(Read the entire program carefully and with your doctor’s permission before using it for guided practice)
Caution.
1.The methods and data provided in this plan are formulated 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 depending on their own situation, and should be practiced at the same time the healthy side. The improvement of muscle strength is a key factor for joint stability, and must be practiced carefully.
4, 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.
5, 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 insist on completing the exercises.
6.Ice packs should be given for 15-20 minutes immediately after the mobility exercises. If the joint swelling, pain and fever are obvious, ice can be applied again 2-3 times a day.
7.The side with shadow in the appendix is the affected side.
8.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, the swelling will gradually subside. Sudden increase of swelling should adjust the exercise, reduce the amount of activity, and promptly follow up when it is serious.
I. Early stage – inflammatory reaction and relative fixation period (0-2 weeks) Depending on the degree of injury, surgical fixation and suture method, different methods such as movable splint, straight splint or short-term plaster fixation may be adopted after surgery, and the exercises should be based on this procedure and implemented after the doctor’s modification and guidance The purpose of this procedure is to
Purpose: To reduce pain and swelling; early muscle strength exercises; early weight bearing; early small range of mobility exercises to avoid adhesions and muscle atrophy.
At the early stage of functional exercises, the muscle strength level is low, the tissue has a more obvious inflammatory reaction, and the reconstructed ligaments are still fragile. Therefore, endurance exercises with small loads are the main focus. Choose a light load (the amount of load to complete 30 movements that feel fatigue), 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 do 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.
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, the anterior thigh muscles are tensed and relaxed.
(ii) One day after surgery.
1. Ankle pump – forceful, slow, full-range flexion and extension of the ankle joint, 5 minutes/group, 1 group/hour. (Important for promoting circulation, decreasing swelling and preventing deep vein thrombosis) 2 Quadriceps (anterior thigh muscles) isometric exercises – that is, thigh muscle tensing and relaxation. Do as many as possible without increasing pain. (More than 500 times/day) 3 N cord muscle (posterior thigh muscle group) isometric exercise – the affected leg force down the padded pillow, so that the posterior thigh muscle tense and relax. Requirements as above, greater than 500 times/day (iii) 2 days after surgery: drainage removal1 Continue the above exercises.
2. If the pain is milder, the ankle pump is changed to anti-gravity exercises (can be assisted by others or by holding the thigh with hands). Performing this after each time you get out of bed can effectively prevent swelling.
3.Start to try straight leg lift – extend the knee and lift the leg straight up to the heel 15M from the bed, hold until exhaustion. 10 times/group, 2-3 groups/day (pain at the incision is normal and should be tolerated.
4.Start the lateral leg raise exercise (temporarily do not do the medial leg raise), 30 times/group, 2-4 groups/day, with 30 seconds rest between groups.
5.Start posterior leg raising exercise, lying prone (face down on the bed), lift the affected leg straight backward until the tip of the foot is 5 cm from the bed for one time, 30 times/group, 2-4 groups/day, rest 30 seconds between groups.
(iii) 3 days after surgery.
1.Continue the above exercises.
2.If there is no cast fixation, you can start weight-bearing and balancing exercises—separate both feet under protection, alternately move the center of gravity left and right within the range of slight pain, gradually transition to fully weight-bearing standing on one leg.
–5 minutes/time, 2 times/day.
(iv) 4 days after surgery.
1.Continue the above exercises.
2.Strengthen the weight-bearing and balancing exercises, gradually until you can stand on one leg with the affected leg.
3.If you can do it easily, then start to walk with a single crutch (holding on the healthy side).
(E) 1 week after surgery: The doctor will decide whether to start flexion and extension exercises according to the situation.
1.Start flexion exercises (within 0°-60° slightly painful isometric range. (Should be completed by the rehabilitation physician, or with the permission of the physician under the guidance of the rehabilitation program to practice on their own, because early practice is still a certain degree of risk, so do not practice blindly without permission, otherwise it may cause adverse consequences.)
2. Apply ice for about 20 minutes immediately after the flexion exercise. If there is usually a significant feeling of heat and swelling in the joint, ice can be applied 2-3 times / day.
3.Start stretching exercises (sitting suspension): put a pillow at the heel, make the affected leg leave the bed completely, relax the muscles so that the knee joint extends naturally. 30 minutes/time, 1-2 times/day.
4. If you can stand on one foot, you can walk with one crutch.
II. Initial period: (2-4 weeks) Purpose: To strengthen mobility and muscle strength exercises: to improve joint control and stability; to gradually improve gait.
(i) 2 weeks after surgery.
