Physical therapy, massage, physiotherapy, manipulation
Session with a physical therapy and sports medicine doctor/rehabilitation specialist (movement therapy/physical therapy/physiotherapy/massage/manual techniques). 60 min. 3 800 Session with a physical therapy and sports medicine doctor/rehabilitation specialist (movement therapy/physical therapy/physiotherapy/massage/manual techniques). 30 min.2 00016 rehabilitation sessions (motor therapy/physical therapy/physiotherapy/massage/manual techniques) - 5% discount57 760Massage session (massage/manual techniques/manual lymphatic drainage/joint mobilizations and other manual techniques)3 600Shock wave therapy (1 zone)2 700 Physiotherapy session (electrical stimulation/ultrasound therapy)2 000Physical rehabilitation after reconstruction of the anterior cruciate ligament of the knee joint
The anterior cruciate ligament is one of the important ligaments that provides stability to the knee joint. It connects the posterior part of the intercondylar surface of the lateral condyle of the femur with the anterior part of the articular surface of the upper end of the tibia.
The ligament limits excessive anterior displacement of the tibia relative to the thigh. In addition, the nerve endings located in it, in response to load and changes in the position of the joint, give signals to the muscles that stabilize the knee.
Thus, a strong anterior cruciate ligament prevents subluxations and instability in the knee when walking, running, jumping, dancing, i.e. in situations where a sudden change in direction of movement occurs.
Anterior cruciate ligament tears can occur when the knee suddenly twists, hyperextends, or bends while running, landing from a jump, or from a blow to the knee or shin. The most common circumstances of injury are sports games
It should be understood that engraftment of the graft in the knee joint occurs within 12 weeks from the date of surgery. During this period, the new ligament is the weakest and most vulnerable, so care should be taken to exclude the possibility of excessive stress on the ligament. You cannot run, dance, jump, land from a height on the operated leg, squat deeply, perform twisting movements in the knee, stumble and twist your leg, or kneel.
In this regard, the recovery period for this injury is long and is divided into several stages:
POSTOPERATIVE PERIOD
The first week after surgery - in the hospital
The goal is to prevent postoperative thromboembolic complications, reduce postoperative pain and swelling, and restore muscle tone.
Physical exercise:
- active extension-flexion movements of the feet (toes towards you - toes away from you) 30 times every 2 hours during the day;
- voluntary tension of the anterior and posterior thigh muscles for 5 seconds 10-15 times every 2 hours during the day;
Walking
- using crutches and indicating support on the operated leg (place the foot on the floor). Duration: 5-15 minutes 4-5 times a day. During the first 2-3 days after surgery, walk only when necessary (to and from the toilet).
- Supporting load: lean on a straightened leg with a load equal to the weight of the limb (support on the heel, not on the toe). The load should not cause pain in the knee joint.
Forbidden:
- walk with support on a bent leg;
- active extension of the lower leg at the knee joint in the range from 0° to 40°.
Second week after surgery
The goal is to prevent postoperative thromboembolic complications, reduce postoperative pain and swelling, restore mobility in the knee joint (extension - flexion within the range of pain no more than 60°), improve the weight-bearing ability of the operated leg.
Physical exercise:
- Active extension-flexion movements of the feet (toes towards you - socks away from you) 30 times 3-4 times a day.
- Voluntary tension of the anterior and posterior thigh muscles for 5 seconds 10-15 times 3-4 times a day.
- Active flexion and passive extension of the knee joint until pain is felt 10-15 times 1-2 times a day. For patients who have had ligament plastic surgery using the hamstrings, perform the exercise without strong tension in the posterior thigh muscles, helping yourself with your hands to grab the lower third of the thigh.
- Raising a straight leg with weight in a lying or standing position 10-15 times 2-3 times a day.
- Restoring mobility (mobilization) of the patella: move the kneecap with your hand up and down, outward and inward - 10-15 times 3 times a day.
- Full passive extension of the knee joint Position - sitting on a chair, the operated leg lies on a second chair. Place a weight weighing 0.5 kg on the lower third of the thigh. Relax your muscles, trying to fully straighten your leg at the knee. Hold the load for 10 minutes. Repeat styling 2 times a day.
Walking:
With the help of crutches. Duration: 10-15 minutes 4-5 times a day.
Support load: lean on a straight leg with a load of 25-50% of body weight.
Forbidden:
- walk with support on a bent leg;
- active (muscle strength) extension of the knee ranging from 0° to 40°.
