Rehabilitation after a torn knee ligament (ACL)

After a rupture of the ligaments of the ankle, knee and shoulder joint, with inadequate treatment, the patient may experience pain, joint instability, and impaired limb function. To prevent them, rehabilitation specialists at the Yusupov Hospital create an individual program for each patient. It includes a regimen, joint fixation, physiotherapeutic procedures, therapeutic exercises, taping for ruptured ligaments of the knee, shoulder and ankle joint.

The rehabilitation clinic is equipped with modern mechanical and computerized simulators from leading companies in the world. Candidates and doctors of medical sciences widely use the author’s methods of restorative therapy. Comprehensive rehabilitation allows you to reduce the consequences of rupture of the ankle ligaments, normalize the musculoskeletal function of the lower limb in case of damage to the ligamentous apparatus of the knee joint, and restore performance after a shoulder injury.

Rehabilitation program after ligament rupture

As an example, we take an average rehabilitation course in terms of duration and content, which in fact can vary on an individual basis, both up and down.

Total*: RUB 112,500 (price with 10% discount for one-time payment of the full course RUB 101,250)

Course duration is 3-4 weeks.

* The cost of the rehabilitation course does not include tests and examinations. If you have already taken them, you can bring the results with you to your initial appointment with the doctor.

You can also take advantage of an additional 25% discount on procedures on the day of your initial appointment.

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Causes and degrees of ligament rupture

Mechanical destruction of the connective tissue bundles that hold articular cartilage together can be caused by injury or degenerative processes. This leads to muscle swelling and loss of limb mobility.

In treatment and rehabilitation, ligament ruptures are divided into three degrees:

1. Tensile or local micro-fractures.
2. Multiple micro-tears leading to partial loss of functionality of the ligamentous apparatus.
3. Complete rupture with loss of functionality (surgery required).

Most often, patients with injuries to the knee, ankle, foot, collarbone, shoulder, and elbow seek treatment and rehabilitation after ligament rupture.

The weakening of connective tissue fibers occurs with age, as well as due to deterioration of muscle blood circulation due to physical inactivity. Athletes and people whose work involves lifting weights often need rehabilitation after a ligament rupture.

Gymnastics for the ankle after a ligament rupture

Rehabilitation after a ruptured ankle ligament is carried out by specialists from the Yusupov Hospital. Its duration depends on the severity of the injury and the individual characteristics of the patient. The rehabilitation course is carried out in 3 stages:

• the use of physiotherapeutic procedures and massage - begin immediately after the acute period, on the second or third day after the injury, actively use phonophoresis and the method of electrical stimulation in combination with a course of massage of the ankle joint, calf muscle and knee area;
• the use of a set of physical therapy measures - first passive and then active exercises, which make it possible to finally remove joint swelling, reduce the risk of muscle atrophy and develop primary mobility of the ankle joint;
• the final stage, at which the loads are gradually increased to the maximum possible, which allows the muscles to return to their natural tone and the joint to regain its usual mobility.

A course of rehabilitation is also necessary after surgery on the ankle joint. Rehabilitation specialists at the Yusupov Hospital select a set of exercises that will help relieve swelling in the shortest possible time, develop habitual mobility of the ankle joint, and strengthen ligaments to reduce the risk of re-injury.

Immediately after restoring the integrity of the ligamentous apparatus, they resort to general developmental exercises in a sitting position - breathing exercises with smooth rotations of the arms and bending of the body in combination with diaphragmatic breathing. It provides a good mood and raises the overall tone of the body, which is important for recovery processes. 3-4 days after the injury, rehabilitation physical therapy begins. Its main goal is to reduce swelling of the ankle joint, develop the necessary plasticity of the ligaments and strengthen the muscles that ensure the functioning of the ankle joint.

The patient performs the first group of exercises while sitting on a chair:

• in a “sitting” position, rolls a stick or bottle back and forth with his foot;
• gradually increasing the amplitude and frequency, bends and straightens the toes without straightening the knee joints;
• puts his feet together and moves them along the plane of the floor, as if stroking it;
• places the feet parallel to each other and makes movements simultaneously with all fingers inward, like clenching a hand into a fist;
• places a light rug under the feet and gathers it under the feet with the toes;
• puts the foot on the heel and moves it gradually to the toe, and then in the opposite direction.

