Ankle massage after a fracture

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According to statistics, 54% of fractures and fracture-dislocations of the ankle joint occur at a young age, when it is important for a person to maintain working capacity. These injuries are classified as severe injuries to the musculoskeletal system. Even with high-quality treatment, they lead to disability in 3-12% of cases. Therefore, restoring the functions of the ankle joint requires a careful approach, individual for each patient.

The situation is similar with injuries to the ligamentous apparatus. The ankle is often injured in athletes and young, active people. In 30-50% of them, late diagnosis or poor-quality treatment leads to chronic instability of the ankle joint. It interferes with leading an active lifestyle, and over time even leads to disability.

Early diagnosis and quality treatment help reduce the risk of disability. Moreover, ligament injuries, sprains and fractures are much easier to treat initially, immediately after the injury. At the same time, the chances of restoring ankle function are much higher. And the treatment and rehabilitation itself is less invasive and takes less time.

ankle fracture

ankle fracture
The ankle is the distal part of the fibula and tibia (lateral and medial malleolus, respectively), which performs the most important function: it stabilizes the ankle joint. They form the ankle fork, which holds and distributes the weight of the entire human body.

Ankle fractures account for about 15% of all bone fractures. They are one-, two- and three-malleolar (in the latter case there is also a fracture of the posterior edge of the distal metaepiphysis of the tibia). Most often these are complex injuries. At the same time, not only the ankles are damaged, but also the ligaments, and subluxations of the foot are noted. In 10% of cases, a rupture of the distal tibiofibular syndesmosis occurs.

In most cases, patients are managed conservatively. Approaches used:

Anesthesia. Half an hour before the bone reposition procedure, narcotic analgesics (for example, promedol solution) are administered. Local anesthesia is performed directly. It can be conductive. In this case, the tibial and peroneal nerves are blocked. It is also possible to inject local anesthetics into the ankle joint.
Closed reduction of bone fragments. After achieving an analgesic effect and eliminating stress in the patient, reduction begins using the closed method. All movements are made smoothly, without jerking. The effect is reversed to the mechanism of injury.
Application of a plaster cast. Performed under X-ray control. Subsequently, the person remains in the hospital for several days. He receives analgesics to reduce pain.

With the advent of fixation devices, the number of operations performed has increased. But their results are not always better than conservative treatment. In addition, two operations are required: during repeated intervention, the installed metal structures are removed. There are also advantages: there is no need for long-term plaster immobilization.

If the patient is managed conservatively, careful monitoring is required. Especially in the case of ruptures of the deltoid ligament or tibiofibular syndesmosis. Because in this case, subluxation of the foot is possible after the swelling is eliminated. After 10 days, x-rays of the joint are repeated to determine whether the ankle joint remains stable.

Exercise sets

Therapeutic techniques aimed at rehabilitation after a foot fracture at home include morning exercises, standing exercises, moving exercises, and sitting exercises.

Morning exercises are so-called hygienic exercises, which should be done immediately after waking up. It consists of three parts. The first part must be done in bed - bend and straighten your toes, rotate it outward and inward, and make circular movements. Then it is recommended to perform self-massage with cream or ointment.

General developmental exercises that need to be done in the morning:

sequential lifting onto your toes and lowering onto your heels;
the knee of one leg bends, hands rest on the wall; the second leg is laid back on the toes; the calf muscle and Achilles tendon are severely stretched;
feet standing parallel to each other roll from the outside to the inside;
the knees rise to the chest, the ankle stretches;
lunge to the side with the body turned to the side.

Important. It is best to do the exercises barefoot for 30-40 minutes.

Rehabilitation after a foot fracture:

the toes are bent in such a way that the emphasis is on the outer side of the feet;
rolling from heel to toe;
half-squat position, feet simultaneously rolling left and right;
squat position, heels off the floor.

These exercises are performed in 2 sets of 10-15 times.

Popular movement exercises:

jumping in place: legs are placed apart and brought together again;
walking backwards;
walking on all fours;
jumping with the right and left foot alternately;
jogging.

