In recent years, with the improvement of people’s living standards and the popularization of health knowledge, more and more people are involved in exercising, such as basketball, soccer, ice skating, jogging, rock climbing, etc. However, in the process, due to the lack of awareness of their own protection or sports accidents, some people may suffer ACL injuries or even rupture during the exercise process. Of course, injuries caused by car accidents or accidents also occur from time to time. In China, there are more and more surgical cases of ACL rupture reconstruction, but most people lack scientific and effective rehabilitation guidance and exercises, which makes it difficult to achieve satisfactory functional needs after surgery.
So, what should we start to do for functional exercise after ACL reconstruction? In fact, rehabilitation exercise is not a one-time process. Different periods of postoperative rehabilitation training have different goals and methods. In the following, we will use different periods as the dividing line to tell you the ideas of rehabilitation training respectively.
The first stage of postoperative rehabilitation (week 0-2)
The correct position placement in the early postoperative period is especially important. Generally, the affected leg is taken to be elevated on a pillow, with the toes in a position directly above, not crooked to one side, and the lower part of the knee joint should be vacated, and the leg should not be padded into a slight bend with a pillow. If the pain is unbearable, the leg should be placed in a comfortable position under medical supervision.
The focus of rehabilitation at this stage is on knee mobility from 0° to 90°, restoration of full passive extension, muscle strength training of the relevant muscle groups, progressive weight bearing, and control of postoperative swelling.
Joint mobility is required between 0° and 90°, and patients can perform joint mobility exercises on the first postoperative day, usually one leg bending exercise a day early on.
After removal of the stitches, before joint mobility, patients can perform patellar activities by pushing the edge of the patella with the finger belly or palm root and slowly pushing the patella to the limit in four directions: up, down, left, right and left, which is not necessary for flexible patellar activities. Generally 10-20 times in each direction, 1-2 times/day, do not increase the amount on your own to avoid increasing the swelling around the patella!
After the patella is loosened, start bedside leg dropping exercises, sit or lie on your back at the edge of the bed, relax the thigh muscles, protect the lower leg (you can slowly lower the affected leg with the healthy leg) so that the lower leg drops naturally, hold it in the position where you feel pain for 5-10 minutes, continue to increase the angle after the pain is reduced, and practice for no more than 20 minutes in total.
It is very important to restore full extension, as limited extension after ACL reconstruction can cause abnormal gait, aggravate patellofemoral symptoms and quadriceps weakness, leading to functional limitations. Patients are usually required to be passively able to fully straighten the knee 2-3 weeks after surgery. Patients can generally practice sitting knee extension at home, or increase the number of exercises if preoperative extension is severely limited.
Seated knee extension exercises: Sitting or supine position, ankle joint, i.e., ankle and wrist pads, so that the lower leg and the lower knee joint are completely empty, completely relaxing the muscles and relying on the self-weight of the limb to naturally drop, hold for 20-30 minutes, 2-3 times/day. If necessary, weights can be placed above the knee joint.
The muscle strength training for the relevant muscle groups are as follows.
(1) Ankle pump exercises.
That is, active ankle flexion and extension exercises, requiring slow, forceful, maximum, repetitive, and as much as possible when awake. This exercise is important for promoting circulation, decreasing swelling and preventing deep vein thrombosis, and must be taken seriously. The specific method is to sit on the bed, legs straight, maximum hook, toes and taut toes, bilateral limbs together, generally hold at the limit for 3 – 5 seconds, and continue to practice for 5 minutes every 1-2 hours.
(2) Quadriceps re-education.
Supine or seated position, with the affected knee straight, tense the muscle with the greatest possible force for 5 seconds without increasing pain, and then relax for 1 time. The intensity of this exercise is very low for a muscle as strong as the quadriceps and can only slow down the rate of muscle atrophy, so it should be practiced as much as possible. The general requirement is greater than 1000 times/day. This exercise mainly strengthens the muscle strength of the anterior thigh muscle group, that is, the exercise of the quadriceps, to improve the knee joint control ability.
(3) N cord muscle isometric exercises.
Supine or sitting position, the affected knee straight or slightly flexed, thigh and heel force downward pressure of the padded pillow, so that the posterior thigh muscle tense. In the premise of not increasing pain as much as possible maximum force tense muscle for 5 seconds, and then relax for 1 time. This exercise intensity for the N rope muscle, the intensity is very small, can only slow down the rate of muscle atrophy, so should be practiced as much as possible. Generally require more than 1000 times / day. This exercise mainly strengthens the muscle strength of the posterior thigh muscle group, i.e., exercises the N cord muscle and improves the knee joint control ability.
(4) If not specifically explained by the surgeon, the patient may begin to try straight leg raising exercises.
Lie in the supine position, straighten the knee joint as much as possible, and lift the straight leg until the heel is 15M from the bed. Maintain until exhaustion, i.e., unable to hold on for 1 time, 10 times/group, 2-4 consecutive sets of exercises, rest for 1 minute between sets, and change to sitting position when strength increases. After feeling that you can easily complete, you can add sandbags at the ankle joint for load strengthening exercises. This exercise mainly strengthens the muscles of the anterior thigh group, exercises the quadriceps and hip flexor muscles, improves hip and knee joint control and maintains knee stability.
(5) Lateral leg lift exercise.
Medial straight leg lift, with the affected lower limb in the same lateral recumbent position, that is, the right lower limb shown in the figure is the affected limb on the right side. Straighten the knee joint and lift the leg medially straight, 10-20 times/group, 2-4 consecutive groups with 1 minute rest between groups. After the strength is increased, sandbags can be added to the ankle joint as a load to strengthen the exercise. This exercise mainly strengthens the medial thigh muscles, exercises the adductor muscles, and improves the stability of the medial knee joint and the control of the hip adduction.
Lateral straight leg lift, with the affected lower limb on the opposite side of the lateral position, that is, as shown in the figure, the left lower limb for the affected limb is the right side of the lying position, straighten the knee joint straight leg lateral lift, 10-20 times / group, 2-4 sets of continuous exercises, rest 1 minute between groups. After the strength is increased, sandbags can be added at the ankle joint as a load to strengthen the exercise. This exercise mainly strengthens the muscle strength of the lateral thigh muscle group, exercises the abductor muscle, improves the lateral direction of the knee joint stability and hip abduction control ability.
(6) Rear leg lift exercise.
Prone position, try to straighten the knee joint to lift backward to the tip of the foot from the bed 5M. Maintain until exhaustion, that is, not able to hold on for 1 time, 10 times / group, 2-4 consecutive sets of exercises, rest 1 minute between groups. After the strength is increased, sandbags can be added at the ankle joint as a load to strengthen the exercise. This exercise is mainly to strengthen the rear thigh muscle group, and hip extension muscle strength, exercise N rope muscle and gluteus maximus, etc., to improve the hip and knee joint control ability and stability.