REHABILITATION PERIOD (3-5 weeks after surgery)
The goal is to improve the mobility of the knee joint ranging from full extension to flexion at an angle of about 90″, restore the supportability of the leg, and increase the tone and elasticity of the thigh muscles.
Physical exercise:
- Voluntary tension of the anterior and posterior thigh muscles for 5 seconds 10-15 times 3-4 times a day.
- Active flexion and passive extension of the knee joint 10-15 times 2-3 times a day.
- Raising and holding a straight leg suspended in a lying position 10 times 3 times a day.
- Active bending of the leg at the knee from a lying position on the stomach 10-15 times 2-3 times a day. For patients who have had ligament plastic surgery using the hamstrings, perform the exercise from the 5th-6th week.
- Restoring mobility (mobilization) of the patella: move the kneecap with your hand up and down, outwards and inwards - 10-15 times 3 times a day.
- Full passive extension of the knee joint with placement of a weight weighing 1 kg on the anterior part of the knee joint for 10 minutes, 2 times a day. The exercise is performed at the end of the training cycle.
Walking:
From the 4th week, walking without additional support.
Forbidden:
- Walk with support on a bent leg;
- Active (muscle strength) extension of the knee ranging from 0 to 40°.
6-7 weeks after surgery
The goal is to restore mobility in the knee joint, restore tone, elasticity and increase the strength of the thigh muscles, restore leg support and walking skills, and restore everyday ability to work.
Physical exercise:
- Restoring mobility (mobilization) of the patella: move the kneecap with your hand up and down, outwards and inwards - 10-15 times 3 times a day.
- Bend the leg at the knee joint using manual traction using a loop of a towel or rubber bandage 10-15 times 2-3 times a day.
- Leg abduction in a lateral position with external resistance 10-15 times 2-3 times a day.
- Active bending of the leg at the knee joint while lying on the stomach with external resistance 10-15 times 2-3 times a day.
- Bringing the leg in a position lying on its side with external resistance 10-15 times 2-3 times a day.
- Raising a straight leg forward in a standing position with external resistance 10-15 times 2-3 times a day.
Walking
No additional support. Duration: 20-40 minutes 4-5 times a day.
Forbidden:
Walk with support on a bent leg;
Functional period (8-12 weeks after surgery)
The goal is to restore physiological mobility of the knee joint, restore tone, elasticity and increase strength of the thigh muscles, improve muscle balance and coordination of movements, restore daily activity, return to office and light physical work.
Physical exercise:
- Perform all of the above exercises.
- Exercises to restore coordination of the muscles of the operated leg and maintain body balance on an unstable support. Balance training should begin with simple exercises with a rehabilitator's belay or self-belay at the wall: turns, bends, swaying the body on two bent legs with eyes open and closed. Use a hard floor as a support at first, and only as you gain confidence in your leg, switch to unstable supports (mattress, sofa cushion, gymnastics mat, special inflatable pillows or swinging platforms).
- Half squats on one leg from 10° to 60′ 10-15 times 1-2 approaches.
- Exercise on an exercise bike for 10-30 minutes a day.
Control of loads and intensity of exercise: swelling and pain in the joint should not be constant. If knee swelling does not go away after rest and in the morning, then you need to stop exercising for 2-3 days. If swelling persists after rest, you should see a traumatologist.
Walking without restrictions.
TRAINING PERIOD (13-30 weeks after surgery)
The goal is to restore normal mobility and stability in the knee joint, muscle strength and endurance, muscle control and coordination of complex movements, and restore the ability to perform physical labor and play sports (for athletes).
3. Walk without restrictions.
4. Exercise:
- Performing a set of exercises similar to the period of 8-12 weeks.
- Training to maintain body balance on an unstable support
- Exercise on an exercise bike for 30 minutes 1-2 times a day,
- Fast walking on a treadmill.
- Exercises on weight machines aimed at strengthening the strength of the posterior and anterior thigh muscles and other muscle groups - 2 times a week. Please note that until 6 months after surgery you should not train the anterior thigh muscles on a machine with a block; premature force load on the kneecap can lead to damage to the patellar cartilage.
- Jogging outside - from 16-18 weeks.
- Squats from 0′ to 90* - from 18-20 weeks.
- Squats from 0° to 90° with weight, side steps, jumping, exercises with a skipping rope, snake running and acceleration - from the 20-24th week.
