* Caution.
1. The methods and data provided in this plan are developed 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. Pain in 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 upper limbs, waist and abdomen, 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 exercise. If you usually feel swelling, pain and heat in the joint, you can apply ice again, 2-3 times a day.
7.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 exercise, reduce the amount of activity, and in serious cases should be timely follow-up.
Full text
I. Early stage
Straight splint fixation period (0-4 weeks)
Purpose: To reduce pain and swelling; early muscle strength and passive mobility exercises to avoid adhesions and muscle atrophy.
Except for some patients with combined cartilage injury, the early stage can wear a straight splint vertical full weight-bearing, but should not walk too much, and should not use walking as an exercise method. Otherwise, it is very easy to cause joint swelling and fluid accumulation, which will affect functional recovery and tissue healing.
(i) On the day of surgery.
After anesthesia subsides, begin to move the toes; if pain is not obvious, try to contract the quadriceps muscle (i.e., anterior thigh muscle tensing and relaxation).
(ii) The day after surgery.
1. Move the toes – forcefully, slowly, and as widely as possible. 5 minutes/group, 1 group/hour. (Important for promoting circulation, decreasing swelling and preventing deep vein thrombosis)
2, N rope muscle (posterior thigh muscle group) isometric exercise – the affected leg force down the padded pillow, so that the posterior thigh muscle tense and relaxation (see Appendix 1 – Figure 2). Requirements as above, greater than 500 times/day.
(iii)
2 days after surgery.
1 .Continue the above exercises.
2.Quadriceps (anterior thigh muscle group) isometric exercises i.e. thigh muscle tensing and relaxation. Do as many as possible without pain. (More than 100 times/day)
3.Can walk on the ground with the help of crutches, but only to go to the toilet but the necessary daily activities.
4. Separate both feet under the protection of weight and balance, alternately move the center of gravity from side to side within the range of slight pain, and gradually transition to full weight-bearing standing on one leg. (See Appendix 1 – Figure 7).
–Separate the feet anteriorly and posteriorly, move the center of gravity, and gradually transition to full weight-bearing standing on one leg. (See appendix 1-figure 22). 5 minutes/time, 2 times/day
(IV) 3 days after surgery
1.Continue and strengthen the above exercises.
2.Back leg lift exercise: prone position, back leg lift until the foot is 5 cm from the bed, 30 times/group, 2-4 groups/day, 30 seconds rest between groups. absolutely no straight leg lift exercise for 4 weeks!
(E) 1 week after surgery The doctor will decide whether to start flexion exercises according to the situation
1. Start flexion (leg bending) exercises within 0°-60° slightly painful isometric range. Should be completed by the rehabilitation physician, or with the permission of the doctor under the guidance of the rehabilitation program practice (see Appendix “sitting leg”), because early practice is still a certain degree of risk, so do not practice blindly, otherwise may cause adverse consequences.
2.If there is any obvious feeling of heat and swelling in the joint after the flexion exercise, apply ice immediately for about 20 minutes. If not, there is no need to ice.
3.Start stretching exercises (seated 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. (See Appendix 1 – Figure 14) 30 minutes / time, 1 time / day.
1 time/day.
Thereafter, knee flexion exercises are performed daily or every other day, and the knee continues to be straight splinted after the exercises.
Immobilization. The flexion angle is gradually increased to the point of slight pain, and the thigh muscles must be completely relaxed during the exercise to avoid excessive strain on the internally displaced tibial tuberosity.
The method can be used to start the flexion exercise with the knee in sitting or lying position. (See Appendix 1 – Figures 11 and 12).
Hold the knee until you start to feel pain and hold it for 10 seconds, relax slightly and rest for 5 seconds, then hold the knee again and control the whole process for 20 minutes, once a day, with some progress in the angle (do not rest fully extended throughout the exercise and repeatedly flex and extend).
Second, the middle period – mobility and muscle strength exercises period (4-8 weeks)
Purpose: To strengthen the mobility exercises to reach the full range in 4-6 weeks. And strengthen the muscle strength exercises to improve joint control and stability; gradually improve gait.
