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 the doctor depending on their own conditions and surgical situations.
2, the presence of pain in the functional exercise, is inevitable, but always to the extent that the patient can tolerate.
3, muscle strength exercises should focus on the target muscle. The number of exercises, time and conformity depend on their own situation, and should be practiced on the healthy side at the same time. The improvement of muscle strength is the key factor of joint stability and must be practiced carefully.
4.In addition to the surgical limb training, the rest of the body parts (such as upper limbs, waist and abdomen, healthy side of the leg) should be practiced as much as possible to ensure physical quality and promote the overall recovery of body function.
5.Early joint mobility exercises, daily adhere to complete the training, as far as possible early painless and resistance-free recovery of larger angles, internal fixation instability need to protect the specific situation specific analysis.
6.Ice packs should be applied for 15-30 minutes immediately after the mobility exercise. If you usually feel the joint swelling, pain and fever is obvious, you can ice again, 2-3 times a day.
7, joint swelling will accompany the entire exercise process, swelling does not increase with the angle of the exercise and the amount of activity that is normal, until the angle and muscle strength is basically back 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.
8. See appendix for training methods.
Rehabilitation program changes depending on the type of fracture, degree of fracture, surgical technique and fixation method
Overall rehabilitation goals:
ROM: To restore the total joint of knee and hip and to prevent lagging of joint extension
Maintain rectus femoris length to avoid compromising hip and knee mobility
Maintain ligament flexibility, as this may lead to re-trauma and stiffness of the joint
Muscle strength.
Promote and improve muscle strength recovery of quadriceps and N cord muscles
Promote quadriceps-N cord muscle strength balance
Preoperative rehabilitation.
Elevation of the affected limb, ankle pump, edema control.
Braking of the affected limb.
Strength training of the upper limb and the healthy limb.
Postoperative rehabilitation.
Phase I: Maximum protection period
1 day – 6 weeks
1-2 days after surgery
Contraindication: Avoid standing and weight-bearing with the affected limb in flexion
Purpose: To reduce pain, control swelling, prevent deep venous thrombosis, release muscle spasm, avoid adhesions and muscle atrophy. If the pain and swelling are controlled, you can move to the next small phase.
Rehabilitation content.
1. Educate the patient: inform the patient of the expected recovery time, instruct the patient to place the affected limb in a safe position and safe movement, paying special attention to contraindicated movements. Prevent wound infection.
2. Elevation of the affected limb.
3.Ankle pump.
4.Deep breathing and coughing exercises.
5.Ice packs on the knee joint.
6.Active or assisted-active knee mobility training
7.Active joint mobility training for the ankle joint.
8.Quadriceps, N cord, gluteus maximus submaximal strength isometric muscle contraction training.
9.Start bed activity, lying-sitting transition
10.Muscle strength training of upper limb and healthy side limb.
11.Correct body position placement.
3 days-1 week after surgery
Contraindicated: avoid standing weight-bearing with the affected limb in flexion
Purpose: To restore muscle strength and improve the patient’s transfer ability
1.Continue the exercise of the previous phase
2.If stable internal fixation is achieved, aROM,no pROM
3.Gentle quadriceps isometric training, submaximal gluteus maximus isometric muscle strength training
4.Straight leg elevation under brace fixation, with the exception of unstable fracture or unsound internal fixation.
5.With the affected limb fixed in plaster or brace in straight position (0 degree), weight-bearing walking can be performed under tolerance, after 3 weeks, if the quadriceps strength is good, the fixation can be removed
2-6 weeks.
Objectives: active knee mobility (0°-90°), restoration of muscle strength, improvement of gait 6 weeks X-rays fracture point healing and stabilization, enter the next phase
1. Start gentle patellar mobilization (parellar mobilization), teach the patient to do it himself.
2. Active or assisted-active knee active mobility training.
2, Begin point stimulation of the quadriceps nerve muscle.
3. Once the brace is removed, begin assisted-active and passive joint mobility training.
4. Once the brace is removed. Full weight-bearing walking is possible.
5. Long muscle strength training of the quadriceps, N cord, and gluteus maximus.
Phase II: Moderate protection period (6-3 months)
6 weeks-3 months after surgery
Objective: To restore normal joint mobility of the knee joint and restore functional activities
1. X-rays to determine fracture healing
2, If the knee does not regain normal joint mobility, PROM, arthrodesis
2. If fracture healing is good, add 0.5-1KG load straight leg raise in front of the thigh
3.Increase the speed and endurance of walking
4.Start gentle closed chain training.
5.30° micro squat.
7.Stool scoots.
8.Lateral step-ups.
9.Place 1-2.5KG load on the ankle joint, N rope muscle flexion knee joint.
Phase 3: Minimum protection period
>3 months
Purpose: To further restore muscle strength and good knee stability.
1.BAPS board training.
2. Power bike training for strength and endurance.
Special consideration: partial or total patellar resection, or severe fracture internal fixation plus external fixation rehabilitation program according to the patient’s specific situation
Appendix:
1.Limb elevation: It is a method of using gravity to help blood and tissue fluid return to reduce swelling and relieve pain at the traumatic site. As much as possible, the injured part is placed above the level of the heart to use gravity to help blood return to the heart. This action is recommended for post-operative swelling.
2. Ankle pump: extreme dorsal extension of the ankle joint, hold for 10 seconds, relax and rest for 10 seconds, then extreme plantar flexion, hold for 10 seconds, then relax for 10 seconds, and so on in a cycle of 10 as a group.
The movement of the ankle joint plays a pump-like role to promote blood circulation and lymphatic flow in the lower limbs and reduce swelling. You can do it often after surgery.
3. Deep breathing and coughing training. In the lying or sitting position, instruct the patient to breathe deeply in the abdomen; cough training in the sitting position to expel the phlegm as much as possible and keep the airway open.
4.Ice pack for the hip: Our hospital has special ice packs. For 3 days after surgery, apply ice packs 4 times a day in the morning and afternoon for 10 minutes each time. After each functional training, each ice pack should be applied once for 15 minutes each time.
The main principles of icing are
1. constrict the blood vessels at the injured area to reduce bleeding, thus reducing swelling.
2.To relieve pain.
3, relief of muscle spasm.
4.Reducing the risk of cellular tissue damage by decreasing the metabolic rate.
5.Active or assisted-active or passive hip mobility training: It is best if the patient can do it actively, if the patient is not able to do it actively, it can be done with the help of the therapist or passively. It is required to move in the range that the patient’s pain can tolerate.
6.Quadriceps femoris, N cord muscle, gluteus maximus submaximal strength isometric contraction training.
The above three groups of muscles are tensed without action within the pain-free range of the fracture point, tensed for 10 seconds, relaxed for 10 seconds, for one group, 10 groups of training each time.
7.Start bed activities, lying-sitting conversion: let the patient do it independently or with assistance as early as possible after the anesthesia period, if dizziness, let him/her lie down slowly; repeat lying-sitting-lying position to prevent postural hypotension.
8, upper limb strength exercise and exercise of the muscles on the healthy side: hold each force for 10 seconds, come down slowly, rest for 10 seconds, 10 consecutive movements as a group, 10 groups each time
9. Correct body position: the affected limb is placed in a comfortable position, and there is no stress effect on the fracture point.
10.BAPS board training.