Forbidden:
For up to 6 months from the date of surgery, perform strength exercises for the anterior thigh muscles on a machine with a block (i.e. extension)
The beginning of general and special sports training for the coordination of complex movements, strength, speed and endurance of muscles under the guidance and control of the coach and team physiotherapist - from the 24-25th week after surgery.
damage
damage
A fairly common provoking factor is a decrease in the strength of connective tissue fibers, in which a violation of their integrity is possible against the background of normal functional loads.
results
During this study, contact with 4 patients from the comparison group was lost. In turn, the implementation of the proposed program was carried out by all (100%) patients of the main group.
By the end of the 1st month of rehabilitation, 4 (11.8%) patients of the main group complained of pain in the operated knee joint, of which 3 patients rated the pain at 3 points, 1 at 4 points on the VAS. The pain was relieved with non-steroidal anti-inflammatory drugs. There were no restrictions in mobility or symptoms of instability in patients of the main group at the end of the late postoperative period. In the comparison group, 12 (33.3%) patients had pain in the area of the operated joint by the end of the first month, of which 3 patients rated the pain at 2 points, 4 at 3 points, 2 at 5 points, 3 at 6 points according to YOUR In addition, 8 (22.2%) patients had contractures in the operated knee joint and limitation of movements. Further rehabilitation of these patients required the use of passive development of movements, see table .
Dynamics of pain indicators according to VAS and goniometry in patients after ACL reconstruction
Note. When calculating the Student's test, differences in characteristics between groups were compared. The obtained value was compared with the critical value of the criterion at p=0.05.
By the end of the functional period (2nd month after surgery), not a single patient in each group experienced pain. It must be emphasized that 75.8% of patients in the main group noted the restoration of the functional activity of the joint during rehabilitation by the end of the 1st month after treatment and had no difficulties in performing everyday tasks. While in the comparison group, in 20 (55.5%) patients, restoration of daily activities occurred only in the 3-5th month after surgery.
No undesirable effects were noted during the study. The set of rehabilitation exercises in the 1st month excluded pathological situations in which ACL injury was possible. Further adherence to the rehabilitation program accelerated the recovery of the ligamentous apparatus after surgery.
Rules for conducting exercises
The general rules of rehabilitation after autoplasty of the anterior cruciate ligament have already been outlined earlier. First of all, it is safety and reasonable load distribution. All procedures must be performed strictly under the supervision of the attending physician.
You cannot start physical therapy until the effect of the operation is consolidated and the swelling subsides. You cannot exercise through pain, especially if the pain is sharp and “shooting” - most likely, this is evidence of serious disorders that can lead to new ruptures and, in the worst case, to a repeat operation.
The load on the legs is increased gradually, as you get used to the already mastered weight. The main emphasis in performing exercises should be on developing endurance, restoring mobility and balance. The knee performs a load-bearing function and serves as a support for the entire body.
Types of operations
The cruciate ligament stabilizes the knee joint, which determines its special function in the body. The loads that the ligaments have to withstand are extremely high, which leads to frequent injuries, sprains, and in the most severe cases, rupture. The rehabilitation process after cruciate ligament injury requires patience, caution, and a thorough approach.
Due to the structural features of the joints, independent healing of the ligament after a rupture is impossible; surgical intervention is required.
The work of doctors begins with determining the extent of damage. The ligament must be restored in such a way that subsequently there will be no problems with the functioning of the musculoskeletal system.
Internal structure of the knee
Features of ligament injuries are explained by their direct functions, among them are:
- simple rupture of the anterior ligament;
- posterior cruciate ligament rupture;
- rupture associated with a bone fracture at the attachment points of the ligament;
- rupture of the anterior, posterior, lateral cruciate ligaments, as well as the articular capsule.
Depending on the type of injury, the usual application of plaster after removing excess fluid in the injured knee may be sufficient; in more complex cases, when independent fusion is impossible and stitching will not give the desired result, the patient is advised to undergo plastic surgery.
That is, instead of a torn ligament, a graft is implanted into the patient. There are:
- autografts - namely, fragments of ligaments, other connective tissue, bones taken from the patient’s body, which are implanted in place of the removed damaged ligament;
- allografts – taken from a donor, specially treated ligaments (usually tendons: Achilles, popliteal, patellar). When used, the patient’s healthy ligaments remain intact, which is preferable.
Important! In the event of a ligament rupture, it is necessary to seek qualified medical help as soon as possible. Because elastic tendon tissue tends to contract quickly, more serious intervention may be required if surgery is delayed. The treatment process and rehabilitation after cruciate ligament surgery will become more complicated.