You can also stretch your injured foot while sitting:

a tennis ball is rolled back and forth by the foot;
pick up a rag or towel with your toes;
the towel is wrapped around the ankle and pulled towards itself;

The entire set of exercise therapy exercises given above is recommended to be done in a static position. This could be swallow pose.

Also, over time, you can add exercises with another popular simulator:

Petr Popov developed his own system for foot rehabilitation after a fracture. It is based on micro movements that make the whole body work. Such a small load on damaged bones, according to many experts, gives the best effect.

massage

massage
Auxiliary procedures for normal restoration of function of the lower limb begin to be used from the first days of immobilization. Use:

physical therapy (mainly static loads);
massage.

Ankle massage is not performed after an ankle fracture. Massage the tissue nearby. Procedures begin on the 3rd day. A total of 10 sessions are required. They aim to:

elimination of swelling;
pain reduction;
increased blood circulation;
preparing muscles for upcoming physical exercises.

In combination with physical therapy, massage helps prevent atrophic changes in muscle tissue that are inevitable as a result of prolonged immobilization. After all, the load on the muscles decreases. Being at rest for a long time, blood flow in them worsens and muscle volume decreases.

After 3-6 weeks, the permanent bandage can be replaced with a removable one. During this same period, rehabilitation measures begin. Now physical therapy involves performing dynamic exercises. Only flexion and extension at the ankle joint is allowed. More complex movements (eversion, inversion, lateral deviations) are carried out no earlier than 2 weeks after the removal of the cast.

During the same period, several more massage sessions are performed. Both full loads on the foot and massage procedures begin only after an x-ray has been taken and the formation of a bone callus has been confirmed. Massage helps to quickly develop a joint, eliminate stiffness, and build up lost muscle mass.

Prescription of exercise therapy after a foot fracture

Rehabilitation after a foot fracture poses the following tasks for the patient:

restoration of foot mobility;
activation of the tone of the ligaments and muscles of the damaged area;
strengthening the base of the ankle;
elimination of swelling and activation of metabolic processes;
return to normal gait.

Main treatments include:

Exercise therapy - a set of motor and gymnastic exercises;
massage;
orthopedic shoes, instep support;
drinking regime (at least two liters per day).

Physical therapy is prescribed from the first day of injury and continues for several months until complete recovery.

Massage after surgery

Open fractures - in this case, at least primary surgical treatment of the wound is required. Often it is necessary to perform bone reduction using an open method.
Location of tendons between bone fragments.
Trimalleolar fracture, when the fragment of the posterior edge of the tibia constitutes more than 30% of the articular area.
Displacement of the fragment of the posterior edge that persists after closed reduction by more than 3 millimeters.
Impossibility of closed reduction due to severe swelling.

After surgery, massage begins a few days later, after the pain has subsided. The impact is carried out in the most gentle way possible. Massage tissues that are located at some distance from the damaged area. In the immediate vicinity of the ankle, they limit themselves to only stroking.

A few weeks after the injury, when the damaged bones are healing, massage can also be used. It goes well with exercise therapy and can be an alternative to physiotherapeutic techniques or complement them. Massage is done several times a day, including before performing dynamic exercises.

Physiotherapy for fractures of long tubular bones

Features of the use of physiotherapy for fractures of long tubular bones

V.I. Makolinets, T.N. Grashchenkova, A.N. Gaevskaya, V.V. Melnik - State Institution “Institute of Pathology of the Spine and Joints named after. prof. M.I.Sitenko AMS of Ukraine”, Kharkov, Ukraine

The problem of bone tissue regeneration has been studied for a long time and many of the problems facing specialists have already been practically solved. There are many different means and methods for optimizing osteoreparation, and their number is constantly increasing.

Physical factors in the treatment of bone fractures play an important role both for complete and faster functional recovery of the limbs after injury and the prevention of various complications, and for optimizing osteoreparation. When using them, the patient’s condition, the peculiarities of the course of the traumatic process and the stage of regeneration must be taken into account. The process of bone regeneration is influenced by both general phenomena at the systemic organism level and local changes in tissue metabolism. The entire subsequent course of the reparative process, and ultimately the rate of healing of a bone fracture, depends on the stability of bone fragments, the rate of biosynthesis of proteins and specific enzymes. Conditions can be considered optimal if the bone fragments are well matched and sufficiently firmly fixed and there are no pronounced pathological changes in the most important systems of the body that could disrupt the processes of bone tissue restoration.

