I Functional exercise after fracture of extremities
(I) Clavicle fracture
1 Objective.
To increase local blood circulation, accelerate the repair of surrounding soft tissue injury, and prevent complications such as muscle atrophy and joint stiffness in the upper limbs. Wang Hui, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
2 Methods of functional exercise.
Active exercises such as fist clenching, finger extension, finger splitting, wrist flexion and extension, wrist winding, elbow flexion and extension, and forearm internal and external rotation (Figure 1, 2, 3), with as large an amplitude as possible, gradually increasing the degree of force.
Figure 1 Fist clenching, finger splitting, finger extension Figure 2 Forearm internal and external rotation
Figure 3 Wrist and elbow flexion and extension
The ball pinching, resistance wrist flexion and extension exercises and passive or assisted shoulder abduction and rotation exercises (Figure 4, Figure 5, Figure 6) can be added 2 weeks after the fracture.
Figure 4 Pinch small ball exercise
Figure 5 Resistance wrist flexion and extension
Figure 6 Resistance shoulder abduction and rotation exercises
Resistance elbow flexion and extension can be added 3 weeks after the fracture for internal and external rotation of the forearm; supine position with head and double elbow support for chest raising exercises (Figure 7).
Figure 7 Double elbow support thoracic exercise
After the fracture heals and is released from external fixation, a full range of shoulder mobility exercises should be performed.
flexion of the upper limb to the affected side in the standing position, with anterior-posterior shoulder oscillation (Figure 8).
Figure 8 Shoulder anterior-posterior oscillation
Shoulder ladder climbing with the affected limb up, resistance pulling shoulder and elbow flexion and extension exercises (Figure 9, Figure 10)
Figure 9 shoulder ladder climbing Figure 10 resistance pulling shoulder and elbow flexion and extension
However, substantial shoulder inversion and pronation exercises should be avoided within 2 weeks of the fracture.
3 Caution.
Functional exercises should be adhered to with gradual amplitude and strength of activity. During the period of internal or external fixation, it is forbidden to do forward flexion and internal flexion of the shoulder joint.
(B) Humeral stem fracture
1 Objective.
To increase local blood circulation, eliminate swelling, accelerate the repair of surrounding soft tissue injury, and prevent complications such as muscle atrophy and joint stiffness in the upper limb; it can increase the squeezing pressure of the two fracture ends on the heavy axis, prevent separation of the bone fracture ends, promote fracture healing and prevent decalcification.
2 Methods of functional exercise.
After fixation, you can do extension and flexion finger, palm and wrist joint activities, and active muscle contraction activities for the affected limb (see Figure 1, Figure 2 and Figure 3).
Shoulder and elbow joint activities: 2-4 weeks after the injury, in addition to continuing the above training, gradually do shoulder and elbow joint activities, the method is: hold the wrist of the affected limb with the healthy hand, do shoulder and elbow forward flexion, back extension, then flexion of the elbow joint, while the upper arm back extension (Figure 11).
Figure 11 Shoulder and elbow anterior flexion and posterior extension
Rotation of the shoulder joint: The patient’s body is tilted to the affected side, the elbow joint is flexed over 900, the healthy hand holds the wrist of the affected side, and the shoulder joint is rotated, i.e., in a circular motion (Figure 12).
Figure 12: Elbow flexion, rotating shoulder joint
Abduction and external rotation movements: the upper arm is abducted and externally rotated, and the back of one’s head is touched with the hand (Figure 13).
Figure 13 Upper arm abduction, external rotation
Rotation of both arms: the affected limb is flexed at the elbow and the forearm is placed in front of the chest with the palm backward and upward; the upper limb on the healthy side is straightened and abducted to the side of the body with the palm downward. The affected limb to the outer top through the outer bottom and then inward arc circle, back to the original place; while the healthy side of the upper limb down through the inner upper outward arc circle, back to the original place (Figure 14). So on and so forth. This method can make the shoulder, elbow, waist, legs, neck can be exercised. The above exercise method is 15 minutes each time, 3-4 times a day.
Figure 14 double arm rotation
3 Caution.
Functional exercise should be adhered to when exercising, and the amplitude and strength of the activity should be gradual. During the period of internal or external fixation, it is forbidden to do forward flexion and inward movement of the shoulder joint.
