Exercise therapy for a fracture of the femur. Learning to sit and walk. Exercises in the sitting position for half-bed rest

At least one tenth of total number of all fractures are fractures of the lower leg. Moreover, if appropriate treatment has not been carried out, this can lead to very serious consequences at the very least, incapacitation. Physical therapy plays an important role in therapy.

Therapeutic exercise for fractures of the lower leg is divided into three stages. The first one is dedicated to solving the following problems:

• Elimination of edema.
• Raising muscle tone.
• Accelerating the recovery of lymph and blood circulation in the leg.
• Increasing the level of joint mobility.

During this period, general developmental, various movements alternate, aimed at the development of the joints, exercises, respiratory and special (tension of the muscles of the lower leg and thighs, gradually increasing the time when the muscles are tense, ideomotor exercises, holding the limb in one position, active movements toes and the legs themselves in the hip joint, such as extension and flexion, adduction and abduction, various rotational exercises).

To achieve the first two goals, patients are usually advised to raise and lower the injured leg at regular intervals. After a period of three to four days, the patient is allowed to begin to move with crutches around the hospital, including stairs.

At the second stage of rehabilitation with existing injuries and injuries of the ankle joint, the main goals of physiotherapy exercises change to the following:

• Elimination of edema of the injured leg.
• Restoration of the movement skill and all functions of the ankle joint.
• Prevention and prevention of complications, such as curvature of the fingers, growth of "spurs" (most often observed in the calcaneus), traumatic flat feet, foot deformity, etc.

In the early days, all physical therapy exercises are performed in light conditions, that is, with the help of roller carts, sliding planes, block installations, etc. Exercises that involve muscle tension alternate with relaxation exercises, as well as breathing. On the this stage to breathing and general developmental exercises for the injured limb, a wide variety of exercises are added to develop and restore the ankle joint. These exercises are performed from various starting positions - on the stomach, sitting, on one side, lying on your back, resting your feet on the floor, sitting with your legs in the air, sitting with the support of a sore leg with the help of a healthy one, on all fours, etc.

Below is one of options a special complex of therapeutic physical exercises prescribed for fractures of the bones of the lower leg at the second stage of exercise therapy:

Starting position - lying on your back:

• Flexion and extension of the feet in the sole.
• Alternating adduction and abduction of the straightened leg to the side along the bed.
• Exercise "bike", performed simultaneously with two legs.
• Internal and external rotation of the injured leg.
• Extension and flexion of the toes.
• Extension and flexion of the legs at the knee, both simultaneous and alternate.
• Tension of the thigh muscles for 4-5 seconds.
• Internal rotation of the feet.

Starting position - lying on the stomach:

• Alternating abduction and adduction of the legs to the side.
• Alternate flexion and extension of both legs at the knees.
• Leg movements that mimic those of breaststroke swimming.

Starting position - sitting on a chair:

• Grabbing small objects with your toes and holding them for a short time.
• Alternating extension and flexion of the legs at the knees, both simultaneous and alternate.
• Medical ball exercises.

All exercises are done without excessive stress in a calm measured rhythm. Each exercise is repeated 7-8 times. Breathing may be voluntary.

In the third stage of physical therapy, the following tasks are important:

• Bringing back to normal all the functions of the body.
• Full restoration of all motor functions of the injured limb.

At this stage, exercises such as running and walking with obstacles, dismounts, dance steps are assigned. In this case, you need to fix the joint with an elastic bandage.

Exercise therapy for a fracture of the lower leg helps to normalize blood circulation, restore muscle tone and full-fledged work of the limb after injury. Combining training with massage, you can quickly restore sensitivity to the injured leg, relieve swelling and return to active life. However, it is necessary to develop the limb carefully; far from any physical exercises are suitable for this.

Types of tibia fractures

Injuries to the bones of the lower leg are very diverse:

• ankle fractures;
• fracture of the tibia and fibula;
• fracture of the bones of the leg.

Each type of fracture requires different treatments. If the fracture is not displaced or has a slight dehiscence that does not require reposition, a plaster cast from the fingers to the thigh is sufficient.

If the case is more serious - a fracture of the lower leg with displacement - reduction will be required, and then fixing the leg with a plaster cast.

Sometimes surgery is required if torn ligaments or blood vessels need to be stitched together.

Exercise therapy for fracture of the tibia

You need to start training immediately after the acute pain at the fracture sites subsides. This will take from 7 to 50 days depending on the severity of the injury.

Fracture immobilization with a plaster cast

After the cast has been applied to the leg, you should try to periodically keep it in an upright position. The first exercises of exercise therapy:

• the foot can be placed on the floor, but you can not lean on it;
• the next day after applying the plaster, you can already sit up in bed;
• after three days, you can get up, leaning on the back of a chair or bed;
• after exercise, it is immediately recommended to keep the leg in an elevated position. You can put a pillow or a folded blanket under it.

These simple movements will help to avoid stagnation of the lymph and maintain normal blood circulation. Important! You need to get up on crutches no earlier than 5 days after applying the cast!

First steps

Exercises for recovery after a fracture should be performed under the supervision of a doctor.

When it will be possible to walk, then you need to do this only leaning on a plaster cast. This will affect the creation of the axial load of the broken leg, which is necessary to train. If there is no such load, the development of osteoporosis is very likely.

At this stage, the exercise therapy complex serves to transition from a small load of a broken lower leg to full and constant loads.

Increasing the load on the injured leg at home, you should focus on pain.

Movement should be accompanied by a little pain, this indicates the activation of protective reparative processes, which are aimed at getting rid of the irritant. Severe, almost unbearable pain indicates severe damage to the corn, which makes regeneration difficult.

A fracture of the lower leg will quickly become a forgotten bitter experience only with small loads of exercise therapy.

Complex of therapeutic gymnastics exercise therapy after a fracture of the lower leg

1. In the supine position, alternately bend your legs in knee joint. The exercise should be done with sliding movements of the foot on the bed. At first, it is enough to do 5 repetitions, 5 seconds on each leg.
2. Grab with your toes, hold for 10-15 seconds and release small objects while lying on the bed. The task of the patient is to hold the object as long as possible.
3. Lying on your back, perform circular movements with your feet and imitate walking.
4. Lying on your stomach, perform flexion and extension of the knee joint, take the leg back and to the side.
5. Lying on your side, try to take your leg to the side and hold it in this position for 5 seconds. Smoothly return.
6. Sitting on a chair or in bed, slowly bend and unbend your toes. Roll the medicine ball back and forth with your fingers, while rolling the foot from toe to heel and vice versa.

Treatment of an ankle fracture using the Bubnovsky method

Recovering from an ankle fracture takes time and patience

Professor Sergei Mikhailovich Bubnovsky created his own effective method of treating not only fractures in the joints, but also the prevention of other diseases.

Treatment of Bubnovsky is a complete rejection of medicines, other medicinal products and surgical intervention. The body itself must direct all its energy to eliminate the problem in the process. complex lessons physical education.

Despite the skepticism of representatives traditional medicine, the method of treating Bubnovsky more than once brought positive results.

It is worth choosing recovery methods together with the attending physician. In some cases, the refusal of medication is fraught with prolonged inflammation and impaired mobility.

Elastic bandage to prevent the development of varicose veins

Due to the constant pressure of the cast, there is a risk of disruption of the free outflow of blood and lymph in the leg. And if the victim has varicose veins, you should use a special compression bandage. It must be ensured that it is not tightened tightly, and the bandage should be worn throughout the day.

If training is planned to be carried out at home, you should purchase a gymnastic mat in advance.

It is also worth buying the right shoes in advance, better orthopedic. It will correctly distribute the weight and effort when walking, this contributes to the regeneration of damaged tissues. But this is only preparation for the path of recovery after the fracture. The main thing is exercise therapy.

In addition to gymnastics, proper nutrition, including calcium-rich foods, will help you quickly get back on your feet.

On the video - a complex of physiotherapy exercises for a fracture of the lower leg with and without displacement.

Among the complex fractures of the pelvic bones, the most common are rupture of the pubic symphysis and the anterior half-ring of the pelvis, Malgenya-type pelvic fractures, fractures of the acetabular floor, including those with central hip dislocation.

LH is prescribed after removing the patient from shock. The technique of LH depends on the nature of the fracture and the method of its treatment. For most pelvic fractures, conservative treatment is used and a long stay of the patient on bed rest in the supine position is required. Therefore, the general tasks of PH correspond to bed rest and are aimed at preventing complications associated with hypokinesia.

Special exercises

From the 4-6th day, extension in the knee joints is allowed, while the hips remain on the surface of the roller. At skeletal traction movements are performed with the free leg without taking the foot off the plane of the bed.