The healing process of fractures occurs in stages. The first stage is traumatic inflammation. At this stage, a blastema is formed - a material reserve for regeneration; cellular and tissue resources surrounding the damaged area are mobilized.

From approximately the fourth to the thirtieth day after the injury, the second stage of bone repair begins - the phase of formation and differentiation of tissue structures. At this stage, vascular networks, including capillary networks, are formed, the number of cellular elements increases, which can subsequently differentiate into osteoblasts, fibroblasts and chondroblasts. Primary callus is formed.

The third stage of the bone regeneration process does not depend on the severity of the formation of angiogenic bone structures and the mineralization of the regenerate (25–50 days). It is already well diagnosed x-ray due to the presence of calcium salts in the regenerate. At this stage of rehabilitation treatment, the patient is allowed to dose the injured limb.

Subsequently, the fourth stage begins - the stage of remodeling and outcome. During this period, the formation of finely looped bone trabeculae occurs, and the resorption of excess regenerate occurs. Ultimately, the maternal and newly formed bone tissue become identical in structure.

The main objectives of physiotherapy, after comparison of bone fragments and immobilization of the limb, in the treatment of fractures are to provide analgesic action, fight wound infection, eliminate swelling and optimize blood circulation, relieve muscle strain, accelerate wound healing and callus formation, prevent the development of osteomyelitis, muscle atrophy and joint contractures, accelerating the recovery of limb function as a whole.

In the first stage of fracture consolidation, treatment with physical factors should be aimed at relieving pain and swelling. In addition, physiotherapy can mobilize the tissue resources of the damaged area. For this purpose (from 2 to 3 days after the fracture), a UHF electric field (UHF EP) to the fracture area longitudinally in the presence of a metal implant or transversely in its absence. A low-thermal dosage of 30–40 W is used for 10 minutes, for a course of 8–10 daily exposures. E.p. UHF can cause persistent, prolonged and deep hyperemia. At the same time, along with the dilation of blood vessels, arterial blood flow and local lymphatic drainage improve. In the presence of metal structures, the use of E.p. UHF does not cause significant heating, electrolysis or oxidation of the implanted metal.

In order to relieve pain, eliminate edema, increase hyperemia, improve blood circulation and mineral metabolism, mainly phosphorus and calcium, ultraviolet irradiation is used in erythemal doses symmetrical to the fracture of the area of a healthy limb or the anterior-inner surface of the shoulder or thigh, well equipped with nerve receptors. Two fields of 150 cm2 each are irradiated at a dose of 2–3 biodoses, with each subsequent irradiation the dose is increased by 1–2 biodoses. In total, 8–10 irradiations are carried out per course. Irradiation of a healthy limb using the principle of repercussion has an effect on all tissues in the area of the fracture, improves blood circulation in them, and accelerates the resorption of edema and hematoma. In addition, ultraviolet irradiation of reflex-segmental zones is also carried out according to generally accepted methods. General ultraviolet irradiation also has a beneficial effect on fracture healing.

At the same stage of osteoreparation (from 2-3 days), electrophoresis of the following anesthetic drugs is used: 0.5–1% novocaine solution, 1.5% trimecaine solution, 2% lidocaine solution. Electrodes are applied longitudinally above and below the fracture area. Current density is 0.05 - 0.08 mA/cm2, duration is 15 -20 minutes daily, 10 - 15 procedures are performed per course of treatment.

Irradiation with a Sollux lamp has an anti-edematous and analgesic effect , which is used from the first days after injury, lasting 30–60 minutes, daily, 10–12 procedures per course.

Magnetic therapy also has a pronounced anti-edematous effect , under the influence of which proliferative processes in the regenerate are activated, the process of differentiation of osteoblastic tissue is accelerated, and blood circulation in the injured limb is normalized. Clinically, this is manifested by a decrease in post-traumatic swelling and a decrease in pain. For this purpose, a sinusoidal, pulsating or traveling pulsed magnetic field with a magnetic induction of 30 mTs from the devices “Polyus 1”, “Polyus 101”, “Magniter”, “PDMT”, “MAG-30”, “Gradient”, “ALIMP” is used. etc. Duration of exposure is 10 – 20 minutes, daily. 15 procedures are used per course.