The second group consists of exercises with the ball:

• put the sore foot on the ball and roll it back and forth;
• make an attempt to grab the ball with bent fingers and rise to a height;
• grab the ball with the middle of the foot;
• The feet are tilted so that the ball can be rolled between the soles.

Then move on to the third group of exercises with a gymnastic stick:

• roll a stick with a certain effort;
• grab the sticks with clenched toes, while making sure that the foot does not lose contact with the floor;
• They try to lift the stick from the floor by grabbing it with their toes.

In order to restore the natural elasticity of the muscles and give them their usual tone, they do special exercises with a chair and a ball. For 5 minutes, the patient walks first on his heels and then on his toes.

When using an orthosis, the rehabilitation course begins without waiting for the end of treatment, even if pain and swelling of the joint remain. Its hinged design allows you to exactly repeat all movements of the ankle joint, developing it without discomfort and significant pain. The procedures are carried out in a “sitting” position, with the legs bent at the knee joint.

The orthosis is often replaced with a bandage. It is simple and easy to use, and its compression and heat-retaining properties have a beneficial effect on the injured area. The use of an orthosis and bandage significantly reduces the patient’s fear of re-injury, which allows the body to quickly cope with the consequences of injury.

Clinical manifestations

In the field of treatment and rehabilitation, the following symptoms are identified that appear when ligaments are torn:

• pain syndrome (connective tissue has many pain receptors, so when it is damaged, sharp acute pain occurs);
• edema (traumatic inflammation leads to increased permeability of the vascular walls, which causes the release of the liquid component of the blood into the soft tissues);
• hematoma (a bruise occurs due to rupture of blood vessels; with severe hemorrhage, the affected area may increase in volume, the skin becomes hot);
• limitation of mobility (due to a violation of the integrity of the ligamentous apparatus and pain, the joint cannot fully function).

Features of ligament injuries

Such injuries are extremely painful and are divided into several types depending on the severity of the injuries:

1. Microfractures . They are classified as mild injuries and do not require specific treatment measures. Mild sprains go away on their own.
2. Partial . There is a significant decrease in the functionality of the damaged joint, but with preservation of performance. The person feels mild pain and maintains the reaction of the joint tissue.
3. Full . Significant injuries that occur with the formation of large-scale hematomas and complete loss of activity.

If the recovery processes for grade I and II injuries take 2-14 days, then a serious problem requires more strength and an individual approach.

Clinical case of ankle ligament rupture.

Patient Ch., 23 years old, injured while playing football, turned his right foot outward during a sharp push, heard a crunch, felt a sharp pain. He went to the emergency room, where x-rays were taken without weight-bearing, immobilization in an orthotic bandage for 2 weeks and conservative treatment were recommended. Considering the lack of positive dynamics, I decided to seek a consultation at the K+31 clinic.

History of repeated ankle injuries. For a long time (more than 3 years) on the right ankle joint.

3-4 times a year there were episodes of “tucking” of the ankle joint inwards, after which swelling in the area of ​​the outer ankle and pain when walking were noted for 1-2 weeks. He was treated conservatively, fixation with an elastic bandage, cold, topical diclofenac ointment; during this treatment, he noted a gradual regression of edema and restoration of a painless range of motion.

The latest football injury caused an increased feeling of instability, and the swelling was more pronounced. The lack of positive dynamics forced the patient to consult a doctor.

In our clinic, patient Ch. Was examined by a doctor, damage to the distal tibiofibular syndesmosis was suspected, due to chronic instability of the ankle joint. An MRI of the ankle joint and a standing radiography of the ankle joints with body weight loading were performed, as well as stress radiographs in a forced position, which confirmed the diagnosis.

Below are MRI sections that clearly show the location of damaged ligamentous structures.

In almost 100% of cases, these injuries are missed during the initial visit to the emergency room. If untimely or inadequate treatment is used, instability of the ankle joint leads to destruction of the articular cartilage, severe pain, deformation, and ultimately to complete loss of the function of support and walking. Depending on which ligaments are torn and on how pronounced the instability is, arthrosis develops in different periods, from 1 year with a rupture of the syndesmosis, to 20 or more years with an isolated rupture of the anterior talofibular ligament.

