Knee ligament ruptures are rarely diagnosed, even if the joint is subjected to severe stress. It is equipped with a powerful ligamentous-tendon apparatus that stabilizes the joint during movement. Therefore, the knee is usually damaged during intense sports training, as a result of a strong blow or a fall from a height. After carrying out all the necessary treatment measures - conservative or surgical - the victim is discharged from the hospital for rehabilitation after rupture of the knee ligaments. He is prescribed physiotherapeutic procedures, massage, a course of taking chondroprotectors and vitamins, and following a gentle diet. But the most effective method of restoring ligaments is daily exercise therapy and gymnastics.
Duration of rehabilitation
The duration of the recovery period depends on the type of injury. Ligaments are connective tissue bands that connect bones and are designed to strengthen the joint and guide or limit movement in the knee. In case of partial rupture, conservative treatment methods are used, and in case of complete separation from the bone base, surgical methods are used. Sometimes a piece of bone comes off along with the ligament, which significantly complicates therapy and requires long-term rehabilitation.
For minor injuries, young patients are given a plaster splint for about 20 days, while the knee of older people is often immobilized with orthoses.
Knee brace for ligament rupture.
Rehabilitation continues for 1.5-3 months, depending on the characteristics of the victim’s body. The age of the person is also important:
- in young people, regenerative processes in the joints proceed much faster, they receive sufficient nutrients for all biochemical reactions;
- the ligaments of elderly patients will recover more slowly, since with age the body’s production of collagen, the building material for all connective tissue structures, decreases.
If the ligaments are completely torn from the bone, patients are advised to undergo plastic surgery, or restoration through surgery. In this case, the rehabilitation period is from 4 months to six months.
Reconstruction of knee joint ligaments.
In the absence of contraindications, patients are referred to physiotherapeutic measures, and after immobilization is completed, to a physical therapy doctor. He is developing a set of exercises to build a powerful muscle corset. This will help avoid excess stress on the knee, promoting proper healing of the ligaments. The functioning of the joint depends on the condition of the skeletal muscles. If it is weakened, then the entire load during movement falls on the knee, causing rapid wear of the cartilage tissue lining the bone heads. And when immobilized, the muscles do not contract for a long time, which can cause their atrophy and the development of post-traumatic gonarthrosis. Rehabilitation experts note that 2 weeks is enough to lose muscle volume.
Classification of ligament injuries
- First degree.
This includes small stretches and micro-tears. Such problems are accompanied by moderate pain, slight limitation of range of motion, and moderate swelling. - Second degree.
As a rule, they are characterized by the same external manifestations as in the case of the first one, but they have a constant basis, repeating periodically (secondary appearance occurs under lower loads/impacts). - Third degree.
Ruptured cruciate ligaments with intense pain and severe swelling, accompanied by blockade and impaired knee stability. Conservative methods are not suitable for treatment.
General principles of rehabilitation
Pharmacological drugs (NSAIDs, muscle relaxants, glucocorticosteroids) eliminate the symptoms of inflammation, so the need for their use soon disappears. But taking the following medications is indicated throughout the entire rehabilitation period:
- balanced complexes of vitamins and microelements - Vitrum, Centrum, Selmevit, Multitabs, Complivit. To accelerate the restoration of the integrity of torn ligaments, B vitamins and microelements copper, sulfur, iron, molybdenum, calcium, and phosphorus are needed. Treatment regimens must include fish oil with a high content of polyunsaturated fatty acids (omega-3, omega-6), fat-soluble vitamins;
- chondroprotectors - Teraflex, Structum, Chondroxide, Artra, Chondroitin-Acos. The only group of drugs whose active ingredients restore damaged cartilage, bone, and connective tissue. After a week's use, chondroprotectors begin to have anti-edematous, analgesic, anti-inflammatory effects;
- ointments with a warming effect - Turpentine, Apizartron, Viprosal. They are used in the first 2-3 weeks of rehabilitation to improve microcirculation and regenerate small blood vessels damaged during injury.