The second period lasts until the moment of lifting the patient (the end of the process of consolidation of the fracture). General tasks are solved by a wider use of general developmental exercises for the hands (dynamic free and with weights), all kinds breathing exercises. The special tasks of this period are the improvement of blood circulation in the area of ​​the fracture, the gradual strengthening of the muscles lower extremities and pelvic girdle.

If LH is carried out in the "frog" position, exercises (flexion of the legs in the knee joints, abduction of the legs, rotation in the hip joints) from the 10th-12th day are performed along the plane of the roller. The exception is patients with a rupture of the pubic joint. In these cases, isometric tension of the muscles of the thighs, gluteal muscles is used, breeding of the hips and rotation in the hip joints are contraindicated. These movements are performed from the 21st-24th day after the injury.

Approximately 3-4 weeks later. leg exercises are carried out with the separation of the foot from the plane of the bed. At this time, the roller is removed, and the patient continues to lie on a flat bed on his back. During immobilization by skeletal traction in this period, movements are performed in the knee joint (for which a removable cloth hammock is put on the horizontal support of the splint), isometric tension of the muscles of the thighs and gluteal muscles.

Muscle strengthening

The third period begins from the moment the patient rises. Raise the patient, bypassing the sitting position, from the prone position or standing in the knee-wrist position. The patient begins to adapt to vertical position, strengthening the muscles of the pelvic girdle and lower limbs, learning to move using crutches.

LH is carried out in all starting positions. Movements are performed for all muscle groups of the lower extremities, gluteal muscles, muscles pelvic floor, iliopsoas muscle. A course of manual massage of the lumbar region, gluteal muscles, muscles of the anterior surface of the thighs is carried out. When walking, be sure to use crutches, paying attention to the correct gait: it is better to walk in small steps and monitor the stability of the pelvis (do not “swing the pelvis”). If there are no pain manifestations in the area of ​​the fracture when walking, the patient is allowed to sit and walk without the help of crutches (on average, 2 weeks after lifting).

Features of PH in central hip dislocation and acetabular fracture

Immobilization period

After removing skeletal traction, physical exercises are aimed at restoring mobility in the hip and knee joints, restoring the tone and strength of the gluteal muscles. In the first 5-6 days, to restore mobility in the hip joint, active exercise in combination with manual traction along the axis of the limb. For example, the instructor performs traction of the limb, then helps the patient to bend the leg at the hip joint, and when straightened, again conducts traction. To restore mobility in the knee joint, the prone position is used; bendings are performed actively, with the self-help of a healthy leg and with the help of an instructor.

In the absence of pain in the hip joint, exercises to mobilize the latter can be performed in the lying position on the side, on the stomach, in the knee-wrist position. The patient gets up, bypassing the sitting position, and moves with the help of crutches without relying on the injured leg. With good adaptation to the vertical position, exercises are performed in a standing position on healthy leg resting your hands on the back of a chair or bed. Free, swing movements in the joint are performed in all planes with multiple repetitions. For the convenience of performing the exercises, it is better to stand on a stand (small platform) so that the injured limb hangs freely without touching the floor.

After removing the traction, a manual massage of the gluteal muscles and thighs is prescribed on the side of the injury, the lumbar region. In the presence of a pool or hydrokinetic bath can be used underwater massage and exercise in the aquatic environment.

Strengthening of the periarticular muscles begins in parallel with the mobilization of the joint. It should be emphasized that, while strengthening the muscles, it is impossible to increase the pressure on the articular surfaces, which happens, for example, when lifting a straight leg with weights in the prone position. Therefore, it is better to strengthen the stabilizers of the hip joint (gluteal muscles and hip flexors) while standing on a healthy leg. A dosed load on the leg should be started after 4-5 months, and a full load - after 5-6 months. since the injury. To prevent the development of coxarthrosis with such damage, further treatment in outpatient settings and compliance with the orthopedic regimen of loading on the limb.

Exercise therapy for pelvic fractures is important part treatment. It is necessary not only to immobilize damaged bones, but also to improve breathing, as well as maintain muscle tone. Without gymnastics, complications from various organs can occur, and the rehabilitation period after an injury is much more difficult. That's why therapeutic exercises begin from the first days of therapy. Even if skeletal traction or a plaster cast is used for immobilization, the patient performs movements with his arms, upper body, and healthy leg. Special exercises are also used, for example, upward movements of the pelvis, which makes it possible to place the vessel and greatly facilitates patient care.

How is a fracture treated?

The pelvis serves as a support not only for the spine, but for the entire human skeleton. With the help of these bones, the limbs are attached to the body. In addition, inside pelvic ring many internal organs. Therefore, fractures of this part of the musculoskeletal system are considered severe injuries in medicine. Usually occur during car accidents, traffic collisions, falling under landslides. Injury is accompanied severe pain and bleeding, shock.

A fracture is diagnosed with an x-ray. The rectum is also examined, and women are prescribed gynecological examination. Fragments of bones can damage internal organs. Then immobilization is carried out, its method depends on the type of fracture. If the bone fragments are displaced, then skeletal traction is applied. With a bilateral fracture, the patient is placed in the Volkovich position: the patient lies on a hard bed with knees apart, special rollers are placed under the legs.

The duration of treatment takes from 1.5 to 6 months. Exercise therapy for pelvic fractures plays an important role in the process of therapy and rehabilitation. Gymnastic exercises help to avoid complications and recover faster.

When can I start therapeutic exercises

After the patient is taken out of the state of shock, you can begin to perform special exercises for fractures of the pelvic bones. Usually, exercise therapy is started on the second day after the patient is admitted to the hospital. Gymnastics cannot speed up the process of bone fusion. But exercise helps prevent congestion in the respiratory system, constipation, muscle weakness and atrophy.

Periods of the medical and physical culture complex

Therapeutic gymnastics for a pelvic fracture is divided into several periods. At each stage of therapy, physical exercises have their own tasks:

• 1 period. On the early stage gymnastics therapy is necessary to maintain normal metabolism, prevent a decrease in muscle tone and rapid healing of damage. Breathing exercises, movements of the upper limbs, feet and toes are allowed.
• 2 period. At this stage, immobilization is usually already removed. Gymnastics is aimed at strengthening the muscles of the belt, limbs and torso. Gradually begin to train the joints and legs.
• 3 period. During this period of treatment, the patient learns to walk. It is important to restore the support function and mobility of the joints of the lower extremities.

In more detail, each period of exercise therapy after a pelvic fracture will be discussed below.

First period of exercise therapy

This stage lasts from 10 to 14 days. Patients can do breathing exercises and active movements of the upper body and arms. The legs must remain on the rollers. Special exercises for fractures of the pelvic bones include lifting the hips (for using the vessel). At first, this movement is performed under the supervision of an instructor, but from the 4-6th day of illness, the patient can do it on his own.

On days 5-7, the patient can bend the leg at the knee. The thigh should lie on the roller. If skeletal traction is used, then the patient can make more active movements of the leg on the healthy side.

Exercise therapy for a pelvic fracture during this period can be combined with massage. This will help reduce swelling and prevent blood clots. Massage treatments you can start from 3-4 days, if there are no contraindications.

Before starting the exercises, the room must be well ventilated. The head should be in a slightly elevated position. After 10-14 days, you can proceed to the next stage of treatment.

The second period of exercise therapy

How much to do exercise therapy after a pelvic fracture in the second period? This stage of treatment lasts about 2-2.5 weeks. More complex and intense exercises are allowed. In this case, both lower limbs must be involved, and the hips do not rest on the roller. You can bend your knees, lift and hold each leg in a straightened state.

Usually 2.5 weeks after injury, patients are allowed to roll over. From this point on, exercises for a pelvic fracture can be done not only on the back, but also on the stomach.

If the patient tolerates gymnastics well and does not experience pain during exercise, then after 3-3.5 weeks he is allowed to get up and walk. After that, the third period begins.

The third period of exercise therapy

At this stage, the goal of exercise therapy for a pelvic fracture is to strengthen the muscles of the lower extremities, restore walking and overcome possible lameness. Exercises are performed mainly in a standing position. It is necessary to train the strength and endurance of the muscles of the foot, lower leg, buttocks, and thighs.

It is important to establish the correct gait and prevent uneven steps. Otherwise, it may cause lameness in the future. It is useful to take high steps in one place, holding on to the back of a chair or bed. Then, supporting the patient by the arms, you need to gradually teach him to walk without limping.

