Fractures are a common type of injury disorder and an important cause of limb disability. Rehabilitation after a fracture is a necessary process to maximize the recovery of limb function.
The three main principles of modern fracture treatment are: repositioning, fixation, and functional exercise. In fact, the importance of functional exercise is much more than 1/3 of the treatment process; sometimes, the fracture position is good and the healing is fine, but the joint function is not good and the limb function is greatly restricted. Therefore, in addition to the doctor, the patient should also pay full attention to the functional exercise and rehabilitation during the fracture healing process.
Fracture fixation is necessary for fracture healing, and without reliable fixation, fracture healing is not possible. However, failure to perform functional exercises in the adjacent joints after surgery can cause disuse changes in the corresponding tissues of the limb, such as muscle atrophy, joint adhesion contracture, fracture laxity, and slow formation of bone scabs. Helping patients to regain as much limb function as possible and as soon as possible is a problem to be solved in the rehabilitation process.
Fracture functional exercise – rehabilitation purposes
1.Improve pain, edema, contracture and other symptoms.
2.Improve and maintain the local blood circulation and tissue metabolism, which is conducive to the increase of blood flow to the fracture part and fracture healing.
3.Promote the improvement and maintenance of the mobility of the injured joint, adjacent joints, and even the healthy side joints.
4.Reducing the degree of costal osteoporosis.
Principles of fracture rehabilitation treatment to restore as much function of the injured part as possible
When non-surgical external fixation measures such as plaster are used, soft tissue stretching activities should be carried out early without affecting the fracture fixation to prevent the occurrence of fracture diseases such as muscle atrophy, tendon contracture and osteoporosis; unfixed joints should be moved early to maintain their normal function; to eliminate swelling, control pain and reduce muscle spasm, attention should be paid to local treatment; on the premise that the reset and fixation is secure, early To eliminate swelling, control pain and reduce muscle spasm, attention should be paid to local treatment.
If the fracture is treated surgically and fixed properly, external fixation such as plaster is not needed, and functional training should be started 1 to 2 days after the pain is relieved, which has the advantage of providing early exercise and maximizing the recovery of limb function.
In some fractures, internal fixation is done, but the fixation is not very reliable, and additional external fixation is still needed after surgery, which should also be exercised as early as possible depending on the specific situation. The general principle of fracture rehabilitation is to ensure internal and external fixation while emphasizing early start.
Functional exercise
The basic contents of functional exercise include: active and passive activities, non-weight-bearing, partial weight-bearing and full weight-bearing.
It is the functional exercise content of the fracture, and other rehabilitation methods play a supplementary and complementary role. Functional exercise requires active participation of the patient in order to carry out, and is a therapy for both body and mind.
The active movement of the limb is divided into two forms according to the characteristics of muscle action: isometric contraction and isotonic contraction. Active exercise is effective in maintaining or increasing joint mobility, enhancing muscle strength, and improving general function.
Isometric contraction: muscle contraction with constant muscle length, muscle contraction with a slightly shortened muscle belly, but muscle tone is significantly higher (the muscle is X-hard), the joint does not appear to be active, such a contraction is called isometric contraction.
Isotonic contraction: muscle contraction when the length of the muscle shortens, the angle of the joint changes (flexion and extension activities) to produce joint activity, but muscle tension basically remains the same, this is called isotonic contraction.
In functional exercise, you can perform isotonic contraction exercises and isometric contraction exercises, both have their own characteristics. Isometric exercises are simple and easy to master, and are most commonly performed in post-fracture cast immobilization; isotonic exercises can be performed within the range of motion of the whole joint, and the patient can see the movement of the limb. In practice, the two exercises should be performed in a coordinated manner according to different needs, so as to receive a more desirable exercise effect. These two exercises should be performed under the guidance of a treating physician or rehabilitation specialist.
Passive Exercise
The purpose of passive exercise is to restore or maintain joint mobility. It is important to understand that there are two types of joint mobility: active mobility, which is dynamic, and passive mobility, which is static. Mobility training should be performed within the limits of pain tolerance and in a gradual manner, with an improvement of 5-10° per week. Passive activities can be performed by the patient himself or with the help of others, preferably with professional guidance.
Resistance exercises and muscle strengthening exercises
Resistance exercise is the exercise of muscle contraction with a certain load on the fracture muscles, the most commonly used load is sandbags, dumbbells, etc. There are many different programs of resistance exercises, such as progressive resistance exercises, isometric exercises, slow exercises, fast load exercises, endurance exercises, etc.
Points to note for plyometric exercises
Exercise within the range of permission of the treating physician and avoid severe pain during exercise. Master the principles of progressivity and individualization, and different exercise programs should be developed according to each individual’s original physique, age and nature of fracture.