It is very important that during the initial visit to the emergency room, patients with damage to the ligamentous apparatus of the ankle joint are given full radiographs, standing with body weight, an oblique projection with internal rotation of the leg of 15 degrees, and, if necessary, stress radiographs.

A detailed study of the images reveals an increase in the tibiofibular gap to 7.5 mm, a decrease in the area of ​​overlap of the tibia and fibula to 5 mm, and the absence of overlap of the shadow of the talus and fibula on the affected side.

On the x-ray of the bones of the right and left ankle joints in a direct projection, standing photographs - on the right, signs of damage to the distal tibiofibular syndesmosis are determined - the degree of mutual overlap of the tibia bones is 5 mm (normally more than 6mm), enlarged tibial-fibular space - 7.5mm (normally up to 6mm).

When performing stress radiographs, pronounced lateral instability of the ankle joint is determined.

This patient also had excessive mobility of the fibula at the level of the distal tibiofibular syndesmosis with compression of the tibia at the level of the middle third, which was clinically manifested by pain along the anterior edge of the lateral malleolus.

Considering his young age, desire to actively engage in sports, and anamnestic data indicating chronic instability of the right ankle joint, a decision was made on surgical treatment.

Below are the stages of surgical treatment.

After restoration of the lateral ligamentous complex according to Brostrom in Gold's modification and fixation of the tibiofibular syndesmosis with a screw, the stability of the ankle joint is assessed using a valgus stress test under the control of an image intensifier.

Hypermobility of the ankle joint is eliminated, the position of the talus remains unchanged despite the application of valgus load.

This is followed by layer-by-layer suturing of the wound and application of a plaster cast.

Rehabilitation for torn ligaments

For uncomplicated microtears, apply a pressure bandage. For complete ruptures, a plaster splint is used. Special orthopedic devices - orthoses - can also be used. Immobilization and drug therapy can last from 3 weeks to 2 months.

After this, they begin rehabilitation after a ligament rupture. At this stage, it is especially important to take measures to restore normal mobility of the injured limb. For this purpose, our center uses kinesitherapy. Unlike standard therapeutic exercises, it is an individual set of exercises performed on multifunctional exercise machines. They have an anti-gravity and decompression effect, eliminating increased stress on the joints and spine.

Kinesitherapy as part of rehabilitation after ligament rupture has the following advantages:

• helps to naturally restore limbs to normal mobility;
• restores muscle tone and strength through optimal movements in terms of load and amplitude, which gradually become more complex;
• strengthens connective tissue fibers and prevents their re-damage.

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Rehabilitation after knee ligament rupture

Rehabilitation after a ruptured knee ligament begins from the moment the patient is admitted to the hospital. A correctly selected treatment regimen will restore the functionality of the joint as early as possible. If a patient has a complete rupture of the ligament with instability of the knee joint, with other damage to the joint or surrounding tissues, the traumatologist prescribes surgery. In other cases it will not be required.

The patient is prescribed analgesics intramuscularly (ketorolac) or for oral administration. Use ointments, creams and gels with an anesthetic component. Cold compresses or cryotherapy are applied to the knee. The lower limb is fixed with a splint or an orthosis is prescribed. The lower limb cannot be loaded.

If a vessel is damaged during an injury, blood may accumulate in the cavity of the knee joint. To remove it, the traumatologist, under local anesthesia, inserts a needle into the side of the knee and removes all accumulated fluid. If necessary, injects drug solutions into the joint. Patients use the ointment to repair torn foot ligaments.

Treatment of patients with knee ligament rupture is complemented by modern physiotherapeutic procedures:

• ultrasound therapy;
• magnetic therapy;
• cryotherapy;
• ultrasound;
• UHF therapy.

The senior instructor-methodologist of exercise therapy at the Yusupov Hospital conducts individual physical therapy classes. At the first stage of rehabilitation (within 1-7 days after injury), patients do all exercises with both legs, 3-4 times a day, 10 approaches each. You should not exercise while overcoming pain. Patients are offered the following set of exercises for rehabilitation after a cruciate ligament rupture:

• flexion and extension of the leg at the knee joint (rehabilitation after a torn ligament of the knee joint involves performing exercises with slight resistance, but you should not rush to complicate the exercises);
• static muscle tension on the front surface of the thigh (quadriceps) to stimulate blood circulation and increase tone;
• swinging the foot forward and backward, to the sides - helps maintain the strength of the lower leg muscles, stimulates blood circulation;
• walking without full support on the injured leg using crutches, a cane or an orthosis.

