Purpose: To prevent the occurrence of postoperative deep vein thrombosis and pulmonary embolism, to help restore adequate knee mobility after surgery, to strengthen the strength of the muscles around the knee joint and the stability of the knee joint, to help the patient hold the crutches correctly or walk independently after surgery, to help the patient carry out rehabilitation training as soon as possible after surgery, to improve the patient’s ability to carry out independent activities of daily living after surgery, and to improve the quality of life.
Ankle pump exercises: the patients themselves do plantar flexion (toes and instep hook upward) and dorsiflexion (toes and instep hook downward) exercises of the ankle joint, which is very important to prevent phlebitis of the gastrocnemius plexus and deep vein thrombosis of the lower limbs in the elderly after surgery. The method is as follows: with both lower extremities straightened in bed, the patient relaxes both ankles naturally and then does dorsiflexion, which must be maintained at maximum for two seconds. Then do plantarflexion from the maximum dorsiflexion state, plantarflexion must also reach the maximum to maintain two seconds, around the ring for a week, and so on repeatedly. Plantarflexion and dorsiflexion exercises can be performed continuously while the patient is in bed watching TV, reading a book or newspaper and talking with family members. As shown in the figure.
Second, quadriceps strength exercises: contraction and relaxation exercises for quadriceps: contraction and relaxation exercises for quadriceps while lying in bed: the patient lies in bed, legs naturally straight, repeatedly perform the activity of contracting the thigh muscles of both lower limbs for 5 seconds and then relaxing for 2 seconds. Do as much as possible without increasing pain.
Third, straight leg raising exercise: raise the affected limb in full extension at an angle of 15° to the bed. Then maintain in this position without moving until there is no strength to maintain it. Rest the leg on the bed for a moment and continue with the second straight leg lift exercise. Side leg raise and back leg raise exercises, 20 times / group, 3-4 groups / day, 30 seconds rest between groups.
Fourth, the method of static squatting exercises: posture with the Chinese martial arts in the horse riding squatting crotch action or become a standing pile action. The patient’s legs apart, the distance between the two feet is slightly wider than the shoulders, the body remains upright position, can not lean forward, the toes and knees are forward, not “inside and outside the eight”, at this time the knees began to bend squat. The bending angle of both knees varies according to the patient’s physical condition and muscle strength. If the patient’s physical condition is good, good thigh muscle strength, squatting angle can reach 90 °, if the patient’s body and thigh muscle strength is weak, both knees can be lightly flexed, which is a half squat position higher, the patient more effort, with the practice of muscle strength and then increase the angle of knee flexion to the maximum angle without pain (not more than 90 °), 2 minutes -5 minutes / time, interval 5 seconds, 5-10 consecutive / group. 2-3 groups / day. Day.
V. Extension exercises (as far apart from flexion exercises as possible!) Stretching exercises in the muscles and posterior joint capsule pulling feeling and slight pain is normal, do not contract the muscles against, should be completely relaxed, otherwise it will be ineffective. The weight of the load used in the exercise should not be too large, but should make the affected knee dare to relax and last up to 30 minutes to the limit, with a clear pulling sensation is appropriate. The exercise should not be rested in the middle of the exercise, otherwise it will affect the effect. 1. Seated knee extension: Sitting position, foot pads high, weight above the knee joint. Relax the muscles completely and hold for 30 minutes. 30 minutes/time, 1-2 times/day. See Appendix 1-Figure 14. 2. Prone suspension: (if the extension angle is significantly limited) prone, below the knee suspended outside the bed, with weight at the ankle joint. See appendix 1-figure 15. 3. Active stretching: see appendix 1-figure 16, 20. hold at the limit for 10 seconds, relax for 5 seconds. 20-30 times/group, 1-2 groups/day.
Sixth, joint function exercises flexion exercises: the following methods in accordance with their own flexion angle, any applicable method, once a day, and strive for a slight increase in the angle can be. If you have any special discomfort during or after the exercise, you should inform your doctor in time. The exercise process should not be straightened and rested, repeatedly flexed and extended, otherwise the effect will be affected and it will be very easy to cause swelling.
1. Patellar release (start after stitch removal, no need to perform if the patella is flexible): push and hold the edge of the patella by hand and push the patella slowly and forcefully in the up and down direction to the limit position. 20 times in each direction, 2-3 times/day. This can be done before flexion exercises.
2. Sitting (or supine) position hanging leg: (for 0-95° range) Sitting on the edge of the bed, hanging below the knee outside the bed. Relax the thigh muscles under protection, so that the lower leg drops naturally to the limit and hold for 10 minutes. If necessary, add load to the ankle joint.
