise.
6.The swelling of the joint will accompany the whole exercise process, and it is normal that the swelling does not increase with the angle exercise and activity, until the angle and muscle strength basically return to normal swelling will gradually subside. Sudden increase of swelling should adjust the exercises and reduce the amount of activity, and consult the attending doctor when it is serious.
Rehabilitation procedures
I. Protection period: 1 day to 4 weeks after surgery
Purpose: To reduce pain and swelling; early muscle strength exercises; early weight-bearing; early mobility exercises to avoid adhesions and muscle atrophy.
(i) On the day of surgery: after the anesthesia subsides, start to move the toes and ankle joint; if the pain is not obvious, try to contract the quadriceps muscle. That is, tensing and relaxation of the anterior thigh muscles.
(ii) 1 day after surgery: 24 hours after surgery, you can walk without touching the ground by holding the affected limb with double crutches (only to the bathroom!)
1. Ankle pump: forceful, slow, full range of flexion and extension of the ankle joint, as much as possible. (Important to promote circulation, reduce swelling and prevent deep vein thrombosis)
2, quadriceps (anterior thigh muscle group) isometric exercises: that is, thigh muscle tensing and relaxation. Do as much as possible without increasing pain, more than 500 times/day.
3, posterior thigh muscle group isometric exercise: the affected leg force down the padded pillow, so that the posterior thigh muscle tensing and relaxation, more than 500 times / day.
4, correct body position: the affected leg is elevated on the pillow, the toe is directly above, not crooked to the side, the knee joint should be vacant below, do not use the pillow to cushion the leg into a slightly
The leg should not be padded into a slightly bent position with a pillow. If the pain is unbearable, place in a comfortable position under the guidance of the doctor.
5. Start to try straight leg lift: fully straighten the leg and lift it up to the heel 15M from the bed, hold it until exhaustion. 10 times/group, 2~3 groups/day.
(iii) 2 days after surgery: remove the drainage tube, remove the cotton leg, and install the chuck support (0° position fixation).
1.Continue straight leg raising exercises, 10 times/group, 2~3 groups/day.
2.The ankle pump is changed to anti-gravity exercise (can be assisted by others or hold the thigh by hand). Performed after each time you get out of bed can effectively prevent swelling.
3.Start side leg raise exercise: 10 times/group, 2~4 groups/day, 30 seconds rest between groups.
4.Start posterior leg lift exercise: prone position, lift the affected leg straight backward until the toe is 5 cm from the bed for 1 time, 20 times/group, 2~3 groups/day, rest 30 seconds between groups.
(iv) 3 days after surgery.
1.Continue the above exercises, leg lifting exercises in all directions (anterior, posterior and lateral), 20 times/group, 3 groups/day.
2.Walk on the ground without weight, but the operated limb should not be weight-bearing, and walking should not be too much, as it is easy to form joint effusion.
(v) 4 days after surgery: Start joint mobility exercises according to the situation as decided by the doctor.
1.Continue the above exercises.
2.Start flexion exercises: Sit on the edge of the bed with the brace removed, hang below the knee outside the bed, and flex to the maximum within the range of 0°~90° in a slightly painful state.
3.Stretching exercise: stretching exercise: remove the brace, put a pillow at the heel, make the affected leg leave the bed completely at the N fossa, relax the muscles to make the knee joint straighten naturally. (Very important to prevent limping) 3 times/day
(vi) 5 days after surgery.
1.Continue to strengthen the above leg raising muscle exercises.
2.Continue to practice maximum flexion in the range of 0°~90° once a day.
(vii) 1~2 weeks after surgery: (The progress of flexion angle varies according to the individual differences)
1.Continue to strengthen the above leg raising muscle strength exercises.
2.Continue to practice maximum flexion in the range of 0°~90° once a day, and strive for active flexion up to 90° by 2 weeks later.
3. Keep the functional knee brace fixed in extension position (i.e. 0°) for 4 weeks.
(iv) 2 to 4 weeks postoperatively.
1.Continue and strengthen the above strength exercises.
2.Start “kicking” exercises to strengthen the leg.
3. Increase the passive knee flexion angle by about 10° every week.
(v) 4 weeks postoperatively.
1.Strengthen the strength exercises.
2.Passive knee flexion to 100°.
3.Active knee flexion to 90°.
4, Begin exercises to rotate the lower leg, range until just natural stop.
5.Weight-bearing exercises are detailed at the end of this article
Second, resume weight-bearing period: 5~8 weeks after surgery
Do not walk too much during this period, otherwise it will easily lead to joint swelling and fluid accumulation, which will affect functional recovery and tissue healing.
1.Weight-bearing and balance exercises: separate both feet under protection, alternately move the center of gravity left and right within the range of slight pain, gradually transition to full weight-bearing standing on one leg, 5 minutes/time, 2~3 times/day. Separate both feet anteriorly and posteriorly, move the center of gravity, and gradually transition to single-leg full weight-bearing standing.
2. 6~8 weeks after surgery, continue to perform passive knee flexion exercises on your own at the bedside, but maintain the passive movement angle at 120°.
3.Flexion and extension knee 0~30° strength exercises, 30 times/group, 2~4 groups/day, with 30 seconds rest between groups.
III. Recovery period: 9 weeks to 12 weeks after surgery
1. Eight weeks after surgery, the knee can be passively flexed over 120°, and active knee exercises can be performed on your own.
2. You can start “leg hooking” exercises. To strengthen the posterior thigh group muscle strength. Should be static exercises, flexion to pain-free angle to maintain 10-15 seconds, 10 times / group, 4 groups / day.
3.Can start front and back, lateral straddle exercises.
4.Fixed bicycle exercises, no load to light load. 10-20 minutes/set, 2 times/day.
IV. Recovery exercise period: after 3 months
Purpose: Full return to exercise or strenuous activity. Gradually resume strenuous activities, or special training. Strengthen the muscle strength and the stability of the joints in running and jumping. Through the test, the affected muscle strength reaches 85% or more of the healthy side, no pain in sports, no obvious swelling, then can fully resume sports.
Weight-bearing training.
1, the meniscus suture 2 stitches or less (including 2 stitches): under 30 years old, 2 weeks after surgery, partial weight bearing, weight bearing is 1/3 to 1/2 of body weight, weight bearing 3-4 weeks before full weight bearing, generally after the third week of weight bearing to a crutch, pay attention to the ground activities after the ice; under 40 years old, 3 weeks after surgery, partial weight bearing; over 40 years old, 4 weeks after surgery, partial weight bearing.
For patients under 40 years of age, partial weight-bearing begins 3 weeks after surgery; for patients over 40 years of age, partial weight-bearing begins 4 weeks after surgery; for patients with more than 2 stitches in the meniscus (excluding 2 stitches or transverse body sutures): partial weight-bearing of the operated limb begins 4 to 5 weeks after surgery, with weight-bearing of 1/3 to 1/2 of body weight, and full weight-bearing only after 6 to 8 weeks, with attention to icing after moving to the ground.