During this period, the muscle strength level is low, the tissue has an inflammatory response, and the healing is still fragile.
Therefore, endurance exercises with small loads are the main focus. Choose a light load (the amount of load that is fatigue to complete 30 movements), 30 times/group, 2-4 groups of continuous exercises, 30 seconds rest between groups, until fatigue.
(i) 4 weeks after surgery: Start joint mobility exercises at the discretion of the doctor according to the situation.
1.Start flexion exercises (flexion exercises to 0°-60° range, if basically pain-free can reach close to 90°. Should be completed by the rehabilitation physician, or with the permission of the doctor under the guidance of the rehabilitation program to practice on their own, because the early practice is still a certain degree of risk, so do not practice blindly without permission, otherwise may cause adverse consequences.) The method of flexion exercises is described in the Remarks. 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 again 2-3 times/day.
2.Start stretching exercises (seated suspension): put a pillow at the heel, make the affected leg leave the bed completely, relax the muscles to make the knee joint extend naturally. (See Appendix 1 – Figure 14) 30 minutes / time, 1-2 times / day.
3. *If you can easily accomplish unipedal standing of the affected leg, start walking with a single crutch (holding on the healthy side). If there is no obvious instability in the joint, the abutment can be removed for indoor walking.
(ii) 5 weeks after surgery.
1.Extension up to basically the same as the healthy side (non-operated side of the leg).
2.Flexion up to 0°-100° range.
3. Gradually adjust the splint or knee brace to 0°- 70° range of flexion and extension, and increase the angle every 3-5 days. If joint instability is evident during walking and weight-bearing after adjustment, reduce the angle back to the pre-adjustment angle.
4. Start “leg hook exercises” in prone position, 30 times/group, 2-4 groups/day. (Method as in Appendix 1 – Figure 18, sandbag as the load, in the range of motion of the splint, immediately after the exercise ice.)
5. Start active flexion and extension exercises and strengthen them to strengthen muscle strength and joint flexibility.
(iii) 6 weeks after surgery: (sleep without splint)
1.Walk completely off the crutch.
2.Adjust the splint or knee brace until it can be flexed and extended in the range of 0°-110°.
3.Start “leg hook” exercises in the standing position. (See Appendix 1 – Figures 17, 18, 19). Static force should be applied
30 times/group, 4 groups/day.
4. Start anterior-posterior and lateral straddle exercises.
(See Appendix 1 – Figure 21, 23, gradually transition to Appendix 1 – Figure 24, 25, and gradually increase the load to Appendix 2 – Figure 6, 7, 8, 9) 30 reps/group, 4 groups/day.
5. Begin painless angle squatting or sliding exercises against the wall. (See appendix 2-figures 1 and 2)
6.Strive to achieve normal gait walking.
(iii) 7 weeks postoperatively.
1.Passive flexion up to 140°.
2.According to the muscle strength, decide to start the knee exercises with semi-squat flexion and extension in 45° position on the affected side of one leg. 5 minutes/time, 4 times/day.
3.Fixed bicycle exercises, no load to light load. 30 min/time, 2 times/day.
(iv) 8 weeks postoperatively.
1.Passive flexion angle up to the same as the healthy side.
2.Progressively try full squat under protection.
3.Strengthen the muscle strength, see Appendix 1 – Figure 18, 19; Appendix 2 – Figure 4, 5, 10, 11, (but do not increase the load, only increase the angle, number of exercises and time.)
III・Later stage: (8 weeks-3 months)
Purpose: To strengthen the joint mobility until it is as flexible as the healthy side. Strengthen muscle strength and improve joint stability. Resume daily life and gradually regain motor ability.
*With the improvement of muscle strength level, absolute strength exercises will be the main focus in the middle period. Choose a medium load (the amount of load to complete 20 movements that feel fatigue), 20 times / group, 2-4 sets of continuous exercises, rest 60 seconds between groups, until fatigue.