To achieve active hyperemia (from 5 – 6 to 15 days) microwave therapy using the “Romashka” (power 10 – 12 W) or “Volna-2” (power 30 – 50 W) UHF therapy devices. The duration of the procedure is 8 – 10 minutes, daily or every other day; 10 - 12 procedures are carried out per course.

To improve the general condition, in case of sleep disturbance, headache, irritability, medicinal electrophoresis of 2% bromine solution is used on the collar area according to Shcherbak, 15–20 minutes, current density 0.05 mA/cm2, daily, for a course of 8–10 procedures; electrosleep using the orbitomastoid method, frequency 100 Hz, 30 – 40 minutes, daily, 10 procedures per course.

The main goal of physiotherapy during the second period of osteoreparation is to accelerate the consolidation of fragments. Since during this period the body creates reserves of calcium necessary for the intensively developing regenerative processes in the bone, medicinal calcium electrophoresis should begin precisely from this time. At earlier stages, the use of calcium electrophoresis, in our opinion, is inappropriate. Depending on the type of immobilization and the method of treatment of the fracture, calcium electrophoresis is prescribed according to the general Vermeule method, alternately at the site of the fracture, or one electrode is applied to the segmental zone, and the other to the symmetrical area of the healthy limb. Use a 5% calcium chloride solution and a 5% sodium phosphate solution. Current density 0.05 - 0.08 mA/cm2, exposure time 10 -20 minutes, daily, 12 -15 procedures per course. Considering that other macro- and microelements are also involved in the process of osteogenesis, it is possible to use medicinal bischofite electrophoresis according to the method described above.

In cases where there is access to the fracture zone, it is possible to prescribe ultrasound , which, in the pulsed mode with an intensity of 0.4 W/cm2 using a stable-labile technique, has a pronounced stimulating effect on the processes of osteogenesis. We consider the data available in the literature on contraindications to the use of ultrasound after metal osteosynthesis of a fracture to be unfounded. We have not observed a slowdown in the formation of callus, and even more so in its resorption, when performing phonotherapy in a pulsed mode with an intensity of 0.2-0.4 W/cm2 over a period of more than thirty years of work.

Infrared laser therapy is effective in enhancing bone tissue metabolism . The site of a bone fracture or the corresponding segmental area of the affected limb is exposed to laser irradiation.

The third stage is clinically characterized by the absence of symptoms of pain in the fracture area. Radiologically, by the end of this stage, the fusion of bone fragments is determined, which serves as an indication for cessation of immobilization.

In the presence of muscle wasting, paresis, one of the active means of combating the weakening or loss of motor function is electrical stimulation , which increases the functional ability of muscles, improves the course of trophic and reparative processes. More often, a bipolar technique is used directly on the area of the muscles concerned, lasting 10-20 minutes, for a course of treatment of 15-20 procedures.

At this stage, it is also advisable to use ultrasound therapy , which promotes the formation of arterial and venous collaterals, enhances microcirculation, metabolic and trophic processes, and has an analgesic effect. The impact is carried out on the fracture site using a labile technique. Sounding begins with an intensity of 0.2 W/cm2 in a pulsed mode for 5 minutes. From the 6th-7th procedure, the intensity of exposure is increased to 0.4 W/cm2, and the exposure is increased to 8 minutes. Therapy is carried out daily, 10-12 procedures per course.

The methods listed above are combined with balneotherapy : sodium chloride, salt-pine, radon, sulfide baths. They are used at a temperature of 36-37°C, for 10-20 minutes, 4 times a week or every other day, for a course of 10-12 baths. The treatment complex also includes local whirlpool baths with a temperature of 36-37°C, with a water jet pressure of 1.0-1.5 atm, lasting 10 minutes, for a course of treatment of 10-12 procedures.