1.Passive flexion to 60-70° by the end of the week.
2.Intensive muscle strength exercises. (straight leg raise preferably up to 6 minutes)
3.If there is no significant instability in the joint, indoor walking can be off the crutches.
4.Extension up to basically the same as the healthy side (non-operated side leg).
5.Start to practice flexion on your own with guidance, see remarks for method.
6, gradually adjust the splint to 0-30 ° range of flexion and extension, and every 5 days or so to increase the angle.
If the joint instability is obvious when walking and weight-bearing after the adjustment, reduce the angle back to the pre-adjustment angle.
(ii) 3 weeks after surgery: Adjust splint or knee brace to 0°-50° of flexion and extension.
1. Passive flexion to 70-80°.
2. Intensify active flexion and extension exercises and strengthen muscle strength exercises.
3.Start walking off the crutches.
4.Start to hold the knee in sitting or lying position to practice flexion and extension. Hold the knee until you start to feel pain and hold it for 10 seconds, then relax slightly (do not rest in full extension during the whole exercise) and rest for 5 seconds, then hold the knee again and repeat the exercise for 20 minutes, once a day.
5.Start the “leg hook” exercise in the prone or standing position. The exercise should be performed in the range of angle allowed by the movable splint, flexing to a painless angle for 10-15 seconds. 15-20 times/group, 4 groups/day.
(iii) 4 weeks postoperatively.
1.Passive flexion up to 80-90°.
2.Adjust splint to allow flexion and extension in the range of 0-70°.
3.Start anterior-posterior and lateral straddle exercises. 30 times/group, 4 groups/day.
4.Strive to achieve normal gait walking on flat ground.
Third, the middle term: (5 weeks-3 months) purpose: strengthen the joint mobility to the same as the healthy side. Strengthen muscle strength and improve joint stability. Restore the ability to perform all activities of daily life.
With the improvement of muscle strength level, absolute strength exercises are the main focus in the middle stage. Choose a medium load (the amount of load that makes you feel fatigued after completing 20 movements), 20 times/group, 2-4 groups of continuous exercises, with 60 seconds rest between groups, until fatigue.
(i) 5-6 weeks postoperatively: adjust the splint or knee brace to allow flexion and extension in the range of 0°-90°.
1 Passive flexion should be greater than 90° (100-110°).
2 Start static squatting or sliding exercises against the wall. Performed at a pain-free angle. 2 min/rep, 5 sec interval, 10 consecutive sets of 2-3 sets/day.
(ii) 7-8 weeks postoperatively: adjust splint or knee brace to allow for flexion and extension in the range of 0°-110°.
1. Passive flexion angle up to 110-130°.
2. stationary bike exercises, no load to light load. 30 min/time, 2 times/day.
3.Strengthen the muscle strength (but not increase the load, only increase the angle, frequency and time of the exercise.
4.Start the knee exercise of single leg 45° semi-squat flexion and extension on the affected side. 5 minutes/time, 4 times/day.
(iii) 10 weeks-3 months postoperatively: (splint can be removed) 1 The angle of active and passive knee flexion and extension is basically the same as that of the healthy side, and there is no significant pain.
2. Daily prone flexion so that the heel is close to the hip (same position as the healthy side) and continuous stretching for 10 minutes/time.
3.Start kneeling exercises.
4.Start pedaling exercises.
4.Later stage: (4 months-6 months) Objective: To fully resume all activities of daily life. Strengthen muscle strength and joint stability. Gradually resume exercise.
In the later stage, increase the maximum strength, choose a large load (complete 12 movements that is the fatigue of the load), 8-12 times / group, 2-4 groups of continuous exercises, rest 90 seconds between groups, until fatigue.
1.Start the knee ring exercise.
2.Start jumping up and down exercises.
3.Start lateral straddle exercise.
4.Start swimming (breaststroke is prohibited in the early stage). Jump rope and jogging.
5.The athlete starts the special exercises of the base movement.
During this period, the reconstructed ligaments are not strong enough, so the exercises should be done gradually, not reluctantly or blindly. The knee joint should be strengthened to ensure the stability and safety of the knee joint in sports, and the knee brace can be worn for protection if necessary, but only during strenuous sports.
V. Recovery period: (7 months – 1 year) Purpose: Full recovery from sports or strenuous activities. To strengthen muscle strength and joint stability during running and jumping. Gradually resume strenuous activities or special training. *If the mobility of the affected joint is normal and the muscle strength is at least 85% of the healthy side, then full return to sports can be achieved. Review and surgical removal of the internal fixation.