1, daily prone position flexion so that the heel touches the buttocks, continuous stretching 10 minutes / time.
2.Start kneeling exercises (see Appendix 2 – Figure 14).
3.Start pedaling exercises (see Appendix 2-Figure 12).
4.Start knee loop exercises (see Appendix 2-Figure 15).
5.Start jumping up and down exercises (see Appendix 2-Figure 16).
6.Start the lateral straddle exercise (see appendix 2-figure 13).
7.Start swimming, rope skipping and jogging.
8.The athlete starts the special exercises of the base movement.
The reconstructed ligaments are not strong enough during this period, so the exercises and training should be gradual, not forced or blindly adventurous. You should strengthen the muscles to ensure the stability and safety of the knee joint during sports.
V. Recovery period: (after 3 months)
Purpose: Full recovery from sports or strenuous activities.
To strengthen muscle strength and joint stability during running and jumping.
Full or special training.
This period emphasizes the improvement of maximum strength, choose a large load (complete 12 movements that fatigue load), 8-12 times / group, 2-4 sets of continuous exercises, rest 90 seconds between groups, until fatigue.
Remarks.
I. Exercise methods for flexion.
Choose any one of the following methods. Once a day, strive for a slight increase in angle can be. If you have any special discomfort during or after the exercise, you should promptly inform your doctor. Exercise process shall not be straightened rest, repeated flexion and extension, otherwise it will affect the effect, and very easy to cause swelling. Violent pushing is absolutely prohibited.
1 .Patella release (start after removal of cast).
Push the edge of the patella with your hand, to the left and right (not to the outside!) Slowly and forcefully push the patella to the limit position. 20 times in each direction, 2-3 times/day. This can be done before flexion exercises.
2.Sitting (or supine) leg drop.
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, add load at the ankle joint.
3. Supine leg drops.
Supine on the bed, thighs perpendicular to the bed (hands hold the legs to fix), relax the thigh muscles, so that the lower leg natural droop, if necessary, you can add load at the ankle joint (the load should not be too large, otherwise the muscle can not relax, that is, no effect). The requirements are the same as above. See Appendix 1 – Figure 9.
4.Sitting position “top wall”.
Sitting on the chair, the affected side of the toe against the wall or fixed, slowly move the body forward to increase the angle of flexion of the knee, feel the pain and keep still, a few minutes after the pain disappears or lower, and then move forward to the limit. The whole procedure is controlled within 30 minutes. See Appendix 1 – Figure 10.
5. Prone knee flexion.
Prone position (face down on the bed), legs naturally extended, hold the ankle joint of the affected leg by yourself, so that the knee joint is flexed (a long towel or wide band can be tied at the ankle to facilitate pulling). Or assisted by others.
6 .Active flexion and extension exercises.
(performed after passive flexion)
Sitting position, the foot does not leave the bed. Slowly and forcefully, flex the knee to the maximum, hold for 10 seconds and then slowly straighten. 10-20 times/group, 1-2 groups/day. See Appendix 1-figure 13.
II. Exercise method for extension and flexion.
Stretching exercises in the muscles and posterior joints of the pulling sensation and slight pain is normal, not to contract the muscles against, should be completely relaxed, otherwise it will be ineffective.
The weight of the load used in the exercise should not be too large, should make the affected knee dare to relax, and last until 30 minutes, there is a clear pulling sensation is appropriate. No breaks should be taken in the middle of the exercise, otherwise the effect will be affected.
1. Seated knee extension.
Sitting position, foot cushioned and weighted above the knee joint. Relax the muscles completely and hold for 30 minutes. 30 minutes/time, 1-2 times/day. See Appendix 1 – Figure 14.
2. Prone suspension.
Prone, suspended below the knee outside the bed, weighted at the ankle joint. See Appendix 1-figure 15. same requirements as above.
3.Active stretching.
See Appendix 1-figure 16, 20. hold at the limit for 10 seconds, relax for 5 seconds. 20-30 times/group, 1-2 groups/day.