Exercises for the first period

All exercises are done lying on your back and keeping your feet on the roller. Exercise therapy for a pelvic fracture during this period should be performed for 20-25 minutes 4-5 times a day. The following types of exercises are shown:

1. Bending and straightening of the fingers of the foot and hands (7-11 times).
2. Circular movements of the foot. First, the exercises are performed with a healthy leg, then with a sick one. Next, make movements with two limbs at the same time.
3. Fingers capture small objects (balls, pencils).
4. The feet rotate in and out, as well as bend and unbend.
5. Bending the legs at the knees.
6. Pulling each leg to the stomach in turn.
7. Abduction of each lower limb to the sides and return to the starting position. This exercise is contraindicated in case of trauma to the pubic joint.
8. Raise each leg straight up. This exercise for a pelvic fracture should be done by holding on to the edges of the bed.

When performing gymnastics after each exercise, you need to do several times deep breath and complete exhalation.

Exercises for the second period

During this period, you can perform exercises in the starting position on the stomach. A pillow should be placed under the body. You can increase the load on the lower limbs. At the same time, you need to continue to do gymnastics to strengthen the shoulder girdle, arms and back. You can perform the following approximate set of exercises:

1. Raise straight legs back alternately. Both limbs are raised, holding on to the headboard.
2. To breed and reduce straight legs (contraindicated in case of damage to the pubic joint).
3. Raise the pelvis, leaning on the hands and socks.
4. Raising the legs bent at the knees.
5. Deflection of the body in the lower back, in the position on the stomach. The same exercise can be done on all fours.

With some types of pelvic fractures, the patient is carefully transferred to the prone position. This applies to damage to the symphysis. The attending physician should prescribe gymnastics, taking into account the patient's condition and the speed of healing of the injury. With good health and rapid healing of the fracture in the second period, the patient should learn to roll over on his stomach without using his hands. This will be a good muscle workout.

To perform the shoulder girdle, you need to lie on your back. It is necessary to do the following movements:

1. Lower your arms along the body. Then spread the upper limbs in front of you and bring them together in front of the chest. Then lower again along the body. Repeat movements 4-5 times, alternating inhalation (when bringing the hands together) and exhalation (when lowering).
2. Spread your arms to the sides and make circular movements, bending in the lower back. In this case, you need to use the muscles of the shoulders and forearms.
3. Leaning on your elbows and shoulders, arch your chest.
4. Bend the upper limbs at the elbows and make circular movements back and forth with them.

Exercises for the third period

What exercises should be done with a pelvic fracture in the third period? These are movements of the legs and arms in a standing position. At the stage of recovery, it is important to establish the correct gait of the patient. Elderly patients at first perform gymnastics, holding on to the back of the bed. The following exercises are recommended:

1. Hands on the belt. The patient takes steps in place, raising his legs high.
2. Walking on toes and on heels, with simultaneous movements of the hands (forward, backward, up and to the sides).
3. Swing your legs in all directions.
4. Exercises on the gymnastic wall (climbing, push-ups).

You can also do squats, but with caution. This exercise can be performed only if the patient can be on his feet for about 2 hours without feeling discomfort and pain in the area of ​​injury. If the patient has suffered severe damage to the pelvic bones, then you can not squat for another 6-8 months.

Full recovery of working capacity occurs approximately 1.5-3 months after the fracture.

Features of exercise therapy for injuries of the acetabulum

In case of damage to the recess in iliac region the third period of treatment takes place for a long time. Patients are allowed to step on the affected leg later and have to use crutches for longer.

If plaster immobilization is used, then physiotherapy exercises are aimed at maintaining movements in the joint. A moderate load is needed along the axis of the limb when the patient is lying down, and during the beginning of walking with crutches in a cast.

Walking with pelvic fractures

To form the correct gait, you need to avoid dragging your legs and transferring from one limb to another. useful exercise in the third period is walking in the water.

Walking without crutches is allowed approximately 3 months after the injury. To develop the legs, you need to take daily walks. Their duration should be increased gradually. Restoring the correct gait will also help special simulators- steppers.

The process of rehabilitation after a pelvic fracture is different. Many patients manage to fully recover motor function. When injured, most people remain disabled. Often, patients suffer from periodic pain syndrome within 1-2 years after the injury. As for professional athletes, they usually do not return to training and competition after suffering an injury.

Injuries of the musculoskeletal system cause violations of the anatomical integrity of tissues and their functions, accompanied by both local and general reaction from various body systems. Changes in muscles and joints are not only the result of the injury itself, but are also aggravated by immobilization. Injuries are always accompanied by pain, dysfunction of movement.

In the treatment of fractures, fragments are repositioned (reduced) to restore the length and shape of the limbs and fix them until the bone fusion. Immobility in the area of ​​damage is achieved by fixation, traction or surgical methods.

More often than others, in 70-75% of patients with fractures, the fixation method is used by applying fixing dressings made of gypsum, polymeric materials.

When using traction (extension method), the limb is stretched with the help of weights to compare fragments for several hours to several days (first repositioning phase). Then, in the second retention phase, fragments are held until complete consolidation and prevention of recurrence of their displacement.

At operational method comparison of fragments is achieved by fastening them with screws or metal clamps, bone grafts (open and closed comparison of fragments are used).

Therapeutic exercise is a mandatory component of complex treatment, as it helps to restore the functions of the musculoskeletal system, has a beneficial effect on various systems organism on the principle of motor-visceral reflexes.

It is customary to divide the entire course of exercise therapy into three periods: immobilization, post-immobilization and recovery.

Exercise therapy begins from the first day of injury with the disappearance of severe pain.

Contraindications to the appointment of exercise therapy: shock, large blood loss, the risk of bleeding or its appearance during movements, persistent pain.

Throughout the course of treatment, when using exercise therapy, general and special tasks are solved.

I period (immobilization)

In the I period, the fragments coalesce (formation of primary callus) in 60-90 days. Special tasks of exercise therapy: improve trophism in the area of ​​injury, accelerate fracture consolidation, help prevent muscle atrophy, joint stiffness, develop the necessary temporary compensation.

To solve these problems, exercises are used for a symmetrical limb, for joints free from immobilization, ideomotor exercises and static muscle tension (isometric), exercises for an immobilized limb. The movement process includes all intact segments and joints that are not immobilized on the injured limb. Static muscle tension in the area of ​​damage and movement in immobilized joints (under a plaster cast) is used in good condition of the fragments and their complete fixation. The danger of displacement is less when connecting fragments metal structures, bone pins, plates; in the treatment of fractures with the help of Ilizarov, Volkov-Oganesyan and other devices, it is possible to early dates include active muscle contractions and movements in adjacent joints.

The solution of common problems is facilitated by general developmental exercises, breathing exercises of a static and dynamic nature, exercises for coordination, balance, with resistance and weights. Lightweight PIs are used at first, exercises on sliding planes. Exercise should not cause pain or make it worse. At open fractures exercises are selected taking into account the degree of wound healing.

Massage for diaphyseal fractures in patients with a plaster cast is prescribed from the 2nd week. They start with a healthy limb, and then affect the segments of the injured limb, free from immobilization, starting the impact above the injury site. In patients on skeletal traction, massage of a healthy limb and extrafocal on the damaged one begin from the 2-3rd day. All massage techniques are used, and especially those that help relax the muscles on the affected side.

Contraindications: purulent processes, thrombophlebitis.

ll period (post-immobilization)

II period begins after the removal of the plaster cast or traction. Patients developed a habitual callus, but in most cases, muscle strength was reduced, and the range of motion in the joints was limited. In this period, exercise therapy is aimed at further normalization of trophism in the area of ​​injury for the final formation of callus, the elimination of muscle atrophy and the achievement of a normal range of motion in the joints, the elimination of temporary compensation, and the restoration of posture.

When applying physical exercises, it should be borne in mind that the primary callus is not yet strong enough. In this period, the dosage of general strengthening exercises is increased, various IPs are used; prepare for getting up (for those who were on bed rest), train vestibular apparatus, teach movement on: crutches, train the sports function of a healthy leg (with a leg injury), restore normal posture.

For the affected limb, active gymnastic exercises are used in lightweight, PI, which alternate with relaxation exercises for muscles with increased tone. To restore muscle strength, exercises with resistance, objects, near the gymnastic wall are used.

Massage is prescribed for muscle weakness, their hypertonicity and is carried out according to the suction technique, starting above the injury site. Massage techniques alternate with elementary gymnastic exercises.

III period (recovery)

AT III period Exercise therapy is aimed at restoring the full range of motion in the joints, further strengthening the muscles. General developmental gymnastic exercises are used with greater load, supplement them with walking, swimming, physical exercises in water, mechanotherapy.