(C) ulnar radius fracture
1 Objective.
To increase local blood circulation, eliminate swelling, accelerate the repair of surrounding soft tissue injury, and prevent complications such as muscle atrophy and joint stiffness in the upper limb; it can increase the squeezing pressure of the two fracture ends on the heavy axis, prevent separation of the bone break ends, promote fracture healing, and prevent decalcification.
2 Methods of functional exercise.
After fixation, you can do extension and flexion finger, palm and wrist joint activities, and active muscle contraction activities for the affected limb (see Figure 1, Figure 2 and Figure 3).
Shoulder and elbow joint activities: 2-4 weeks after the swelling is eliminated, in addition to continue the above training, because gradually do shoulder and elbow joint activities, the method is: the healthy hand to hold the affected limb wrist, do shoulder and elbow forward flexion, back extension, then flexion elbow joint, while the upper arm back extension (see Figure 11).
Exercise after fracture healing: After the fracture heals, increase the forearm rotation activity and pushing the wall with the hand to produce longitudinal compression at the upper and lower fracture ends (Figure 15 and Figure 16).
Figure 15 hand pushing wall Figure 16 forearm rotation
3 Caution.
Functional exercise should be adhered to, and the magnitude and strength of the activity should be gradual. After the swelling is eliminated, shoulder and elbow extension and flexion activities are feasible, but rotation activities are not recommended.
(D) Fracture of femoral neck
1 Objective.
To increase local blood circulation, eliminate swelling, accelerate the repair of surrounding soft tissue injury, prevent lower limb muscle atrophy, joint stiffness, neuromuscular adhesions and other complications; it can increase the squeezing pressure of the two fracture ends on the heavy axis, prevent the separation of bone fracture ends, promote fracture healing and prevent decalcification.
2 Functional exercise methods.
Active extension and flexion and rotational activity exercises of the toe and ankle joints can be done early after the fracture is reset and fixed, with resting contraction of the quadriceps, 3-4 times a day, 10 strokes each time. (Figure 17).
Figure 17 Resting quadriceps contraction exercise
Active hip and knee flexion and extension activities were started in the second postoperative week while keeping the femur non-rotated and non-inverted. (Figure 18)
Figure 18 Hip and knee flexion and extension exercises
After 3 weeks, active flexion and extension of the affected limb can be performed by sitting on the edge of the bed with the lower legs down and the feet on the ground or in stirrups, and practicing supporting the upper body with the arms and lifting the hips. (Figure 19)
Figure 19 Upper body support with both arms and hip lift
During the fracture recovery period, the muscles of the hip, knee, and ankle should be strengthened 1 month after surgery to restore the ability to walk and strengthen the stability of the lower limbs. The main method is to perform exercises of sitting and standing transition activities to exercise the hip; active flexion and extension and rotation activities of the ankle joint, and squatting and rising. (Figure 20, Figure 21)
Figure 20 sitting and standing conversion Figure 21 squatting and standing
3 Caution.
Functional exercise should be adhered to when exercising, and the magnitude and strength of the activity should be gradual.
(V) Intertrochanteric fracture of the femur
1 Objective.
To increase local blood circulation, eliminate swelling, accelerate the repair of surrounding soft tissue injuries, and prevent complications such as lower limb muscle atrophy, joint stiffness, and neuromuscular adhesions; it can increase the squeezing pressure of the two fracture ends on the heavy axis, prevent separation of the bone fracture ends, promote fracture healing, and prevent decalcification.
2 Methods of functional exercise.
The functional exercise procedure for intertrochanteric fractures is the same as that for femoral neck fractures, but the process can be appropriately accelerated.
3 Precautions.
Functional exercise should be adhered to when exercising, and the magnitude and strength of the activity should be gradual.
(VI) Fracture of the femoral stem
1 Purpose.
The closer the femoral stem fracture is to the knee joint, the greater the damage to the knee joint function, and the hematoma is likely to cause knee joint dysfunction due to adhesion of the middle femoral muscle, so functional exercise must be started early to promote hematoma absorption, reduce adhesion formation, and enhance muscle strength.
2 Functional exercise methods.
Early in the fracture, do resting contraction of the quadriceps muscle of the lower limb and ankle extension and flexion activities. (See Figure 17)
After 4 weeks, you can practice active movements of the hip, knee, and ankle while sitting on the bedside (the exercise method is the same as for femoral neck fracture).
3 Caution.
Functional exercise should be adhered to when exercising, and the magnitude and strength of the activity should be gradual.