For hypertrophic, excessively developing calluses, balneological and thermotherapy procedures are prescribed: paraffin and ozokerite applications, mud therapy, as well as medicinal electrophoresis of a 5% novocaine solution and a 4% potassium iodide solution.

Physiotherapeutic measures at the stage of rehabilitation of patients are aimed at restoring the full function of the damaged limb, preventing muscle atrophy and stiffness in the joints adjacent to the fracture area. They also have a regulatory effect on the function of the autonomic nervous system and help improve the general condition of the patient. It is advisable to apply physical factors locally to the lesion of the bone, and it is also possible to influence at any other level of the body (segmental, etc.).

To restore the patient’s protective and adaptive forces, priority is given to physical therapy , which begins in such patients from the first days after injury. Air and sun baths , swimming in the pool, sauna, massage and self-massage, aeroionotherapy are also shown It is advisable for such patients to undergo restorative water procedures, such as rain, needle, dust, or circular showers . The shower technique involves gradually lowering the water temperature from indifferent to cool and even cold, that is, from 36-37 °C to 25-28 °C, with a water jet pressure of 1-1.5 atm. The duration of the procedure can increase from 1-3 to 5-7 minutes, the course consists of 10-15 effects. To improve sanogenesis, the patient is prescribed pine, sage, sea, iodine-bromine, pearl, foam, mustard, turpentine baths at a water temperature of 35-37°C, for 8-15 minutes, depending on the type of procedure used. The course of therapy consists of 10-20 treatments.

Underwater massage gives a good effect : pressure – 1.5-2.0 atm, duration – 15-20 minutes, 5-12 procedures per course.

In case of residual swelling of soft tissues in the area of injury after removal of the plaster cast, it is very important to activate lymphatic drainage and improve the drainage function of deep vessels. For this purpose, it is recommended to carry out a manual “suction” massage at the beginning of the segmental zone and above the damaged area, and then the affected area. They use hardware massage - vibration (pneumomassage), magnetic therapy and heat therapy.

After prolonged immobilization of a limb, contractures often develop in the joints. Physiotherapy in these cases should be aimed at improving blood circulation in the joints and adjacent areas, increasing the elasticity of scar tissue, and reducing pain when developing joints. For this purpose , diadynamic currents, electrophoresis of a 2-5% solution of potassium iodide and a 0.5-1% solution of novocaine are used. The electrodes are placed transversely on the joint area for a course of 10-12 procedures.

To soften connective tissue scar formations during the same period, medicinal electrophoresis of lidase, ronidase, trypsin or phonophoresis of these drugs, as well as hydrocortisone, Trilon B, and aminazine ointment are prescribed to the joint area. The therapeutic effect increases when combining mud and heat therapy and phonophoresis.

For joint contractures, microwave therapy in a low-heat dosage (20-40 W), lasting 6-10 minutes, daily, for a course of 6-10 procedures. In the treatment of contractures (with the exception of the elbow joint), heat therapy is widely used - mud applications, paraffin, ozokerite. The procedures help relieve increased muscle tone, develop active hyperemia, increase tissue trophism, and reduce pain during the subsequent development of movements in the joint. Heat therapy goes well with the above-mentioned electrical procedures. Balneotherapy, underwater shower-massage, and hydrokinesitherapy contribute to faster restoration of limb function.

The effectiveness of rehabilitation treatment increases significantly with the use of electrical stimulation , which helps to normalize and maintain physical condition and performance, and prevents the development of neuromuscular disorders, contractures and muscle atrophies.

With delayed consolidation of bone fractures, physiotherapy should help to maximize blood circulation in the fracture area and normalize the state of the immunological system. Locally, medicinal electrophoresis of calcium and phosphorus, bischofite, and biol is prescribed to the fracture area. The fracture area is sounded with an intensity of 0.2-0.4 W/cm2 in pulse mode, exposure time is 3-5 minutes. Procedures are carried out daily, 10-12 per course of treatment. To treat delayed consolidation of fragments, in case of ununited fractures, mud applications are used (on the entire damaged limb) at a low temperature (36-37°C), local paraffin or ozokerite applications are also used at lower temperatures.