Exercise therapy for spinal injuries

There are fractures of the spine with a violation of stability (stability) and without its violation - compression fractures of the vertebral bodies without damage to the ligaments, intervertebral discs.

Method of treatment:

• simultaneous reposition with the imposition of a plaster corset;
• gradual staged reposition;
• functional method;
• operational methods.

In case of fracture of the bodies of the thoracic and lumbar vertebrae, the functional method is most often used, in which the patient is placed on a functional bed (a shield is placed under the mattress) with a raised head end, under lumbar region put a cotton-gauze roller. At the same time, the patient is stretched by his own weight with the help of straps held behind the armpits.

In this period, in the treatment of traction, exercise therapy is prescribed from the 3rd-4th day. In the early days, exercises are used for small and large joints of the arms and legs (without lifting the legs from the bed) and breathing exercises. Gradually, exercises with bending of the spine are added, relying on arms bent at the elbows and feet of legs bent at the knees. During classes, the bed is set in horizontal position. Classes are held 3-4 times a day for 10-15 minutes. 7-14 days after the trip, they are allowed to turn on their stomach (without bending the torso). In this position, exercises are used in bending the spine with support on the hands, in the future - without support.

In the II period include exercises with a significant muscle tension, nose prerequisite painless on movement. During the first month of this period, exercises with legs off the bed are carried out only alternately. Add IP standing on all fours. For 1-2 weeks. before permission to get up, they teach the transition to a kneeling position with an arched back. The duration of each lesson is increased to 20-30 minutes. The use of exercise therapy is aimed at strengthening the muscles of the back, abdominals, pelvis, arms, legs. At the beginning of the 2nd month apply torso to the sides and slight turns in positions on the back, and subsequently on the stomach.

The duration of the lesson is up to 40-45 minutes several times a day with an emphasis on special exercises that strengthen the muscles of the body.

With fractures of the bodies of the lumbar vertebrae after 6-12 weeks. after injury (with localization in thoracic region- earlier) are allowed to get up from a prone position or from a kneeling position without bending forward. When getting used to the vertical position, walking is added. Sitting is allowed after 3-6 months. 5-10 minutes several times a day. At the same time, they turn on the torso forward, but at first with a bent back. Classes continue after discharge for a year or more.

When treating in a plaster corset, bed rest is prescribed for 7-15 days. Exercise therapy begins on the 2nd-3rd day, using general strengthening and breathing exercises in the IP on the back, with a small load. With permission to get up and walk before removing the plaster corset, exercise therapy is aimed at stimulating regeneration, the formation of a muscular corset by strengthening the muscles of the back and abdominals. Perform exercises in IP lying on your back, stomach, kneeling. After removing the corset, the first time exercise therapy is carried out in the same IP. Forward bends are included with caution after 8-10 weeks. after fracture.

During osteosynthesis, physical exercises are prescribed from the first days in the SP lying on the back, stomach, from the 10-18th day they are allowed to get out of bed and include exercises in the standing SP. At the level of damage, isometric muscle tensions are used. Extension of the spine in periods I and II is not used.

For fractures of the spine in the cervical region, traction behind the head is used. With an injury without violating the stability of the spine, exercise therapy begins in the first days. A few days later, a neck corset, a Shants collar are applied and they are allowed to sit and walk. Accordingly, for exercise therapy include IP sitting, standing. After removing the immobilization, exercises are used to restore mobility and strengthen the muscles of the neck - turns, tilts the head back, forward. These exercises are combined with general strengthening exercises, they are carried out at a slow pace.

In case of fractures of the transverse and spinous processes of the vertebrae, patients are placed in bed with a shield under the mattress for 2-4 weeks. Traction is added with severe pain syndrome. Exercise therapy is prescribed from the first days according to the method of treatment of compression fractures, but the timing of the transition to higher loads is reduced. Turning on the stomach is allowed after 4-6 days, IP on the knees - after 8-12 days. IP standing and walking - after 2-3 weeks.

In case of spinal fractures complicated by dysfunctions of the spinal cord and its roots, special effects are added to the tasks of exercise therapy to restore muscle function (paralyzed or paretic) and treat traumatic disease.

Exercise therapy for chest injuries

For fractures of the ribs, sternum, breathing exercises are used from the first day; first include diaphragmatic, then chest breathing, teach coughing. Gradually, breathing exercises are combined with restorative exercises for the arms and legs in various starting positions accessible to the patient. At open injuries The exercise therapy technique is similar to those used for planned operations on the chest.

Exercise therapy for fractures of the bones of the belt upper limbs and upper limbs

In case of fractures of the clavicle or scapula, exercise therapy is prescribed from the first days after the injury. In the I period, exercises are used for the hand, calves, forearm; in the supine position - abduction of the arm. These movements are combined with general strengthening, relaxation and breathing exercises. In the II period, exercises for the muscles of the shoulder girdle are added. In the Shch. period include exercises with resistance, weights, with objects.

In case of fractures of the bones of the arm, exercise therapy is prescribed from the 2-3rd day. General strengthening and breathing exercises for intact segments are combined with special ones for joints. injured hand. These are ideomotor, isometric and dynamic exercises. In the first period, lightweight IPs are used. In the II period, exercises are complicated, in the III period, muscle strength and normal movements are restored.

In case of fractures of the upper and middle parts of the humerus, rotation cannot be applied before the onset of fusion. Use q resistance exercises for the hand and fingers.

For fractures of the bones of the lower third of the shoulder and in the area of ​​the elbow joint, special exercises are used to shoulder joint, for the hand and fingers. In the II period, they include supination and pronation of the forearm, flexion and extension on a smooth surface or an inclined plane, and then add flexion and extension without effort.

With diaphyseal fractures of the bones of the forearm, supination and pronation exercises are prescribed with good adhesion, and in the first period, active exercises for the fingers are sought.

For fractures of the bones of the hand, exercises are used from the 1st-2nd day for intact joints and ideomotor exercises for damaged ones. In the II period, they begin to include active exercises for damaged segments of the hand and fingers with support for the hand. Special exercises are needed for each phalanx of the fingers. Use objects (sticks, maces, balls, ladders, expanders).

Exercise therapy for pelvic fractures

Exercise therapy is used in the first days after the injury. In the first period, breathing exercises, gymnastic exercises for the upper limbs, neck muscles are used. For the lower extremities, movements in light IP with incomplete amplitude are acceptable, without effort in alternation with relaxation exercises. For the pelvic muscles, ideomotor and isometric exercises are used. In the first 2 weeks on the side of the fracture, raising the straightened leg is excluded. In the II period, they prepare for standing, walking. The transition to getting up is carried out from a prone position. In case of a fracture of the ischial and pelvic bones, the sitting position is not used. In the III period, all IPs are allowed. Special training includes lower extremity movements, tilts, torso rotations, learning to walk, squats. With fractures of the acetabulum for 6-10 months. exclude support on the leg on the side of the injury. Exercises for the hip joint are carried out in lightweight IP.

Exercise therapy for fractures of the lower extremities

In case of fractures of the neck of the femur, therapeutic exercises begin from the 1st day, using breathing exercises. On the 2-3rd day, exercises for the abdominal press are included. In the first period, when treating with traction, special exercises should be used for the joints of the lower leg, foot, and fingers. The procedure begins with exercises for all segments of a healthy limb. In patients with a plaster cast on the 8-10th day, static exercises for the muscles of the hip joint are used. In the II period, it is necessary to prepare for walking and, with the fusion of fragments, restore walking. Assign exercises to restore muscle strength. At first, with help, and then actively, the patient performs abduction and adduction, raising and lowering the leg. Teach walking with crutches and later without them. In the III period, the restoration of muscle strength and full mobility of the joints continues.

At surgical treatment- osteosynthesis - the period of stay of the patient on bed rest is significantly reduced. After 2-4 weeks. after the operation, they are allowed to walk with crutches. To walk the patient in bed, exercises for the hip joint are used, offering to sit down with the help of various devices (straps, "reins", fixed crossbars above the bed).

in fractures of the diaphysis and distal of the femur in the I period, special exercises are used for joints free from immobilization. For the damaged segment, ideomotor and isometric exercises are used. In case of fractures of the bones of the thigh and lower leg in the first period, pressure can be applied along the axis of the limb, lowering the immobilized leg below the level of the bed, at the end of the period, walking in a plaster cast with crutches is allowed, but the degree of support is strictly dosed. In the II period, the volume of exercises is expanded, taking into account the strength of the callus and the state of reposition. In the III period, with good adhesion, walking is trained, gradually increasing the load.