After the inflammatory process has subsided, the patient is advised to undergo physiotherapeutic procedures. These are UHF therapy, laser therapy, magnetic therapy, electrophoresis with calcium solutions, anesthetics, analgesics. Despite various physical factors (electrical impulses, heat, magnetic field) affecting the knee joint, the goal of all therapeutic measures is to improve blood circulation. The elimination of final and intermediate products of the inflammatory process is normalized, and the deficiency of nutrients and bioactive substances is eliminated. Ligament regeneration is significantly accelerated, and the likelihood of scar formation on connective tissue structures is reduced.
Electrophoresis for the knee joint.
Passive stage of rehabilitation
During this period, which lasts about 10-14 days, any stress on the damaged knee is eliminated. Physiotherapy, cold compresses, and kinesiotaping are actively used for 2 weeks to eliminate inflammatory swelling of soft tissues. With the help of lymphatic drainage massage, muscle spasm, which usually occurs against the background of pain, is reduced. The main goals of rehabilitation during this period are to improve the passive range of motion in the knee and prepare it for further recovery. Myostimulation, a procedure for applying low-power electric current to skeletal muscles, helps minimize the likelihood of muscle atrophy.
The only exercise allowed in the first two weeks is static tension of the quadratus femoris muscle (quadriceps), which occupies almost the entire front part of it. It is responsible for leg extension, and its isometric tension helps maintain muscle tone and improve blood circulation in the injured knee.
Quadriceps femoris muscle.
Passive development of the quadriceps also ensures the supply of the joint with nutrients and biologically active substances necessary for accelerated regeneration and prevention of gonarthrosis. How to do the exercise correctly:
- sitting on the floor, put your arms back, lean on them, take a stable position. Stretch the injured leg forward and leave the healthy limb straight or bent;
- tense the quadriceps muscle, pointing the toe of the injured leg towards the body. When the movement is performed correctly, the kneecap moves upward;
- hold in this position for 5 seconds, relax;
- do 2-3 sets of 20 repetitions.
If there are no pronounced painful sensations when performing the exercise, then the number of approaches can be increased. Exercise therapy doctors also recommend frequent rocking of the foot to the right and left, moving the toe of the foot up and down. Exercises help maintain muscle tone in the lower leg.
Loading the joint is only allowed for physically strong patients with minor injuries when less than 25% of the muscle fibers are torn. Bending and straightening the knee, walking slowly around the room with partial emphasis on the sore leg are allowed. If you experience discomfort or fatigue, you should rest for an hour. When the patient recovers quickly, the rehabilitation doctor supplements the treatment complex with calf raises and partial squats with emphasis on the back of a chair.
The first active stage of rehabilitation
In the third week of the knee ligament recovery period after injury, systemic pharmacological drugs are usually no longer used. By eliminating the inflammatory edema that compresses the nerve roots, intense pain also disappears. Traumatologists prescribe gels with non-steroidal anti-inflammatory drugs and ointments with a warming effect to improve blood circulation.
At this stage of rehabilitation, the load on the damaged joint increases. It helps restore lost control over the muscles of the knee, lower leg, and thigh. The correct gait is practiced, the joint is prepared for more active phases of restoration of torn ligaments. During training, exercises must be performed in a gentle manner. Exercise therapy doctors recommend focusing attention on the sensations that arise and more often repeating movements that contribute to tension in the quadriceps. What exercises are most therapeutically effective:
- lie on your back, straighten your legs, stretch your arms along your body. Move your leg to the side 40-50 cm, take the starting position;
- turn on your side, smoothly raise and lower the injured leg without bending the knee;
- lying on your back, bend your healthy leg, resting your foot on the floor. Leave the injured limb straight. Pull her toe towards the body, tensing the quadriceps muscle. Raise the injured leg to 45°, hold in this position for 3-5 seconds.