In our work, due to the limitation of its volume, we were not able to reveal all the possibilities and features of the use of physical factors in the treatment of patients with bone fractures, but tried to point out the features of the use of only those of them that are most often prescribed in clinical practice. When treating patients with this pathology, we always take into account the characteristics of the fracture and the patient’s sanogenetic capabilities. and syndrome-pathogenetic situation. This comprehensive approach allowed us to significantly improve treatment results and recommend the widespread use of physiotherapy in the treatment and medical rehabilitation of patients with bone fractures.

Methodology

Methodology
In the initial period after injury, suction massage is used. Its main goal is to eliminate swelling, prevent congestion, and improve lymph circulation. The main impact is on the thigh. In the area of the lower leg, only stroking is limited if it is not painful for the patient.

After the period of plaster immobilization is completed, a deeper massage effect is carried out. It consists mainly of stroking and kneading techniques. Massage the thigh and lower leg.

Directly the area of the foot and ankle joint begins to be intensively affected only 2 weeks after the removal of the plaster and radiological confirmation of the successful formation of a bone callus. Stroking techniques are used, as well as spiral rubbing. During the same period, the thigh massage is stopped. Instead, a deep calf massage is performed.

Not only manual, but also hardware massage is used. The main method of influence is vibration.

Application of massage procedures

Massage sessions are carried out at different stages of treatment. In combination with other therapeutic methods, they are especially effective because they:

elimination of stagnation;
elimination of remnants of muscle atrophy;
increasing the elasticity of muscles and ligaments;
improving the mobility of the foot joints.

The use of massage procedures is possible in the presence of plaster. Methods:

massage the part of the leg that is without plaster;
light and infrequent tapping on the plaster;
light pressure on the area of the leg near the cast.

After removing the plaster, the procedures are mainly carried out by specialists, but you can learn the technique of self-massage. Stroking movements are performed with the fingertips on both sides of the ankle, across and along the limb. You need to move from the shin to the toes. Discomfort should not be allowed; massage should not cause pain.

The role of massage in patient recovery

Ankle massage after an ankle fracture plays a supporting role in the treatment of patients. This is evidenced by the obvious fact that without performing this procedure, the bones heal successfully, and the person is completely restored with the right approach to treatment. At the same time, massage alone, without other methods of treatment (full reposition of fragments, immobilization or surgery) will not lead to anything good.

However, not only the result of treatment is important, but also the patient’s feelings, the functionality of his limb after the end of therapy, and the rate of recovery. It is to influence these indicators that massage of the ankle joint is performed after an ankle fracture. Using the procedure 3 days after permanent immobilization or in the early postoperative period allows a person to reduce swelling and pain, provide good conditions for the formation of callus, and also protect muscle tissue from atrophic changes.

Massage is also performed at the stage of the late rehabilitation period. It is done when the plaster has already been removed, some time has passed, and the person is allowed to put maximum load on the limb. Physical therapy comes to the fore in restoring the patient’s ability to work. It is this that allows you to develop the joint and strengthen the muscles. But massage helps increase the effectiveness of training by improving microcirculation, preparing muscles for upcoming loads, or, on the contrary, relaxing them after training.

Additional recommendations

To form the natural arch of the foot after an injury and prevent dislocations and fractures, you need to wear orthopedic shoes. It fixes the leg as comfortably as possible and improves blood circulation.

Important. Orthopedic shoes prevent calluses, swelling, fatigue, and help treat bunions and diabetic feet.

Frame insoles are important for rehabilitation after a foot fracture, allowing you to properly distribute the load and reduce pain. Long-term walking significantly reduces discomfort and increases stability.

In combination with exercise therapy and massage, you can use folk remedies , for example, baths :

3 tablespoons of chamomile or chamomile are poured into 500 ml of hot water and infused for 1 hour. The liquid is filtered and poured into a warm basin where you need to place your feet. The duration of the procedure is 20 minutes.
Half a glass of sea salt is dissolved in a bowl of warm water. The feet are kept in the container for at least 15 minutes.

A responsible attitude towards your health and regular performance of complex exercise therapy contribute to a quick recovery and restoration of all functions of the injured foot.