With periarticular and intraarticular fractures of the distal femur, it is necessary to strive for more early recovery movements in the knee joint. With the correct reposition and the emerging fusion, isometric exercises are used first, then active exercises are used - flexion and extension of the lower leg, raising the leg (with a short-term shutdown of the thrust of the load (with skeletal traction). Increase the load very gradually, slowly. During exercises for the knee joint, the area of ​​the hip fracture fixed with hands, cuffs.

After osteosynthesis, the method of physical therapy is similar to that used with a plaster cast, but all loads begin earlier than with conservative treatment. During treatment in the Ilizarov apparatus and others, isometric exercises are used in the area of ​​the operated segment and exercises for all non-immobilized joints in the first days.

With open injuries of the knee joint and after operations on the joint, therapeutic exercises are used from the 8-10th day, exercises for the joint from the 3rd week. after operation. At closed injuries therapeutic exercises are included from the 2-6th day. In the first period of immobilization, isometric exercises are used in the area of ​​injury, as well as exercises for intact joints and a healthy leg. In patients without immobilization, exercises with a small amplitude are used for the knee joint with the help of a healthy leg in IP lying on its side. For the ankle and hip joints, active exercises are used, supporting the thigh with the hands. In the II period, mainly active exercises are used with caution for the area of ​​the knee joint with axial load to restore walking. In the III period, the supporting function and walking are restored.

In case of fractures of the bones of the lower leg in the treatment of traction in the first period, exercises for the toes are used. Exercises for the knee joint should be included very carefully. This can be done by moving the hip while raising and lowering the pelvis. In patients after osteosynthesis, walking with crutches is allowed early with stepping on the sore leg and the load on it is gradually increased ( axial load). In the II period, exercises are continued for full support, restoration of the range of motion in the ankle joint. Apply exercises to eliminate deformities of the foot. Exercises of the III period are aimed at restoring the normal range of motion in the joints, strengthening muscle strength, eliminating contractures, and preventing flattening of the arches of the foot. In case of fractures of the condyles of the tibia, very carefully only after 6 weeks. allow the weight of the body to load on the knee joint. In osteosynthesis, exercises for the knee and ankle joint are prescribed for the 1st week, and axial load - after 3-4 weeks.

For fractures in the ankle area with any immobilization, exercises are used for the muscles of the lower leg and foot in order to prevent contractures and flat feet.

For fractures of the bones of the foot in the first period, ideomotor and isometric exercises are used for the muscles of the lower leg and foot; in IP lying with a raised leg, movements are used in the ankle joint, active - in the knee and hip joints, in the absence of contraindications, exercises with pressure on the plantar surface. Support on the foot when walking with crutches is allowed with correct staging feet. In the II period, exercises are used to strengthen the muscles of the arch of the foot. In the III period, correct walking is restored.

For all injuries, water exercises, massage, and physiotherapy are widely used.

Approximate complexes of therapeutic exercises

Exercises for the ankle and foot joints

1. IP - lying on your back or sitting with legs slightly bent at the knee joints. Flexion and extension of the toes (active passive). Flexion and extension of the foot of a healthy leg and the patient alternately and simultaneously. Circular movements in the ankle joints of the healthy leg and the patient alternately and simultaneously Rotate the foot inward and outward. Extension of the foot with an increase in the range of motion with the help of a band with a loop. The pace of exercises is slow, medium or changing (20-30 times).
2. IP is the same. The toes are placed one on top of the other. Flexion and extension of the foot with resistance exerted by one leg while moving the other. Slow pace (15-20 times).
3. IP - sitting with legs slightly bent at the knee joints Grabbing small objects with toes (balls, pencils, etc.)
4. IP - sitting: a) feet of both legs on a rocking chair. Active flexion and extension healthy and passive - sick. The pace is slow and medium (60-80 times), b) the foot of the sore leg on the rocking chair. Active flexion and extension of the foot. The pace is slow and medium (60-80 times).
5. IP - standing, holding on to the rail of the gymnastic wall, or standing with your hands on your belt. Raising on socks and lowering on the whole foot Raising of socks and lowering on the whole foot. The pace is slow (20-30 times).
6. IP - standing on the 2nd-3rd rail of the gymnastic wall, grip with hands at chest level. Springy movements on the toes, try to lower the heel as low as possible. The pace is average (40-60 times).

Knee Exercises

1. IP - sitting in bed. Leg muscles are relaxed. Hand grip on the patella. Passive shifts to the sides, up, down The pace is slow (18-20 times).
2. IP - lying on the back, the sore leg is half-bent, supported by the hands on the thigh or rests on the roller. Flexion and extension of the EG knee joint with the heel off the bed. The pace is slow (12-16 times).
3. IP - sitting on the edge of the bed, legs lowered: a) flexion and extension of the diseased leg in the knee joint with the help of a healthy one. The pace is slow (10-20 times); b) active alternate flexion and extension of the legs in the knee joints. The pace is average (24-30 times).
4. IP - lying on the stomach. Flexion of the diseased leg at the knee joint with gradual overcoming of the resistance of a load weighing from 1 to 4 kg. The pace is slow (20-30 times).
5. IP - standing with support on the headboard. Raise the affected leg bent at the knee joint forward, straighten, lower. The pace is slow and medium (8-10 times).

Hip Exercises

1. IP - lying on his back, holding his hands on the cord tied to the back of the bed. Transition to a semi-sitting and sitting position. The pace is slow (5-6 times).
2. IP - lying on your back or standing. Circular movements with a straight leg out and in. The pace is only slow (6-8 times).
3. IP - lying on your back, holding hands on the edges of the bed: a) alternately raising straight legs; the pace is slow (6-8 times); : b) circular movements alternately with the right and left legs. The pace is slow (3-5 times).
4. IP - lying on its side, a sore leg on top. Leg abduction. The pace is slow (4-8 times).
5. IP - standing sideways to the back of the bed, leaning on it with your hand: a) raising the leg forward and moving it back; b) abduction of the legs and arms to the side. The pace is only slow (8-10 times).
6. IP - standing, socks together. Tilt forward, try to reach the floor with the ends of your fingers or palms. The pace is medium to fast (12-16 times).

Exercises for all joints of the lower limb

1. IP - lying on your back, the foot of the sick mogi on a stuffed ball. Rolling the ball to the body and to the IP. The pace is slow (5-6 times).
2. IP - lying on your back, holding hands on the edges of the bed. "Bike". The pace is medium to fast (30-40 times).
3. IP - standing facing the back of the bed with support by hands: a) alternately raising the legs forward, bending them at the knee and hip joints. The pace is slow (8-10 times); b) half squat. The pace is slow (8-10 times); c) deep squat. The pace is slow (12-16 times).
4. IP - standing, sore leg one step forward. Bending the sore leg at the knee and tilting the torso forward to the “lunge” position. The pace is slow (10-25 times).
5. IP - standing facing the gymnastic wall. Climbing the wall on toes with additional springy squats on the toe of the sore leg. The pace is slow (2-3 times).
6. IP - hanging with your back to the gymnastic wall: a) alternating and simultaneous lifting of the legs bent at the knee joints; b) alternate and simultaneous lifting of straight legs. The pace is slow (6-8 times).

Some exercises in plaster immobilizing bandages; walking exercises

1. IP - lying on the back (high plaster hip bandage). Tension and relaxation of the quadriceps femoris (“patellar game”). The pace is slow (8-20 times).
2. IP - the same, holding hands on the edges of the bed. Foot pressure on the instructor's hand, board or box. The pace is slow (8-10 times).
3. IP - lying on your back (high cast). With the help of an instructor, turn on the stomach and back. The pace is slow (2-3 times).
4. IP - the same, the arms are bent at the elbow joints, a healthy leg is bent at the knee joint resting on the foot. Raise the affected leg. The pace is slow (2-5 times).
5. IP - lying on your back on the edge of the bed (high plaster hip bandage). Leaning on your hands and lowering your sore leg over the edge of the bed, sit down. The pace is slow (5-6 times).
6. IP - standing (high plaster hip bandage), holding with one hand on the back of the bed or hands on the belt. Tilt the torso forward, putting the diseased leg back on the toe and bending the healthy one. The pace is slow (3-4 times).
7. IP - standing on a gymnastic bench or on the 2nd rail of the gymnastic wall on a healthy leg, the patient is freely lowered: a) rocking the diseased leg (12-16 movements); b) writing off the eight with a sore leg (4-6 times).
8. IP - walking with crutches (not leaning on a sore leg, slightly starting on a sore leg, loading a sore leg). Options: walking with one crutch and a stick, with one crutch, with one stick.

