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 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.
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. 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. Early stage: edema inflammatory reaction period (0~2 weeks)
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: after anesthesia subsides, begin to move the toes and ankle; if pain is not obvious, try to contract the quadriceps. That is, tensing and relaxation of the anterior thigh muscles.
(ii) 1 day after surgery: 24 hours after surgery, you can walk without touching the ground by holding the affected limb with double crutches (only to the bathroom!)
1. Ankle pump: forceful, slow, full-range flexion and extension of the ankle joint, as much as possible. (Important to promote circulation, reduce swelling and prevent deep vein thrombosis)
2, quadriceps (anterior thigh muscle group) isometric exercises: that is, thigh muscle tensing and relaxation. Do as much as possible without increasing pain, more than 500 times/day.
3, posterior thigh muscle group isometric exercise: the affected leg force down the padded pillow, so that the posterior thigh muscle tensing 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
The leg should not be padded into a slightly bent position with a pillow. If the pain is unbearable, place in a comfortable position under the guidance of the doctor.
(5) Start to try straight leg lift: fully straighten the leg lift until the heel is 15cm above the bed and hold until exhaustion. 10 times/group, 2~3 groups/day.
(iii) 2 days after surgery: remove the drainage tube, remove the cotton leg, and install the chuck support (0° position fixation).
1.Continue straight leg raising exercises, 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 by hand). 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 lift 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-bearing by holding the crutches, but the operated limb should not bear weight, and walking should not be too much, as it is easy to form joint effusion by walking more.
(v) 4 days after surgery: start joint mobility exercises according to the situation as decided by the doctor.
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 the range of 0°~90° in the state of slight pain.
3.Extension exercise: remove the brace, put a pillow at the heel, make the affected leg leave the bed completely 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 after surgery: (The progress of flexion angle varies according to the individual differences)
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 the straight position (i.e. 0°) for 4 weeks.
4. See the end of this article for details of weight-bearing exercises
II. Initial period: protective rehabilitation training period (3-8 weeks)
Purpose: To strengthen mobility and muscle strength exercises: to improve joint control and stability; to gradually improve gait.
(i) 3-5 weeks after surgery.
1. Passive flexion exercises up to 100°~110°.
(ii) 6~8 weeks after surgery: This is the period when the reconstructed ligaments are weak, and protective rehabilitation training is the main focus, with the flexion range maintained within 120° and all motion stopping at the
5 weeks ago.
Third, the middle period: intensive muscle training period (9 weeks ~ 12 weeks)
Purpose: To strengthen the joint mobility to the same level as the healthy side. Strengthen the muscle strength and improve the stability of the joint. Restore the ability to perform all activities of daily life.
(i) 9~11 weeks after surgery.
1. Passive flexion up to 120°~130°.
2.Adjust the knee functional brace to move within 0~60°, and perform static squatting exercises under the protection of the brace (usually after 10 weeks).
(ii) 12~14 weeks postoperatively.
1.Passive flexion angle gradually to the same as the healthy side.
2.After the “sitting knee” is exactly the same as the healthy leg, start to gradually protect the full squat.
3.Strengthen the muscle strength, but do not increase the load, only increase the angle, frequency and time of exercises.
(iii) 15 weeks~3 months after surgery.
1, Active flexion and extension of the knee angle is basically the same as the healthy side, and there is no significant pain.
2, Daily prone position flexion so that the heel touches the hip, continuous stretching for 10 minutes/time.
3.After the angle of the knee in the sitting position was exactly the same as the healthy side, kneeling exercises were started.
4.Start pedaling exercises.
Fourth, the later stage: gradually resume daily activities period (3 months ~ 6 months) (can remove the support)
Objective: To fully resume daily life, strengthen muscle strength and joint stability, and gradually resume sports.
In the later stage, the maximum strength should be increased, and a large load should be used (the load that is fatiguing when 12 movements are completed), 8-12 times/group, 2-4 groups of continuous exercises, with 90 seconds rest between groups, until fatigue. 1 knee ring exercise, 2 jumping up and down exercises, 3 lateral jumping exercises, 4 swimming (breaststroke is prohibited in the early stage), jumping rope and jogging. Jumping rope and jogging. 5 Special exercises for athletes to start the base movement. 6 Stepping on the ball exercise (for proprioceptive recovery)
V. Recovery exercise period: (7 months ~ 1 year)
Purpose: To strengthen muscle strength during exercise, and stability of joints in running and jumping. Restore the general level of movement.
Six, full recovery period: (1 year later)
Purpose: Full recovery of sports or strenuous activities. Strengthen the muscle strength, and the stability of the joints in running and jumping. Gradually resume strenuous activities, or special training. (but subject to individual circumstances)
Weight-bearing training.
1.Less than 2 stitches of meniscus suture (including 2 stitches): under 30 years old, partial weight-bearing will start 2 weeks after surgery, the weight-bearing will be 1/3 to 1/2 of the body weight, the weight-bearing will be 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 the activity on the ground; under 40 years old, partial weight-bearing will start 3 weeks after surgery; over 40 years old, partial weight-bearing will start 4 weeks after surgery.
2. Meniscal suture with more than 2 stitches (excluding patients with 2 stitches or transverse body sutures): partial weight-bearing of the operated limb is started after 4~5 weeks postoperatively, with 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.