Precautions.
1. The presence of pain during functional exercises is unavoidable. If the pain can subside to its original level within half an hour of the exercise stopping, it will not cause damage to the tissue and should be tolerated.
2, 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 the key factor of joint stability and must be practiced carefully. Huang Suizhu, Department of Orthopedics, Henan Provincial People’s Hospital
3, in addition to the surgical limb braking 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 insist on completing the exercises.
5. Immediately after the mobility exercise, give ice packs for 15-20 minutes. If you usually feel swelling, pain and heat in the joint, you can apply ice again, 2-3 times a day.
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, then the swelling will gradually subside. The sudden increase of swelling should adjust the exercise, reduce the amount of activity, and timely follow-up when serious.
7. The mobility of the old anterior fork ligament reconstruction joint should not exceed 90° within 3 weeks after surgery.
8.The text is 0° for knee extension and greater than 90° for deep squat.
I. Early stage: inflammatory response period (0-1 week)
Objective.
To reduce pain, swelling; early muscle strength exercises; early weight bearing; early mobility exercises to avoid adhesions and muscle atrophy.
In 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 relatively fragile. Therefore, static exercises (joint inactivity, maintaining a certain posture until muscle fatigue) are the main exercises. Gradually increase the small load of endurance exercises, that is, the choice of light load (complete 30 times the action that the fatigue of the load), 30 times / group, 30 seconds rest between groups, 2-4 groups of continuous practice, until fatigue.
Do not walk too much! Walking should not be used as an exercise method! Otherwise, it is very easy to cause joint swelling and fluid accumulation, which will affect functional recovery and tissue healing.
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.
One day after surgery.
24 hours after surgery, you can hold the double crutches and walk on the foot without touching the ground (only to go to the toilet!)
1. Ankle pump.
Forceful, slow, full range of flexion and extension of the ankle joint, as much as possible while awake. (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.
3, N rope muscle (posterior thigh muscle group) isometric exercises.
The affected leg force down the padded pillow, so that the posterior thigh muscles tense and relaxed.
4, correct body position DD affected leg elevated on the pillow.
The toe is directly above, not crooked to the side, the knee joint should be vacant below, not to use the pillow to pad the leg into a slightly bent position. If the pain is unbearable, place in a comfortable position under the guidance of a doctor.
5. Start trying straight leg raise.
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 during exercise is normal and should be tolerated.) (Pain is normal and should be tolerated). Be sure to straighten the knee joint as much as possible when lifting the leg, and do it quickly and slowly.
2 days after surgery.
Removal of drainage
1. Continue the above exercises.
2. Change the ankle pump to anti-gravity exercises (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, 30 times/group, 2-4 groups/day, rest 30 seconds between groups.
4.Start posterior leg raising exercise, lying prone (face down on the bed), lift the affected leg straight backward until the toe is 5 cm from the bed for 1 time, 30 times/group, 2-4 groups/day, rest 30 seconds between groups.
3 days after surgery.
Start joint mobility exercises at the discretion of the surgeon depending on the situation.
1. Continue the above exercises.
2 Weight bearing and balance – separate the feet under protection, alternately move the center of gravity from side to side within the range of slight pain, aiming to achieve full weight bearing standing on one leg, 5 minutes/set, 2 times/day.
3. Start flexion exercises (within the range of micro-pain. The exercises should be performed under the guidance of the rehabilitation program with the permission of the physician, because there is still a certain risk in the early exercises, so do not practice blindly without permission, otherwise it may cause adverse consequences).
4.Ice pack about 20 minutes immediately after the flexion exercise, if there is usually a feeling of obvious heat and swelling in the joint, ice pack can be applied again 2-3 times/day.
5, stretching exercises DD at the heel pillow, so that the affected leg completely out of bed, relax the muscles so that the knee joint natural extension. 30 minutes / time, 1-2 times / day. Interval with flexion exercises as far as possible.