The second stage of rehabilitation after rupture of knee ligaments continues until the fifteenth day after the injury. The patient, under the supervision of a physical therapy instructor, continues to perform the first stage of therapeutic gymnastics exercises. Several exercises are added to it to train the muscles of the lower extremities and prepare for independent walking without an orthosis and crutches:

• half squats - performed against the wall, the knees should not go beyond the feet, the lower back remains straight;
• raising on toes;
• walking in place.

The third stage of rehabilitation lasts up to 1 month after the injury. The patient performs all previous exercises. Added to them:

• abduction and adduction of the straight leg from the starting position “lying on your back”; Lifting a straight leg up (starting position – lying on your side);
• exercise on an elliptical trainer (something between skiing and cycling);
• independent walking (complete refusal of a cane, crutches, orthosis).

1.5 months after the injury, the fourth stage of the recovery period begins. Simple exercises are excluded from the training scheme, some are made more complicated. Patients perform half squats with weights. The physical therapy instructor selects weight individually. It is very important to carefully follow safety precautions when performing this exercise.

A leg press is performed, stepping onto the platform. Rehabilitation specialists include exercise on an exercise bike and an elliptical trainer in the rehabilitation scheme. Swimming in the pool and water aerobics are useful.

The fifth stage of recovery after a cruciate ligament rupture lasts up to six months from the moment of injury. The patient regularly performs physical exercises at a comfortable pace with selected weights. Professional athletes can gradually return to training after six months. Everyone else should engage in regular physical therapy to maintain muscle strength, balance, and agility. This will prevent future injuries. When the ligaments of the knee joint are torn, the recovery time is shorter than with a complete rupture. It is possible to develop a leg after a ligament rupture only under the supervision of a rehabilitation specialist.

Kinesitherapy is an important part of rehabilitation

This direction is a special science with an individual approach in each individual case. The complexes of medical and health procedures being developed depend on the scale of the damage. Experts identify several areas, the use of which is advisable in case of injury to certain parts of the body:

Clavicular ligaments. In case of injury to the acromioclavicular joint, kinesitherapy is prescribed for 12-14 days. Specialized exercises should be carried out until mild pain appears. The program consists of the following classes:

• in the supine position, the patient slowly and carefully spreads his arms with an amplitude of 90⁰;
• performs rotational movements with the limbs while standing;
• raises his hands straight in front of him and slowly lowers them.

Knee tendons. When the cruciate ligament ruptures, doctors systematically increase the load. At the first stage of rehabilitation, all exercises are gentle; classes are carried out in a lying or sitting position in order to minimize the load:

• the observed slowly flexes and straightens the injured limb;
• strains the thigh muscles;
• in a sitting position produces walking movements.

As the load increases, the patient begins to perform half-squats with support on the handrails. The movements of rolling the leg heel-toe and in reverse order with the help of a ball are connected.

Shoulder joint. Therapeutic and recreational activities begin with gentle loads, which gradually increase. All sudden body movements are excluded. The patient works standing, throws the ball, rotates his arms. As the load increases, push-ups are added, first with emphasis on the wall, and then full presses from the floor.

The Importance of Medical Massage

This type of health procedures is an important component of the overall rehabilitation program. The work of experienced massage therapists is aimed at:

• relief of inflammation and swelling;
• resorption of bruises;
• improved blood circulation;
• restoration of lymphatic drainage.

Restorative therapeutic massage is prescribed individually. Specialists take into account the scale of damage and the location of the injury.

Knee ligaments. It is one of the most difficult types to perform massage. Such interventions require especially increased attention from a specialist, taking into account the accumulation of blood and lymph fluid in the affected area.

The main goal of such manipulations is to restore lost muscle tone, restore active blood flow and resolve the accumulation of lymphatic fluid in the injured area.

Shoulder joints. The main goal of a healing massage is to relieve swelling and minimize fluid accumulation. The massage therapist begins the procedure gradually. Initially, the neck muscles are warmed up, then the affected area is gradually treated. The maximum permissible time for treatment procedures should not exceed 10 minutes. The specialist works with gentle stroking movements, simultaneously working on the back and front surfaces. The patient is in a sitting position.