(VII) Patella fracture
1 Objective.
To increase local blood circulation, eliminate swelling, accelerate the repair of surrounding soft tissue injury, and prevent complications such as muscle atrophy, joint stiffness, and neuromuscular adhesions in the lower limb.
2 Methods of functional exercise.
After a slight reduction in pain in the early postoperative period, the patient can begin to practice resting contractions of the quadriceps muscle and active movements of the hip, knee, ankle, and toe joints. (See Figure 17 and Figure 18)
Straight leg raising and knee flexion and extension exercises of both legs are possible 3-5 days after fixation, and weight-bearing exercises of the affected limb are performed with the help of crutches. (Figure 22 Figure 23)
Figure 22 Straight leg raise
Figure 23 Weight-bearing walking with crutches
Patients with cast immobilization can have the cast removed at 4-8 weeks, at which time they can do passive activities of patellar tendency and active knee flexion and extension exercises, and can walk with weight at 6-8 weeks. (Figure 24)
Figure 24 holding the railing to do squatting exercises
3 Caution.
Functional exercise should be adhered to when exercising, and the magnitude and strength of the activity should be gradual. Patients who get out of bed for the first time after surgery should pay attention to protection to prevent falls and injuries.
(H) Tibiofibular fracture
1 Objective.
To increase local blood circulation, eliminate swelling, accelerate the repair of surrounding soft tissue injury, and prevent complications such as lower limb muscle atrophy, joint stiffness, and neuromuscular adhesions.
2 Functional exercise methods.
Early after external fixation, pain relief was immediately followed by quadriceps resting contraction exercises, passive patellar activities and foot metatarsophalangeal and interphalangeal joint activities. (See Figure 17 and Figure 18)
After removal of external fixation and wound healing, full exercise of all joints of the lower extremity can be performed, and walking with the crutches gradually. (See Figure 23)
Increase hip, knee and ankle joint movement exercises, you can do rising and sitting exercises, the healthy limb standing, the affected limb doing hip flexion and extension, abduction. Abduction activities, knee and ankle de-speaking activities, and ankle inversion resistance activities. (See Figure 24)
3 Caution.
Functional exercise should be adhered to when exercising, and the magnitude and strength of the activity should be gradual. External fixation
Rotation of the thigh with the knee joint straightened is prohibited in the early stage to avoid affecting the fracture stability.
(ix) Dislocation of shoulder joint
1 Objective.
To increase local blood circulation, accelerate the repair of surrounding soft tissue injury, and prevent complications such as muscle atrophy and joint stiffness of the upper limb.
2 Functional exercise methods.
Start the active exercises of finger, wrist and elbow joints in the fixed position in the chest on the same day. Repeat each action 5-6 times. You can add resistance exercises and swing exercises of shoulder forward flexion, abduction and internal rotation in the suspension belt every day, that is, the patient slowly pushes the affected limb with the healthy limb to do abduction and abduction activities, and the range of activities is limited to not cause pain in the affected shoulder. (See Figures 11 and 12)
After removal of the suspension belt: ① active movement exercises of shoulder abduction, posterior extension and external rotation, the movements should be slow and gentle with a gradual expansion of the amplitude; ② exercises of shoulder forward flexion, internal retraction and internal rotation. (Figure 25, Figure 26)
Figure 25 Shoulder abduction, posterior extension, external rotation Figure 26 Shoulder pronation, internal contraction, internal rotation
After 3 weeks, the patient can bend over, hang the arm and throw the shoulder, i.e. the patient bends over 900, the affected limb drops naturally, and makes a conical circular movement with the shoulder as the apex, starting with a small range and gradually expanding the range of the ring. (Figure 27)
Figure 27 Bending, dropping and throwing the shoulder
After 4 weeks, the patient could do finger climbing and hand raising to touch the top of the head. In other words, the patient should face or stand on the healthy side of the body against the wall, touch the wall with the affected hand, and climb the wall with the fingers alternately until the shoulder joint elevation is completely normal. Hand elevation and touching the top of the head means that the affected hand touches the top of the head and then gradually moves to the opposite side, the affected hand crosses the top of the head and touches the opposite ear, or the affected hand touches the opposite scapula, so that the function of the shoulder joint is completely restored to normal. (Figure 9 and Figure 13)
3 Precautions.
Functional exercise should be adhered to, the magnitude and strength of the activity should be gradual, and the range of activity should be limited to not cause pain in the affected shoulder.