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. If this can be done easily, start walking with a single crutch (supported on the healthy side).
3.Flexion exercises to 0°-60° range (with doctor’s permission).
5 days after surgery.
1.Continue and strengthen the above exercises.
2.Flexion exercises to 70°-80° (with doctor’s permission), and active flexion and extension exercises can be started. 5 times after icing, gradually increase to 10-20 times.
1-2 weeks after surgery.
(The progress of flexion angle varies according to individual differences and according to the doctor’s recommendations)
Exercise goal: flexion angle greater than 90°, active flexion up to 90°.
II. Initial period: (2-4 weeks)
Objective.
To strengthen mobility and muscle strength exercises, improve joint control and stability; gradually improve gait.
2 weeks after surgery.
1. Passive flexion to 90-100° (with doctor’s consent).
2.Intensive muscle strength exercises. (Straight leg lift can be weighted on the thigh side as a load.)
3.With the brace, if you can stand on one foot for 1 minute, you can walk with a single crutch, and you can walk indoors with the crutch off.
4.Stretching up to the healthy side (non-operated side of the leg) is basically the same.
5.Start to practice flexion on your own with guidance.
6.Adjust the brace gradually to 0°-70° range of flexion and extension, and increase the angle every 3-5 days, and adjust it to 110° after 4 weeks after surgery. If the joint instability during walking and weight-bearing is obvious after the adjustment, the angle will be reduced back to the pre-adjustment angle.
3 weeks after surgery.
1.Passive flexion to 100-110° (with doctor’s consent).
2.Strengthen active flexion and extension exercises and strengthen muscle strength exercises.
3.Start to try to walk with the brace off the crutches.
4 weeks after surgery: (without brace during sleep)
1.Passive flexion up to 110-120°.
2.Adjust the brace to flexion and extension in the range of 0°-110°.
3.Start anterior-posterior and lateral straddle exercises, with the affected leg in front and weight-bearing on the straddle side.
4.Static squatting exercises: back against the wall, feet shoulder-width apart, toes and knees are forward, not “inside and outside the eight”, gradually increase the angle of squatting (less than 90 °, that is, not deep squatting), 2 minutes / time, 5 seconds interval, 5-10 consecutive / group. 2-3 groups / day.
5, strive to achieve normal gait walking.
Third, the middle: (5 weeks – 3 months)
Objective.
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 will be the main focus in the middle stage. Choose a medium load (the amount of load to complete 20 movements to feel fatigue), 20 times / group, 2-4 sets of continuous exercises, rest 60 seconds between sets, until fatigue.
5 weeks after surgery.
1.Passive flexion up to 120-130°.
2. Begin knee exercises with the affected leg in a 45° single leg semi-squat flexion and extension. Stand with the affected leg on one leg, straighten the upper body, slowly squat to 45° of flexion, and then slowly pedal until fully straightened. 20-30 times/group, 30 seconds interval between groups, 2-4 times/day.
3. stationary bicycle exercises, no load to light load. 30 min/set, 2 times/day.
8-10 weeks postoperatively.
1.Passive flexion angle gradually to the same as the healthy side.
2.”Seated knee hold” for the exact same as the healthy leg.
3.Strengthen the muscle strength, (but not increase the load, only increase the angle, frequency and time of exercises.)
10 weeks-3 months after surgery.
1, Active flexion and extension of the knee angle is basically the same as the healthy side, and there is no significant pain.
2, Daily prone flexion strives to make the heel touch the hip.
3.After the sitting knee angle is exactly the same as the healthy side, kneeling exercises will be started.
4.Start pedaling exercises.
IV. Late stage: (4 months – 6 months)
Objective.
To fully resume all activities of daily life. Strengthen muscle strength and joint stability. Gradually resume exercise.
Late stage to improve the maximum strength, choose a large load (to complete 12 movements that fatigue the load), 8-12 times / group, 2-4 sets 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), rope skipping and jogging.
5.Athletes start the special exercises of the base movement.