Ankle ligaments. If the Achilles tendon is injured, the massage is performed with the patient lying down; a pad is placed under the affected limb. The massage therapist acts delicately, rubbing and stroking the injured leg on both sides. Particular attention is paid when massaging the rupture site itself. All movements are made in the direction from bottom to top and last no more than 5 minutes.

Muscle recovery after training

Anna Belousova

October 24, 2016

People who have been involved in sports for several days know that muscles grow not during training, but during rest. That is why special attention should be paid to muscle recovery after training.

Basically, by the term “recovery” people mean rest, preferably in a horizontal position. During training, toxins and lactic acid are formed in the muscles, which are removed more slowly during “lying down” rest. In this article we will talk about several ways to speed up this process. First of all, you need to restore your breathing. Concentrate, breathe slowly and deeply, each inhalation or exhalation should last at least four seconds. Massage is one of the most wonderful restorative tools that will help quickly restore muscle tone after training. It is useful not only for muscles, but also for the skin and general emotional state. Another common way to relieve muscle tension is stretching. It accelerates the removal of lactic acid from the muscles, has a positive effect on the elasticity of muscle tissue, and that is why it is recommended to stretch after each workout. Take a contrast shower; constriction and dilation of blood vessels will help improve blood circulation in the body. After training, you should pay special attention to sleep. Healthy sleep should last at least 8 hours, you need to go to bed before midnight, at which time all the hormones necessary for life are produced. Shortly before bed, you can take a short walk in the fresh air. It is better to fall asleep in complete silence and absolute darkness. The temperature in the room should be average or slightly lower, and in no case should it be stuffy. It is best to sleep on a hard surface, not forgetting about the pillow. Post-workout nutrition should be balanced, and special attention should be paid to proteins and carbohydrates, which will replenish energy and supply the body with amino acids. Don't ignore special sports nutrition. Immediately after training, drink protein diluted in milk. And after about an hour and a half you need to eat a hearty meal. Your diet should take into account that the body needs proteins, carbohydrates and fats after stress. The preferred fats are: fatty fish, flaxseed or sesame oil. Vegetables should be eaten as they are the biggest source of vitamins, amino acids and fiber. Green tea has a special relaxing property. It contains many different antioxidants that eliminate free radicals. If you need a pick-me-up, add some fresh ginger to your tea. This tea has a positive effect on muscle tone and overall health. It improves not only overall well-being, but also skin color and stomach condition. Special attention should be paid to water. Immediately after training, you should drink no more than one liter, and after 30-40 minutes, drink another glass and continue to drink one glass of water every hour after. However, two hours before bedtime, you should stop saturating your body with water, otherwise you may find yourself swollen in the morning. On days when you don't have heavy workouts, you can go for a short jog, swim in the pool, go to the sauna or bathhouse (only without alcohol) or just take a walk in the fresh air. You shouldn’t stay at home and “seal” while lying on the couch, this will not help your muscles grow, but will only deposit more fat on your sides. Alcohol is one of the main enemies for your muscle growth and overall health. I hope that the muscle recovery tools described in this article will help you gain the desired muscle mass faster.

Anna Belousova

Tags:

• Sport
• Muscles
• Training

Duration of the rehabilitation period

The recovery time after ligamentous ruptures varies. They depend on the type and extent of the injury. In case of partial damage, conservative, classical treatment methods are used, and in case of complete rupture of the tendon and its separation from the base of the bone, doctors use surgical interventions.

In case of minor trauma to the ligamentous apparatus, young and strong patients are given a splint for a period of 20-25 days. Orthoses are used to treat elderly, weakened people. Complete rehabilitation can take up to 3 months and depends on the condition of the body. Age also becomes important:

1. Young patients. In strong and healthy people, regeneration processes proceed quite quickly. Damaged areas receive sufficient amounts of essential nutrients for important regenerative biochemical reactions.
2. Older people and those in poor health will take much longer to recover. A worn-out body does not produce the necessary collagen well, which prolongs the time of connective tissue resuscitation.

The most difficult situation is when the tendon is completely separated from the bone base. In this case, patients are prescribed plastic surgery. Treatment is almost always carried out by surgical intervention. And the rehabilitation time for such patients can last up to six months.