(X) Dislocation of the elbow joint
1 Purpose:
To increase local blood circulation, accelerate the repair of surrounding soft tissue injury, and prevent complications such as muscle atrophy and joint stiffness in the upper limb.
2 Functional exercise methods.
Exercises such as finger extension and fist clenching can be done during fixation, while doing shoulder and wrist joint activities under the protection of external fixation. (See Figure 1, Figure 2, Figure 3)
After the external fixation is removed, practice flexion and extension activities of the elbow joint to strengthen the muscles around the elbow joint. A small ball grip can be used to help with this exercise. (See Figure 4)
3 Caution.
Functional exercise should be adhered to, and the amplitude and strength of the activity should be gradual. Attention should be paid to active exercise, and passive activity should be gentle in order not to cause severe pain, so as not to cause ossifying myositis and aggravate the stiffness of the elbow joint.
Functional exercise after osteoarthroplasty
(A) Functional exercise after total hip arthroplasty
1 Purpose:
Functional exercise after surgery can promote the absorption of hematoma in the affected limb, prevent muscle nerve adhesion, enhance muscle strength and prevent muscle atrophy.
2 Methods of functional exercise:
Postoperative muscle strength training is an important element of postoperative functional exercise after arthroplasty. Resting quadriceps contraction, ankle dorsiflexion, and plantarflexion should be started immediately after surgery. (See Figure 17)
On postoperative days 2 and 3, hip abduction and increased hip and knee flexion and extension exercises are performed, and straight leg raising exercises can be started. The patient may not be able to perform these movements at first, so a soft pillow can be placed under the affected limb. (See Figure 22)
For cemented total hip prosthesis fixation, complete fixation can be achieved within 24 hours after surgery. Therefore, for such patients, standing training can be started on postoperative day 1. When the patient performs standing training, each side of the limb is straightened to practice toe and hind root elevation off the ground, and the surgical side is gradually partially weight-bearing to practice contraction and diastole of quadriceps and gluteal muscles.
Straighten the hip and knee joints. (See Figure 28)
Figure 28 Heel lift off the ground exercise
Lower extremity joint passive motion machine (CPM machine) assisted training: Passive exercise training after hip replacement is often done with the assistance of a CPM machine. The range of motion can be adjusted at any time and gradually increased. Generally, the maximum activity angle of the CPM machine is 400 at the beginning, and the range of motion of the hip joint is 250-450 at this time, and then it can be increased by 50-100 per day, and the training can be done for 3-4 h per day. until about 1 week after surgery, the maximum activity angle of the CPM machine is 900, and the range of motion of the hip joint is 250-850, and then the CPM machine can be stopped gradually and the active activity is the main activity. (Figure 29)
Figure 29 CPM machine assisted functional exercises
The patient was instructed and collaborated to move the affected limb to the bedside and put it down near the edge of the bed.
Since the sitting position is the most likely position for hip dislocation and subluxation, patients should mainly lie, stand or walk in the early postoperative period, and the sitting time should not exceed half an hour. Exercises in the sitting position include hip extension exercises, hip flexion exercises and internal and external rotation exercises in the flexed hip position. (See Figure 18 and Figure 19)
Training with walker and crutches. (See Figure 23)
3 Precautions:
Patients undergoing total hip replacement should be educated to avoid pushing their prosthesis beyond its own limits during functional exercises. To maintain the femoral head in the acetabulum and to prevent joint injury, the following should be noted.
not to flex the hip beyond 900 and not to bend the upper body forward beyond 900.
the hip should not be pronated above the midline and the knee or ankle should not be crossed.
the hip should not be externally rotated, the affected leg should be kept in the external booth when lying down and turning over, and do not bend to the affected side when sitting.
(B) Functional exercise after total knee replacement
1 Purpose.
Functional exercise after knee arthroplasty helps to enhance the muscle strength of the knee extension and flexion muscle groups, which can stabilize the knee joint and obtain satisfactory mobility of the knee joint, and also promote the absorption of hematoma in the affected limb, prevent muscle nerve adhesions, enhance muscle strength and prevent muscle atrophy.
2 Methods of functional exercise.
(1) Day 1-3 after surgery
quadriceps resting contraction exercises: foot forcefully doing upward hooking and downward stepping movements, 10 times every 1 hour, each movement lasting 3 seconds. (Figure 30, Figure 31)
Figure 30 do upward hook action
Figure 31 doing the downward stepping movement
The healthy knee is flexed and the affected knee is fully extended to do the bed press, at this time the quadriceps muscle is contracted, the knee joint is flattened, and the patella can move up and down slightly, practicing 1 group every 2 hours, 30 times per group, each time lasting 10-15 seconds.