Exercise therapy for scoliosis

C about l and about z is a lateral curvature of the spine. Occurs in childhood and adolescence. Causes of scoliosis: trauma, congenital changes, paralysis, dysplasia, etc. Scoliosis is distinguished by its localization: cervical, cervicothoracic, thoracolumbar, lumbar, lumbosacral and total, covering the entire spine. The curvature can have one arc (C-shaped scoliosis), two arcs (S-shaped) or more (several peaks). Scoliosis is necessarily accompanied by a rotation of the vertebral body to the convex side, which leads to the appearance of a muscle roller in lumbar and costal hump in the thoracic region.

Exercise therapy and massage are essential elements in complex conservative and surgical treatment.

The clinical and physiological rationale for the use of exercise therapy and massage is their ability to positively influence the function of the musculoskeletal system, contributing to the reduction or stabilization of spinal deformity processes. Tasks of exercise therapy:

• create conditions for restoring the normal position of the body, strengthen the muscles of the body, increase their strength;
• in the early stages, strive to correct the defect, in the later stages - to prevent the aggravation of the process;
• teach correct posture, contribute to the normalization of the functions of the respiratory and of cardio-vascular system,
• have a strengthening effect.

Forms of exercise therapy: physiotherapy, gymnastics in water. Gymnastic exercises are used in SP lying down, standing on all fours. Train the muscles of the back, gluteal region, abdomen. To correct the defect, special corrective exercises of two types are used - symmetrical and asymmetric. With symmetrical exercises, the middle position of the spine is maintained. Muscles on the convex side tense more intensely, on the concave side they stretch.

Asymmetric exercises are selected for a special effect on the curvature of the spine. Symmetrical exercises are used more often. The procedure also includes breathing exercises of a static and dynamic nature, exercises to develop the correct posture in a standing position, general strengthening exercises. To increase the mobility of the spine, exercises on all fours, mixed hangings, exercises on an inclined plane are used.

Pool activities include exercises at the side of the pool, swimming with inflatable shells, a raft and free swimming.

There are three degrees of curvature of the spine.

In case of scoliosis of the 1st degree, symmetrical, general strengthening special exercises are used to strengthen the muscles of the back, abdominals, chest, corrective, exercises in combination with breathing exercises, exercises for the development of coordination, the development of correct posture. They use walking, exercises in IP lying on the back, stomach, standing, including exercises with the ball, medicine balls. With a weak muscle corset Classes are held only in the supine position.

In case of scoliosis of the II degree, dynamic breathing exercises are added while walking, they include asymmetric exercises, exercises with weights with dumbbells, clubs; balance exercises. IP - standing, lying on the back, stomach, side. More time is spent on corrective exercises (counter-bending, detorsion exercises). The latter in the presence of torsion.

With III degree of scoliosis, 65-70% of the time, classes are carried out in the position of unloading the spine (lying down). Along with general strengthening and breathing exercises, special corrective, detorsion exercises are used.

If scoliosis does not progress within two years, sports are recommended: breaststroke swimming, volleyball, basketball, skiing.

Massage for scoliosis

Tasks of massage:

• strengthen the muscles of the back and abdomen and normalize their tone,
• reduce the feeling of muscle fatigue,
• reduce pain when it occurs
• improve lymph and blood circulation;
• improve breathing function
• help to strengthen the whole body.

Massage is used for scoliosis of all degrees with conservative and surgical treatment. Massage the back, abdomen, chest.

With scoliosis of the 1st degree, stroking, rubbing, kneading and vibration are used. At II and III degrees - all the above methods are used for weakened muscles, and for muscles with increased tone - stroking and vibration. The rib hump is affected by all methods, and especially by vibration, patting with fingers, avoiding strong blows, pressure is used, trying to smooth out the deformation by mechanical methods. The back is massaged in the supine position, a small pillow is placed under the stomach, a low roller is placed under the ankle joints, the arms are placed along the body or they are bent in front of the chest. The head lies straight or turned in the direction opposite to scoliosis.

When massaging the abdomen and chest in front, the patient lies on his back, a low roller is placed under the knee joints, a small pillow is placed under the head, the arms are located along the body.

In the position on the side (opposite side of the thoracic scoliosis), one hand is placed under the head, with the other hand the patient rests in front of the chest.

With a double curvature of the spine in its different sections, the back is conditionally divided into four sections: two thoracic and two lumbar, for each of which various techniques are selectively used, taking into account the state of muscle tone. Massage at the beginning of the procedure is carried out non-selectively, using the techniques of superficial and deep stroking. Then carry out a differentiated effect on the above departments, starting with the chest. The massage therapist should be on the side of the massaged area.

After the operation, massage is prescribed at a time depending on the severity and complexity of the operation. First, light stroking, rubbing, vibration is used, without touching the scar. After 30 days, kneading and tapping is added in the region of the costal protrusion, then massage of the abdomen and legs is added. The duration of the procedure is 20-30 minutes. The course - 20-25 procedures daily or every other day. A break between courses is at least 14 days. Treatment courses are repeated several times a year.

Exercise therapy for flat feet

Flat feet are caused by flattening of the arches of the foot of varying degrees and can be congenital and acquired (after injuries, paralysis, large constant loads, immobilization, etc.). Therapeutic exercise is aimed at strengthening the muscular-ligamentous apparatus that supports the arch of the foot.

General strengthening and special exercises are used. Special exercises include exercises for the muscles of the lower leg and foot with grasping and shifting objects with the fingers of the feet, rolling with the soles of a stick. Apply walking on socks, heels, the outer edge of the foot.

An approximate set of exercises for therapeutic exercises with flat feet
IP - sitting on a chair, without objects

1. The leg is thrown over the knee of the other leg - rotate the foot from the outer edge of the foot to the inner edge.
2. Spread and move your fingers.
3. Feet on the floor. Make crawling movements with the foot forward and backward (each foot separately, and then simultaneously).

IP - sitting on the floor, with objects

1. Hands back, leaning on the palms, legs bent at the knees. Put a stick under the feet; raise the pelvis, roll the stick back and forth with tables.
2. Grab your toes miscellaneous items(pencil, stick, ball).
3. "Writing with feet" (grab a pencil or chalk with all the toes of the foot turned with the outer edge of the foot down).
4. Putting on socks without the help of hands, grabbing the sock with the fingers of both feet.

IP - standing and moving, with objects

1. Walk on "skis" on parallel gymnastic sticks. Strive so that the feet do not slip off the sticks. Walking is carried out in a straight line with turns, without disturbing the parallelism of the sticks.
2. Squat standing on parallel sticks.
3. Walk one stick forward and back.
4. Grab the balls with your toes.

IP - standing and moving, without objects

1. Rise on the toes of one and two feet.
2. Raise and lower the inner edges of the foot.
3. Walk on the outer edge of the foot.

Exercise should not cause fatigue, pain. Therapeutic gymnastics is complemented by foot and leg massage. Massage is carried out in courses of 20-25 procedures, after a break of 10 days, the massage is resumed. It is advisable to learn self-massage.

Exercise therapy for congenital clubfoot

Congenital clubfoot is manifested by adduction, supination and plantar flexion of the foot. Therapeutic exercises begin from the 7-10th day after birth, since at this time the tissues are supple and the correct position of the foot can be formed. Treatment may be conservative with bandaging, plaster bandages, as well as operational. With all types of treatment, physical therapy is necessary. Active exercises are used, as well as passive ones for stretching shortened muscles and ligaments; extension, abduction and adduction, supination and pronation of the feet. Therapeutic gymnastics is combined with massage and wearing orthopedic shoes.

Exercise therapy for congenital muscular torticollis

Congenital torticollis is caused by contracture of the sternocleidomastoid muscle, the same muscle on the opposite side is overstretched. Therapeutic exercises and massage begin as soon as this pathology is detected in a newborn in the first weeks after birth. For the affected muscles, massage is used to relax, the muscles opposite side massage to improve tone. Passive exercises are used very carefully, smoothly turning and tilting the head in the direction opposite to the affected muscle. In the position on the side (on the healthy side), the back is unbent and at the same time the head is tilted to the bed in healthy side and turn towards the injured. Exercises are carried out 3-4 times a day. Treatment by position is carried out with the help of sandbags, laying the head in the correct position.

In cases of surgical treatment with subsequent immobilization, exercises are used to prevent complications: restorative, respiratory, relaxation. After immobilization, passive and active exercises for the muscles of the neck and torso are used; develop correct posture.

Exercise therapy for joint diseases

Diseases of the bone muscular system divided into:

1. inflammatory;
2. degenerative (non-inflammatory);
3. traumatic
4. tumor.

Exercise therapy and massage are used only for the first three groups. There are independent forms of arthritis and forms caused by other diseases.