Mechanotherapy for the development of the knee joint.
Many rehabilitation centers are equipped with orbitracks - elliptical trainers. They are intended both for cardio training and for recovery from various musculoskeletal injuries. These devices combine the functions of a treadmill and a step machine, which provides a gentle load on the knee. The training takes place under the supervision of a physical therapy doctor who supervises the execution of the exercises.
You can now move around the room without crutches; you are only allowed to use a cane. At this stage of rehabilitation, swimming, partial squats, exercise on exercise bikes, climbing and descending stairs, and walks in the fresh air are recommended.
Swimming as a way of rehabilitation after injuries.
Symptoms and diagnosis of knee sprain
Before ordering tests, your doctor will examine and palpate your knee for the following signs of a sprain:
- restriction or difficulty in knee mobility;
- crunching or clicking sounds accompanying joint movements;
- severe pain when palpating the knee, pain when trying to step on the leg or turn the joint in the direction of stretching;
- swelling of the knee joint, sometimes accompanied by hematoma, redness and increased skin temperature (appears some time after the injury and increases).
After a preliminary diagnosis, the doctor prescribes an ultrasound, x-ray, CT or MRI to confirm it and determine the severity of the injury. Research is also aimed at detecting associated injuries, such as fractures. Once the diagnosis has been made, it is time to begin treatment.
Second active stage of rehabilitation
3-4 months after ligament surgery or a month after receiving a mild injury, strength training equipment is used to completely restore knee function. Such training helps strengthen muscles, increase their strength and endurance. Regular classes allow you to gradually return to normal physical activity and physical activity. The joint begins to fully bend and extend, the muscle volume of the injured leg becomes equal to the volume of the muscles of the healthy limb. After 2 weeks of training on a strength simulator, functional testing is carried out to determine the patient’s readiness for running and jumping.
Exercise machine for home workouts.
If you have a simulator, you can train at home. But the best therapeutic results come from exercises under the supervision of a rehabilitation physician. He selects the volume of loads individually for the patient and determines the pace of work. The following exercises are most often included in the treatment complex:
- leg extension. Sit up straight, press your back to the seat, place your legs under the bolsters. Raise and straighten your legs, resting your hands on the handles located on the sides of the machine. Stay in this position for 2-3 seconds. Smoothly, without jerky movements, lower your legs;
- lying leg curl. Lie on your stomach so that your knees are behind the edges of the bench, and its bend is in the waist area. Bend your legs, bring the rollers to your lower back, stay in this position for a few seconds, and return to the starting position.
Exercise therapy doctors recommend doing 2-4 approaches, repeating the exercises 15-25 times. The break between approaches is 2-3 minutes. If during training there is a burning sensation in the knee area, then this is a sign that the exercises are being performed correctly. Static-dynamic classes are conducted 2 to 3 times a week. After about a month, patients are shown running, long and high jumps. The goal of the final stage of rehabilitation is to reduce the likelihood of secondary ligament rupture. It is because of an incorrectly formed motor stereotype that re-injury of the knee joint occurs.
Causes of cruciate ligament rupture
Injury to the cruciate ligaments is a fairly common pathology - this is especially true for the ACL. She is injured approximately 20-30 times more often than all others combined. Moreover, it occurs 7-8 times more in women than in men. The mechanism of anterior cruciate ligament rupture is very clear. Initially, its function is to prevent the lower leg from moving forward and inward. You can easily get a rupture when rotating on your leg, turning your hip to the outside. Also, the ligament is often damaged when the shin receives a strong blow, or rotation occurs during sudden braking. It is very important to remember exactly how the injury occurred - thanks to a thorough reproduction of the situation, it will be much easier for the doctor to understand what pathology is occurring and make the correct diagnosis. Also during the examination, the doctor conducts special tests to assess the degree of impairment in the functioning of the limb.