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 for shoulder injury
If patients rupture the shoulder ligaments, rehabilitation is necessary both during conservative treatment of the injury and after surgery. After making a diagnosis, traumatologists begin treatment, which can consist of many components:
- cryotherapy - use cold compresses and an ice pack during the first day after ligament rupture to narrow blood vessels;
- rest - patients are advised to avoid putting stress on the shoulder joint to reduce pain and inflammation; to ensure fixation, a splint is applied for several weeks;
- the use of non-steroidal anti-inflammatory drugs to relieve pain from ligament ruptures (ibuprofen, naproxen, ketorolac in the form of tablets and external agents).
Surgery is performed for athletes, since in this case a complete restoration of muscle strength and mobility in the shoulder is required, with the ineffectiveness of conservative treatment methods, ongoing pain and repeated ruptures. The purpose of the operation is to restore the integrity of the torn ligament through a transosseous suture. When choosing a procedure method, orthopedists give preference to arthroscopic operations, in which access to the joint is provided through two small incisions.
Doctors can inject various synthetic materials into the interosseous space to ensure smooth sliding between tissues. This significantly reduces pain. In case of severe pain, local anesthetics (Novocaine) and hormonal drugs (hydrocortisone) are injected into the joint area. If the patient has a rupture of the ligaments of the shoulder joint, treatment after surgery is carried out in the rehabilitation clinic of the Yusupov Hospital.
The senior instructor-methodologist of exercise therapy conducts physical therapy classes during the rehabilitation process to replenish muscle strength and limb mobility in the shoulder joint. Such exercises must be performed regularly for several months. The recovery process is accelerated by physiotherapeutic procedures. The process of restoring shoulder ligaments in the rehabilitation clinic of the Yusupov Hospital takes 2-3 months.
Treatment and recovery
Arthroscopic reconstruction is the only way to repair a torn ligament
Ruptures and damage to the ACL and PCL do not mean that surgery is urgently needed. In each individual case, the doctor considers the totality of all factors, including the degree and characteristics of the ligament injury, concomitant pathologies, lifestyle, and others, to decide on the need for surgical reconstruction of the ligament. At the same time, for athletes, as well as those who engage in heavy physical activity as part of their work, this is unacceptable - without surgery they will not be able to engage in their usual activities in full.
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.
Who is the operation indicated for?
Elderly patients, if they have suffered a partial rupture of the ACL, and are generally satisfied with the level of available loads, often choose conservative treatment - medications and injections, therapeutic exercises and massages. If we are talking about a professional athlete who participates in competitions and trains several times a week, then in 99% of cases he will be referred for arthroscopic examination and treatment. This is especially true for those who are involved in sports that involve frequent jerking movements (football, hockey, basketball, volleyball).
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.
Diagnostics
Diagnosis and treatment of ligament rupture is carried out by an orthopedic traumatologist. Initially, the doctor assesses the problem area visually, examines it by palpation, asks the patient to make several movements, analyzing the mobility of the joint, finds out the nature and intensity of the pain, and collects an anamnesis. The following instrumental diagnostic procedures allow us to objectively assess the anatomy of the joint:
- radiography;
- ultrasound examination of the joint;
- Magnetic resonance imaging.
Based on the diagnostic results, a differential diagnosis of bone fractures and ligament ruptures is carried out, since these conditions manifest themselves almost identically.
Knee taping for ligament rupture
Rehabilitators at the Yusupov Hospital use kinesiotaping as a method of physical therapy for ruptured knee ligaments. Tapes are used to treat arthrosis, joint damage, and patellar tendinitis. Kinesio taping of the knee joint immediately affects all parts of the mechanism of development of the pathological process, allowing you to achieve a qualitative improvement in the condition without surgery. Taping for a torn or sprained meniscus is one of the most reliable methods of fixation and prevention of further damage to the cartilage.
If there is stiffness of the knee joint, which may develop in the postoperative period, the treatment effect can be enhanced by applying a mesh. The tape is used on the entire surface of the knee joint, including the anterior, medial and lateral. Rehabilitators apply tape in the form of a cross on the knee, which has an additional positive effect and increases the tone of the latissimus and rectus femoris muscles. Tape, acting as a soft orthosis, relieves the ligament, improves microcirculation in the damaged area and relieves pain.
Taping of the patella is carried out:
- around the kneecap;
- across the ligament;
- crosswise with fixation of the ends.
Taping of the knee in case of ligament rupture is carried out with maximum tension, knee injury - without tension, damage to the quadriceps femoris muscle - with slight tension. In order to undergo an effective course of rehabilitation after a ruptured joint ligament at an affordable price, call the Yusupov Hospital.
Causes
Ligaments are formed from many connective tissue fibers intertwined with each other. The main function of tendons is to fix muscles, joint elements and internal organs. The strength of ligaments significantly exceeds that of muscles. Therefore, ruptures more often appear during sports, during sudden and spontaneous movements (such as falling, jumping, unusual movement, bending of an anatomical area, mechanical impact with an object with blunt edges, etc.).
Sometimes a ligament rupture occurs during a movement that cannot be called unusual (for example, if a person stumbles). Typically, such injuries occur if the tendon has been injured before. Microtraumas to ligaments provoke changes in the properties of connective tissue and a decrease in its resistance to stress.
Tendon injuries are predisposed by degenerative-dystrophic pathologies of the joints, in which changes affect all articular elements, systemic connective tissue diseases and metabolic disorders.