Rheumatoid arthritis - severe inflammatory disease joints, often early leading to disability in patients. The disease is caused by a disorder immune systems in the body. Predisposing factors are foci of infection in the body. Inflammatory process covers the individual elements of the tissues of the joints, appearing first in the loose layer of the synovial membrane of the joint. The process may be limited to this, but most often in the future there is a diffuse lesion not only of the joint itself, its ligamentous apparatus, but also of the tissues adjacent to it, with the involvement of the epiphyseal parts of the bone and soft tissues in the process. An infiltrate and edema are formed, which ultimately leads to a significant limitation or loss of joint function with subluxations, contractures up to the formation of ankylosis.

Small joints of the hands and fingers are more often symmetrically affected, in the elderly, on the contrary, large joints: knee, hip.

In the first period acute course process, the disease is manifested by pronounced inflammatory changes in the joint, joint pain, swelling, and often reddening of the skin. Exudate inside the joint leads to a change in its shape - defiguration - and disrupts the function of movement. The temperature may rise.

AT under acute period there is a tendency to relapse with moderate pain in the joints, an intermittent increase in body temperature up to 37.3-37.5 ° C.

In the joints, not only exudative, but also proliferative changes are expressed, which leads to the development of contractures and ankylosis. Significant violations of the function of movement in the joints are accompanied by changes in the cardiovascular system, gastrointestinal tract, and kidneys.

In the chronic stage, pain in the joints increases without pronounced inflammatory changes, without an increase in body temperature in the area of ​​​​the joints. There are contractures, ankylosis, deformities of many joints, subluxations small joints.

In severe cases, patients are bedridden for years, unable to take care of themselves.

Rheumatoid arthritis is characterized by simultaneous damage to the valves of the heart and, over time, a heart defect is formed. The disease proceeds in the form of attacks - rheumatic attacks.

Gouty arthritis is caused by a violation of purine metabolism, leading to an increase in the content of uric acid in the blood and the deposition of its salts in various organs, especially in the synovial membrane of the joints, tendons, cartilage, articular surfaces of bones. In this case, acute inflammation of the joint and the formation of multiple nodules can occur. Usually one metatarsophalangeal joint of the toe is affected. There is a deposition of salts on the terminal phalanges of the fingers, in the muscles of the arms and legs in the form of grains. When gout occurs suddenly acute attacks with sharp pains, high temperature body and skin. The attack lasts 3-10 days, after which all phenomena disappear. Attacks are repeated 1-2 times a year, over time they become more frequent, and their duration lengthens.

Deforming osteoarthritis. Common joint disease dystrophic character that most often affects middle-aged and elderly people. Often leads to long-term loss performance and even disability. This disease causes degeneration articular cartilage, the articular surfaces of the bones change, osteophytes (bone growths) appear along their edges. At the same time, soft tissues surrounding the joint are affected.

The most loaded joints are affected - knee, hip, shoulder and feet. The disease begins gradually; there are slight pains on movement, which stop at rest. The pains increase in the evening and decrease after a night's sleep.

Initially, there is no effusion in the joints. Defiguration, deformation of the joints and limitation of movements appear in the late period.

Exercise therapy is shown in subacute and chronic periods joint diseases. In the acute period, only positional treatment is used.

Task and exercise therapy:

• impact on the affected joint and ligamentous apparatus in order to develop their mobility and prevent further dysfunction;
• strengthening the muscular system and increasing its efficiency, improving blood circulation in the joints and periarticular apparatus, stimulating trophism and combating atrophic phenomena in the muscles;
• counteracting the negative effects of prolonged bed rest (stimulation of the function of blood circulation, respiration, metabolism, etc.)
• increase in the general tone of the body;
• decrease pain adaptation of the affected joints to a dosed load;
• desensitization of the body to fluctuations in meteorological factors, increased fitness and general working capacity of the patient.

Means and forms of exercise therapy: treatment with position, morning hygienic exercises, therapeutic exercises, mechanotherapy, exercises in water, massage.

Treatment by position - the correct, functionally advantageous position of the limb at rest. Already in the acute stage, the tendency to pervert normal motor acts should be eliminated. The patient is taught to self-control, he must monitor the correct functionally advantageous position of the whole body and the affected limbs, learn to relax the muscles, and also breathe deeply correctly. If the elbow joint is affected, it should be bent at an angle of 90 ° or slightly less; fixation in an extended position is unacceptable). The forearm should be in a position midway between pronation and supination. The hand should be in slight extension; the palm should be facing the front surface of the body. The arm placed on the pillow should be abducted at the shoulder joint by at least 25-30° and gradually up to 90°. The shoulder should be moved 30-40° anteriorly from the frontal plane, and occasionally rotated outward. During the process in the metacarpophalangeal joints, there is a tendency to limit extension in them. In these cases, hyperextension develops in the interphalangeal joints, often leading to subluxations and complete limitation of movement. In this case, the terminal phalanges are bent (type I). During the process in the interphalangeal joints, flexion contractures develop in them; at the same time, overextension may appear in the metacarpophalangeal joints, which is especially pronounced in the terminal joints (type II).

Sometimes both forms are found in the fingers of the same hand. When the joints of the hand are affected, there is a tendency to form the so-called "walrus fins", i.e. deviation of the hand and four fingers to the ulnar side.

In type I disorders, the roller is placed under the metacarpophalangeal joints with their possible full extension (doing this without effort) and with bent interphalangeal joints and unbent terminal ones. In view of the gradual increase in the tone of the muscles that extend the middle phalanges, the patient should be taught to relax them, after which they can be temporarily bandaged to the roller.

In type II disorders, the roller should be laid so that the metacarpophalangeal joints remain free, the interphalangeal joints are adjacent to the roller in the position of possible full extension, and the terminal phalanges are attached with a bandage in a relaxed state, slightly bent to the roller. With a tendency to develop “walrus fins”, it is necessary to ensure that the hand does not hang down with an inclination to the elbow side.

In the presence of effusion in the knee joint, the patient lying down holds the leg in a bent position, therefore, contractures develop rapidly, often in all three joints (knee, hip and ankle). To prevent this, the sore leg should be laid on a pillow in a state of complete muscle relaxation. The foot should be placed at a 90° angle to the shin using a box or plank to prevent horsefoot contractures.

To prevent the development of flexion contracture of the hip joint, the patient should be temporarily laid on his back with only a small pillow under the back of the head. In addition, when laying the patient at the edge of the bed, you can try to passively move the leg and, if possible, lower it down, maintaining the usual angle of flexion in the knee joint, creating conditions for the emphasis of the foot (floor or box). In this position, you can try to increase the extension in the knee joint by slightly swinging the knee joint. In the subacute stage, treatment with position is continued and morning hygienic exercises, therapeutic exercises, mechanotherapy, exercises in water are added (the latter only for arthrosis and ankylosing sponduloarthritis). Therapeutic exercises are carried out in the IP lying, sitting, standing. The choice of IP is determined by the localization of articular lesions, the degree of preparedness of the cardiovascular system and all the muscles of the patient for one or another physical activity. In case of damage to the joints of the lower extremities, you should first practice lying down, which ensures maximum relaxation of the muscles of the whole body, including the lower extremities; without this, it is impossible to relieve tension and increase the range of motion in the joints. Even with the defeat of the joints of the upper limbs, at first, preference should be given to the prone position, and later - sitting, standing. When the lower extremities are affected, walking is included only in the form of training, corrective, so as not to aggravate the shortcomings of gait, but to eliminate them.

Apply active exercises (including with relief) and passive. Relaxation and breathing exercises are widely used. They teach relaxation on healthy limbs, and then on the affected ones. Includes special exercises to strengthen the back muscles. When performing exercises, you should gradually increase the range of motion, taking into account that the more pronounced the pain, the less the load on the joint should be. During passive movements, do not exceed the physiological norms of movement in the joint. After increasing the amplitude with passive exercises, repeat this exercise actively.

In the procedures, exercises are used with objects (balls, gymnastic sticks, maces, dumbbells, medical balls), on equipment (gymnastic wall, gymnastic bench). Classes are carried out individually or combine patients with homogeneous lesions into small groups (4-5 people); this allows you to choose IPs that are the same for everyone. Exercises in such a group are individualized in terms of amplitude, tempo and the number of their repetitions. If the formation of homogeneous groups is impossible, it is still necessary to strive for individual approach and after classes in the group, add a “refinement” for the affected joints; teach the patient the exercises that he must perform independently 3-4 times a day for 5-7 minutes.

