There are four phases of functional rehabilitation after ankle surgery, as described below.
I. Early inflammatory response period (0-1 week)
Purpose: To reduce pain and swelling; early muscle strength exercises; early weight bearing; early mobility exercises to avoid adhesions and muscle atrophy.
Early and early functional exercises, because the muscle strength level is low and there is a more obvious inflammatory response in the tissues, so the static exercises are mainly used (i.e. the exercise method of maintaining a certain posture with weight bearing until fatigue). Or when the swelling and pain are not obvious, choose light load (the amount of load to complete 30 movements that feel fatigue), 10 times / group, 10-15 seconds to maintain / times, 2-4 groups of continuous exercises, 30 seconds rest between groups, until fatigue.
In the early stage, there should not be too much walking (except walking without the affected foot on the ground), and walking should not be used as an exercise method. Otherwise, it will easily cause swelling, wear out the joint cartilage, and affect the functional recovery and tissue healing.
(i) On the day of surgery.
1. After anesthesia subsides, start moving your toes as much as possible; if pain is not obvious, you can start 1) quadriceps (anterior thigh muscle group) isometric exercises – i.e. thigh muscle tensing and relaxation. Do as many as possible without increasing pain. (>500 reps/day)
2. 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 relaxation. The requirements are the same as above, more than 500 times/day.
(ii) One day to one week after surgery.
1 Move toes – forceful, slow, full range of flexion and extension of all toes, 5 minutes/group, 1 group/hour. (Important for promoting circulation, decreasing swelling, and preventing deep vein thrombosis)
2 Start straight leg raise exercise – straight leg raise after knee extension to heel 15M from bed, hold until exhaustion. 10 times/group, 2-3 groups/day.
3 Start side leg raise exercise, 30 reps/set, 2-4 sets/day with 30 seconds rest between sets. (See Appendix 1-Figure 5 and 6 for methods.)
(iii) 1 week after surgery: (The timing of the exercises varies for different surgical mobility)
1. Start mobility exercises at the doctor’s discretion: active flexion and extension of the ankle joint, i.e. slow, hard, maximum toe tensing and toe hooking. (Within the range of minimal pain. If you are undergoing surgery such as ligament repair, the exercise should be done by a rehabilitation physician or with the permission and guidance of a physician.)
2. Immediately after the mobility exercise, apply ice for about 20 minutes. If there is usually a clear feeling of heat and swelling in the joint, ice can be applied again 2-3 times/day.
3. Start the “leg hook” exercise in the standing position. 30 times/group, 4 groups/day.
II. Initial period: (2-4 weeks)
Purpose: To reduce pain; to strengthen mobility and muscle strength; to improve joint control and stability; to gradually improve gait.
(i) 2 weeks after surgery.
1. After the doctor’s review, it is considered that you can fully bear weight, then you can start forward and backward, lateral striding exercises. After several weeks of practice, gradually transition and gradually increase the load. 30 times/group, 4 groups/day.
2. To strengthen the muscles, start heel lifting exercises – that is, standing on your toes, including standing with your feet shoulder-width apart and your toes facing forward; standing in the “outer eight”; standing in the “inner eight” three positions. The three postures are: “outer eight” and “inner eight”. 2 minutes / time, rest 5 seconds, 10 times / group, 2-3 groups / day.
3. If there is no obvious swelling and pain in the joint, you can walk for a short distance without crutches.
4. static squatting or sliding exercises against the wall. 2 minutes/time, 5 seconds rest, 10 times/group, 2-3 groups/day.
(ii) 3 weeks after surgery.
1 Start single leg 0-45° position on the affected side, squat flexion and extension knee exercises. 5 min/time, 4-6 times/day.
2 Fixed bicycle exercises, no load to light load. 30 min/time, 2 times/day.
3 Strengthening mobility exercises, move the ankle joint in all directions with your hands until you start to feel pain, hold for 10 seconds, relax slightly and rest for 5 seconds.
Rest for 5 seconds, then push again, do not repeat the activity, practice for 10 minutes, once a day.
(3) 4 weeks after surgery.
1 Strive to achieve normal gait walking. 2 Strengthen the leg strength.
III. Mid-term: (5 weeks – 3 months)
Purpose: Strengthen joint mobility to the same level 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 that is fatigue), 20 times / group, 2-4 sets of continuous exercises, rest 60 seconds between groups, until fatigue.
Ankle dorsiflexion: face the step, stand on the edge of the step with only the toe part of the foot, hold the handle with your hand to keep your balance, use your body weight to make your heel touch the ground as much as possible, hold it at the slightly painful place for 10-15 seconds, 10 times/group, 2-3 groups/day.
Ankle Tsukimbo: sit on the bed, below the ankle joint empty outside the bed, take a sandbag or other heavy object to hang at the toe, 15-20 minutes / time, 1-2 times / day. 3. gradually try to protect under the full squat.
Fourth, the late stage: (recovery of movement period 4-6 months)
Purpose: full recovery of all activities of daily life. Strengthen muscle strength, and the stability of the joints in running and jumping. Gradually to the surface to resume sports or strenuous activities or special training.
This period to improve the maximum strength, choose a large load (complete 12 times the action that fatigue load), 8-12 times / group, 2-4 groups of continuous practice, rest 90 seconds between groups, until fatigue.
1.Start jumping up and down exercises.
2.Start the lateral straddle exercise.
3.Athletes can start the basic movement exercises of special sports 3 months after surgery.
In case of ligament repair surgery, the reconstructed ligaments are not strong enough during this period, so the exercises should be done gradually, not reluctantly or blindly. If necessary, ankle brace can be worn for protection, but it is only recommended to be used during strenuous sports.
Precautions.
1.This plan is made according to the general routine, the specific implementation should be done under the guidance of doctors depending on your condition and surgery.
2.The presence of 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 in the middle and late functional recovery, 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 exercises, only 1-2 times a day, and strive to improve the angle can be, avoid repeated multiple exercises. If there is no progress in mobility 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, and review it in time when necessary.
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 continue throughout the exercise process and will not disappear completely until the joint mobility is normal and muscle strength is restored and the stimulus disappears. However, the degree of swelling must be controlled and should not be increased continuously, but the general trend should be gradually decreasing. If the swelling increases, local redness, swelling, heat and pain are obvious, you must stop practicing, increase the number of ice packs, and seek medical attention promptly!