3. Lie on your back with your thighs perpendicular to the bed (hold your legs with both hands to fix them), relax your thigh muscles and let your calves sag naturally, add load at the ankle joint if necessary (the load should not be too large, otherwise the muscles cannot relax, i.e. no effect). The requirements are the same as above.
4. Sit on the chair, the affected side of the toe against the wall or fixed, slowly move the body forward to increase the angle of bending the knee, feel the pain and keep still, a few minutes after the pain disappears or lower, and then move forward to the limit.
5. Sit on the bed and hold the ankle with both hands so that the heel slowly approaches the buttocks. Measure the distance between the heel and the hip before starting, and gradually make the distance shorten to the same angle as the healthy side leg. This exercise should be gradual, do not blindly adventurous or afraid of pain.
6. Prone position (face down on the bed) legs naturally extended, hold the ankle joint of the affected leg by themselves, so that the knee joint flexion (can be long towel or wide band tied at the ankle to facilitate pulling). Or with the help of others, but absolutely forbid violent pushing.
7. Sit in a seated position with the foot not leaving the bed. Slowly and forcefully, flex the knee to the maximum, hold for 10 seconds and then slowly straighten. 10-20 times/group, 1-2 groups/day.
8. full squat under protection: full squat under protection of object with hands, body upright, heel does not leave the ground, as far as possible to make the buttocks touch the heel. 3-5 minutes / time, 1-2 times / day.
Seven, weight-bearing exercises weight-bearing and balance: under the protection of double foot separation, alternately move the center of gravity left and right in the range of slight pain, and strive to achieve the affected side of the single leg fully weight-bearing standing. 5 minutes / time, 2 times / day. Separate both feet anteriorly and posteriorly, move the center of gravity, and strive to achieve full weight-bearing standing on the affected side. 5 minutes/time, 2 times/day.
1, the affected side of the single-leg 45 ° position half squat flexion and extension knee exercises. The affected leg stands on one leg, the upper body is straight, slowly squat to the 45° of flexion, and then slowly pedal until fully straightened. 20-30 times/group, 30 seconds interval between groups, 3-4 groups of continuous exercises, 1-2 times/day.
2.Fixed bicycle exercises, light load to large load, and gradually reduce the height of the seat. 20-30 minutes / time, 2 times / day.
3.Step jumping up and down exercises. 20 times/group, 45 seconds rest between groups, 3-4 groups of continuous exercises, 2-3 exercises/day.
4.Lateral jumping exercises. 20 times/group, 45 seconds rest between groups, 3-4 groups of continuous exercises, 2-3 exercises/day.
5, “step down” exercise: face the ground, stand on the first floor of the steps with your back to the steps, your upper body is straight, the affected leg stands on one leg, and the healthy leg is stretched forward. The affected leg slowly squats until the healthy leg follows the ground, then slowly stretches until it is completely straight. 20 times/group, 30 seconds between groups, 2-4 groups in a row, 2-3 times/day. The affected leg stands on one leg, the healthy leg is straight, the toe is supported on the step, the body weight leans forward and falls completely on the affected leg, 0-30° range, slowly squat to flexion at 30°, then slowly pedal until fully straightened. 20 times / group, 30 seconds between groups, 2-4 groups in a row, 2-3 times / day.
6, arrow squat: the front and back of the feet stand apart, two feet separated by a large step distance. The upper body is straight, both legs are flexed and squatted at the same time, until the front leg is flexed 90°, the rear leg knee is on the ground, and both legs are simultaneously powered to stand up straight. 10-20 times / group, 45 seconds between groups, 2-4 groups in a row, 2-3 times / day. The affected leg in the front side and rear side are done!
7, deep squat: feet apart, shoulder-width apart, upper body straight, hands holding the load, legs simultaneously flexed to a full squat, hold for 1 second and then slowly stir up to fully straighten. 10-12 times / group, 60 seconds between groups, 2-4 groups in a row, 2-3 times / day.
Cautions.
1, the specific implementation needs to be completed under the guidance of a doctor depending on their own conditions and individual circumstances.
2, 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 and load depends on your own situation, and should be practiced at the same time the healthy side. The improvement of muscle strength is the key factor of joint stability and must be practiced carefully.
3.Except for the operated limb, the rest of the body parts (such as upper limb, waist and abdomen, and healthy side leg) should be practiced as much as possible to ensure physical quality, improve the overall circulatory metabolic level, and improve the overall physical condition of the patient after surgery.
4.The training process should avoid movements that cause pain or aggravate pain in the lower limbs.
5, mobility and other joints have activities immediately after the exercise ice for about 20 minutes, such as the usual (after standing, walking) there is a significant feeling of heat and swelling in the joint, you can ice again 3-5 times / day.