Points to note before rehabilitation.
1. The presence of anterior knee pain during functional exercises is unavoidable. If the pain can subside to its original level within half an hour of stopping the exercise, it will not cause damage to the tissue and should be tolerated.
2, plyometric exercises should be concentrated until the muscles feel sore and fatigued, 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 and muscle capacity is the key factor of joint stability, and it is expected to be practiced carefully.
3, in addition to the surgical limb brake protection, the rest of the body parts (such as the upper limbs, 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 it should be taken seriously and the treating doctor should be consulted in time.
5. Apply ice for 20~25 minutes each time, 4~6 times a day. If the joint is swollen and hot, the number of ice packs can be increased. It can be increased 1 time after exercise.
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 swelling will gradually subside. Sudden increase of swelling should adjust the exercises and reduce the amount of activities, and consult the attending doctor in time for serious cases.
Rehabilitation procedures
I. Protection period: 1 day to 4 weeks after surgery
Purpose: To reduce pain and swelling; early muscle strength exercises; early weight bearing; early mobility exercises to avoid adhesions and muscle atrophy.
(i) On the day of surgery.
(ii) 1 day after surgery.
1. Ankle pump: forceful, slow, full range of flexion and extension of the ankle joint, as much as possible. (Important for promoting circulation, decreasing swelling and preventing deep vein thrombosis)
2. Quadriceps (anterior thigh muscle group) isometric exercises: i.e. thigh muscle tensing and relaxation. Do as much as possible without increasing pain, more than 500 times/day.
3, the posterior thigh muscle group isometric exercise: the affected leg force down the padded pillow, so that the posterior thigh muscle tension and relaxation, more than 500 times / day.
4, correct body position: the affected leg is elevated on the pillow, the toe is directly above, not crooked to the side, the knee joint should be vacant below, do not use the pillow to cushion 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 to try straight leg lift: fully straighten the leg lift to heel 15M from the bed and hold until exhaustion. 10 times/group, 2~3 groups/day.
(iii) 2 days after surgery.
1.Continue straight leg raising exercise, 10 times/group, 2~3 groups/day.
2.The ankle pump is changed to anti-gravity exercise (can be assisted by others or hold the thigh with hands). Performed after each time you get out of bed can effectively prevent swelling.
3.Start side leg raise exercise: 10 times/group, 2~4 groups/day, 30 seconds rest between groups.
4.Start posterior leg raising exercise: prone position, lift the affected leg straight backward until the toe is 5 cm from the bed for 1 time, 20 times/group, 2~3 groups/day, rest 30 seconds between groups.
(iv) 3 days after surgery.
1.Continue the above exercises, leg lifting exercises in all directions (anterior, posterior and lateral), 20 times/group, 3 groups/day.
2.Can walk on the ground without weight, but the operated limb should not be weight-bearing, walking should not be too much, walking more easily to form joint effusion.
(v) 4 days after surgery.
1.Continue the above exercises.
2.Start flexion exercises: remove the brace and sit on the edge of the bed, hang below the knee outside the bed, and flex to the maximum within 0°~90° in a slightly painful state.
3.Stretching exercise: stretching exercise: remove the brace, put a pillow at the heel, make the affected leg completely leave the bed at the N fossa, relax the muscles to make the knee joint straighten naturally. (Very important to prevent limping) 3 times/day
(vi) 5 days after surgery.
1.Continue to strengthen the above leg raising muscle exercises.
2.Continue to practice maximum flexion in the range of 0°~90° once a day.
(vii) 1~2 weeks postoperatively.
1.Continue to strengthen the above leg raising muscle strength exercises.
2.Continue to practice maximum flexion in the range of 0°~90° once a day, and strive for active flexion up to 90° by 2 weeks later.
3. Keep the functional knee brace fixed in extension position (i.e., 0°) for 4 weeks.
(iv) 2 to 4 weeks after surgery.
1.Continue and strengthen the above strength exercises;
2.Start “kicking” exercises to strengthen the leg.
3. Increase the passive knee flexion angle by about 10° every week.
(v) 4 weeks after surgery.
1.Strengthen the strength exercises.
2.Passive knee flexion to 100°.
3.Active knee flexion to 90°.
4.Start to practice rotation of the lower leg, range until just natural stop.
5.Weight-bearing exercises are detailed at the end of this article
Second, resume weight-bearing period: 5~8 weeks after surgery
Do not walk too much during this period, otherwise it will easily lead to joint swelling and fluid accumulation, which will affect functional recovery and tissue healing.
1.Weight-bearing and balance exercises: separate both feet under protection, alternately move the center of gravity left and right within the range of slight pain, gradually transition to full weight-bearing standing on one leg, 5 minutes/time, 2~3 times/day. Separate both feet anteriorly and posteriorly, move the center of gravity, and gradually transition to single-leg full weight-bearing standing.
2. 6~8 weeks after surgery, continue to perform passive knee flexion exercises at the bedside on your own, but keep the passive movement angle at 120°;
3. Flexion and extension of the knee 0~30° strength exercises, 30 times/group, 2~4 groups/day, with 30 seconds rest between groups.
III. Recovery period: 9 weeks to 12 weeks after surgery
1. Eight weeks after surgery, the knee can be passively flexed over 120°, and active knee exercises can be performed on your own.
2. You can start “leg hooking” exercises. To strengthen the posterior thigh group muscle strength. Should be static exercises, flexion to pain-free angle to maintain 10-15 seconds, 10 times / group, 4 groups / day.
3.Can start front and back, lateral straddle exercises.
4.Fixed bicycle exercises, no load to light load. 10-20 minutes/set, 2 times/day.
IV. Recovery exercise period: after 3 months
Purpose: Full return to exercise or strenuous activity. Gradually resume strenuous activities, or special training. Strengthen the muscle strength and the stability of the joints in running and jumping. Through the test, the affected muscle strength reaches 85% or more of the healthy side, no pain in sports, no obvious swelling, then can fully resume sports.
Weight-bearing training.
1.Under 2 stitches of meniscus suture (including 2 stitches): under 30 years old, partial weight-bearing starts 2 weeks after surgery, weight-bearing is 1/3 to 1/2 of body weight, weight-bearing is fully weight-bearing only after 3-4 weeks, generally after the third week of weight-bearing, go to a crutch, pay attention to the ice after moving down; under 40 years old, partial weight-bearing starts 3 weeks after surgery; over 40 years old, partial weight-bearing starts 4 weeks after surgery.
2. Meniscus suture with more than 2 stitches (excluding patients with 2 stitches or transverse body suture): partial weight-bearing of the operated limb starts 4~5 weeks after surgery, with weight-bearing of 1/3 to 1/2 of body weight, and full weight-bearing only after 6~8 weeks, with attention to icing after going to the ground.