(2) Postoperative day 4-7
Active exercises: the patient holds the thigh with both hands and lifts it up, showing flexion of the knee, 5-10 strokes every 2 hours. (Figure 32)
Figure 32 Holding the thighs up and lifting, showing flexion of the knees
The patient turns on his side with the affected limb on top, performing gravity-free knee flexion and extension, 5-10 strokes every 2 hours. (Figure 33)
Figure 33 Affected limb on top, performing gravity-free knee flexion and extension
The patient lies supine on the side of the bed, hangs the affected calf under the edge of the bed, and adjusts the knee flexion by self-adjusting the position and abduction angle of the hip joint to accomplish active flexion of the knee joint under self-control with a gradual increase in angle. (Figure 34)
Figure 34 Active knee flexion with the lower leg suspended under the bed edge
Patient sitting on the edge of the bed Exercise.
Pressing the foot and calf of the healthy side (or one side) on the ankle of the affected side (or the other side) in a downward yawing motion; (Figure 35)
Figure 35 foot and lower leg pressed on the affected side of the ankle, doing a downward yo-yo movement
the foot of the healthy side (or one side) hooks on the root of the affected side (or the other side) and assists the affected side (or the other side) to make an upward movement of the lower leg. (Figure 36)
Figure 36 foot hooked on the root of the affected side of the foot, the lower leg to do upward movement
or use a bandage with one end tied to the foot and the other end held in the patient’s hand, and tug on it to lift the calf and straighten the knee joint. The two are alternated and practiced for 20-30 minutes every 2 hours to increase the range of motion of the joint. (Figure 37)
Figure 37 Hand-held bandage tied to the foot to lift the lower leg by upward traction
(3) Postoperative days 8-14
Straight leg raising exercises in bed: 300 is sufficient, ensuring straight knee and flat back, for 5-7 seconds, 3-4 sets of 30 reps per day. At first, the patient may not be able to complete the above actions, can be helped by placing a soft pillow under the affected limb and gradually lowering the height of the pillow. (Figure 38)
Figure 38 Recumbent straight leg raise exercise
Squatting exercises with the railing: hold for 5-7 seconds after squatting, 3-4 sets of 30 reps per day, gradually increasing the degree of squatting. (Figure 39)
Figure 39 hold the railing to do squat exercises
Progressive knee and ankle flexion and extension exercises.
Slowly and simultaneously lift your heels until your toes are on the ground, then lower back until your heels are on the ground; alternate exercises with both feet. (Figure 40)
Figure 40 Foot lift exercise
Pull both feet in turn in the direction of the buttocks, to let the entire foot slide on the floor, making sure to press hard on the floor and to have the sensation of tensing the muscles; alternate exercises with both feet. (Figure 41)
Figure 41 pulling both feet in turn toward the hips
Bring one leg forward and hook the toes so that the leg is completely straight. Pull back the leg so that the palm of the foot is completely on the ground; alternate exercises between the two legs. (Figure 42, Figure 43)
Figure 42 Extend one leg forward, hooking up the toe Figure 43 Keep the leg completely straight and pull back with the foot completely on the ground
Extend one leg out and off the ground for some distance. Hold for 7 seconds, slowly lower the leg so that the back of the foot lands on the ground, then land on the ball of the foot and slowly pull the leg back; (Figure 44)
Figure 44 Extend one leg out and off the ground for a distance
pull one leg as far as possible in the direction of the hips and the other leg as straight forward as possible, times holding for 7 seconds while doing the last movement. (Figure 45)
Figure 45 One leg is pulled as far as possible in the direction of the hip and the other leg is straightened as far forward as possible
Practice level walking with a walker accompanied by a health care provider, with a knee weight of about 10 kg, 3-4 times a day for 10-20 minutes each time. (Figure 46)
Figure 46: Exercise of level walking with a walker
Passive exercises: CPM machine exercises can be added on postoperative day 4-7, starting with 200-300 and gradually increasing the angle, 3-4 times a day for 30 minutes each time.
3 Precautions:
Functional exercises should be performed according to the patient’s specific situation in accordance with the principles of individualization, strength, safety and gradual progress.