In the chronic stage, when persistent contractures, partial and complete ankylosis are observed, the tasks of therapeutic exercises are not limited to the impact on these joints, since an increase in the range of motion by several degrees in large joints will not improve function. In these cases, it is necessary to provide overall impact on the body, using all the remaining motor capabilities to activate metabolic processes, improve blood circulation and respiration. Special exercises should be applied to unaffected nearby joints. If adaptive movements are not allowed in the acute and sub-acute stages, then in the chronic one they should be used to develop relatively beneficial compensation.

With arthrosis, a feature of therapeutic exercises is the impact on large muscle groups with sufficient load; at overweight it is necessary to contribute to its reduction in order to avoid increased stress on the joint. When exercising directly for the affected joints, light and unloading IPs should be used, swing movements are advisable; when walking, handrails and crutches are used first. Very effective exercise in the pool.

In the presence of synovitis, therapeutic exercises should be more gentle, the pace of the exercises is medium and slow, the amplitude, movements to pain. Relaxation exercises combined with stretching of the muscles of the arms, legs, and back dominate. PIs are preferred lying on the back, on the side, on the stomach, sitting.

In the absence of synovitis, but with a pronounced pain syndrome, limitation of movement in the joint, the procedures are also gentle, the above provisions are observed. With the regression of the pain syndrome, the total load is increased. The pace of the exercises is slow, medium and fast. IP - lying, sitting. There is a significant proportion of exercises with gradually increasing effort, static stresses, exercises that increase the range of motion, strengthen the muscles of the arms, legs and back, and form the correct posture. Reduce pauses for rest between exercises, increase the number of general strengthening exercises. Features of exercise therapy consist in strengthening the muscles surrounding the affected joint, unloading the affected joint and influencing nearby joints to enhance their compensatory function in this disease.

The duration of the therapeutic gymnastics procedure for arthritis and arthrosis increases gradually from 10-12 minutes at the beginning to 30-40 minutes in the middle and at the end of the course of treatment.

Morning hygienic gymnastics consists of simple exercises with the obligatory inclusion of movements for the small joints of the arms and legs.

Mechanotherapy

It is advisable to use pendulum-type devices with a load of various masses.

According to the degree of volitional participation of the patient in the implementation of movements on the apparatus of mechanotherapy, they are divided into three groups: passive, passive-active and active.

Main tasks of mechanotherapy:

• increased range of motion in the affected joints;
• strengthening weakened hypotrophic muscles and improving their tone;
• improving the function of the neuromuscular apparatus of the exercised limb;
• increased blood and lymph circulation, as well as tissue metabolism of the affected limb.

Before starting procedures on mechanotherapeutic devices, the patient must be examined. It is necessary to check the range of motion in the joint using a protractor, measuring the strength of the muscles of the hand with a dynamometer (if the wrist joints are affected), determine the degree of muscle hypotrophy of the limb visually and by measuring it with a centimeter, as well as the severity of pain syndrome at rest and during movement.

The method of mechanotherapy is strictly differentiated depending on the characteristics clinical forms defeat. The severity of the exudative component of inflammation in the joint should be strictly taken into account, the activity rheumatoid process, stage and prescription of the disease, degree of functional insufficiency of the joints, features of the course of the process.

Indications for the use of mechanotherapy:

• limitation of movements in the joints of any degree;
• hypotrophy of the muscles of the limbs;
• contractures.

R o t i n o o p o n o n i o n :

• the presence of ankylosis.

In accordance with the systematization of exercises on mechano-therapeutic devices, passive-active movements with a large element of activity should be used.

The course of mechanotherapy consists of three periods: introductory, main and final.

In the introductory period, exercises on mechanotherapeutic devices are sparingly training; basically - a training character; in the final, elements of training are added to continue independent exercises in therapeutic exercises at home.

Mechanotherapy is prescribed simultaneously with therapeutic exercises. It can be used in subacute and chronic stages disease, with severe, moderate and mild disease. The exudative component of inflammation in the joint, the presence of an accelerated erythrocyte sedimentation rate (ESR), leukocytosis, subfebrile temperature is not a contraindication for mechanotherapy. With a pronounced exudative component in the joint with hyperemia and an increase in skin temperature above it, with a pronounced activity of the rheumatoid process, mechanotherapy procedures are added with great care, only after 4-6 procedures of therapeutic exercises with their minimum dosage and with its gradual increase. The same conditions should be observed with a significant limitation of mobility in the joint.

In case of ankylosis of the joints, it is impractical to carry out mechanotherapy for these joints, but the nearby non-ankylosed joints should be trained on the apparatus as early as possible for prophylactic purposes.

When applying mechanotherapy, one should adhere to the principle of sparing the affected organ and the gradual implementation of training.

Before the procedure, the patient must be explained the meaning of mechanotherapy. It should always be carried out in the presence of medical personnel who can simultaneously monitor several patients who are engaged in different devices. In the hall of mechanotherapy there should be either an hourglass or a special signal clock.

The mechanotherapy procedure is performed with the patient sitting at the apparatus (with the exception of procedures for the shoulder joint, which are performed in the standing position and for the hip joint, which are performed in the prone position).

The position of the patient on a chair should be comfortable, relying on his back, all muscles should be relaxed, breathing should be arbitrary.

In order to maximize the sparing of the affected joint, exercises begin with the use of a minimum load: at a slow pace that does not cause increased pain, with a small amplitude of movement, including frequent pauses for rest. The duration of the first procedure is no more than 5 minutes, and in the presence of a significantly pronounced pain syndrome - no more than 2-3 minutes. In seriously ill patients, the first mechanotherapy procedures can be carried out without a load in order to make it easier for the patient to take them. First, the load during the procedure is increased according to its duration, and subsequently, according to the mass of the load on the pendulum.

If movements in the joint are limited due to the exudative component of inflammation and pain, mechanotherapy is used after the procedure of therapeutic exercises. Gradually exercise all affected joints.

In the first days, the procedure of mechanotherapy is carried out once a day, exercising all the affected joints, later - twice and in trained patients - up to three times a day (no more). The load is increased very carefully both in terms of the number of procedures per day, and in terms of the duration of the procedure and the mass of the applied load. The degree of hypotrophy of the exercised muscles, the severity of the pain syndrome, the tolerance of the procedure should be taken into account, and for those patients in whom these symptoms are less pronounced, the load can be more actively increased.

Observing general provisions carrying out mechanotherapy procedures, it should be individualized for different joints.

The wrist joint. When exercising this joint, the flexors, extensors, supinators and pronators of the hand are affected; IP of the patient - sitting on a chair.

To exercise the flexors of the hand, the arm in the pronation position is placed on the pad of the apparatus for the exercised limb and fixed with soft straps. The minimum weight on the pendulum is 1 kg, the duration of the procedure is 5 minutes. After 4-5 days, the duration of the procedure is increased every 2 days by 1-2 minutes, bringing its duration to 10 minutes.

Gradually, the mass of the load on the pendulum should also be increased to 2 kg. This increase depends on clinical course diseases: decrease in the activity of the process, decrease in exudative phenomena in the joint, decrease in pain, increase in mobility in the exercised joint. The duration of the mechanotherapy procedure for the wrist joint can be increased to 20-25 minutes, and the weight of the load can be up to 3-4 kg. Movements are carried out at a slow pace.

The right and left hands are alternately trained in the pronation position, and then in the supination position, while there is a uniform training of both the flexors and extensors of the hand.

To increase the range of motion in wrist joint conduct training on the apparatus for supination, pronation, circular motions. In this case, the hand is in the middle position - between pronation and supination, i.e., the hand and forearm should, as it were, be a continuation of the axis of the apparatus.

With the help of soft belts with a clasp, a limb segment located below the joint to be developed is fixed.

Elbow joint. When exercising the elbow joint, the flexors and extensors of the forearm and shoulder are affected. IP of the patient - sitting on a chair. The shoulder is fixed to the stand, the forearm is bent in the supination position; the axes of movement of the pendulum and the joint must match. With active flexion in the elbow joint, the movements of the pendulum are performed in the opposite direction, extension is passive. For active extension in the elbow joint, the forearm is bent and pronated, flexion is passive. The mass of the load on the pendulum is 2 kg, the duration of the procedure is 5 minutes. After 4-5 days, the duration of the procedure is increased every two days by 1-2 minutes, bringing its duration to 10 minutes.

The duration of the procedure can be increased to 20-25 minutes, and the mass of the load on the pendulum - up to 4 kg.

Shoulder joint. When using the device for the shoulder joint, they affect the flexors, extensors, abductors and adductors of the shoulder muscles. IP of the patient - standing. Armpit rests on the fork of the device, installed according to the height of the patient. The arm is straightened and lies on the extended pipe, which is installed at any angle to the fly rod. The duration of the procedure is from 5 to 15 minutes, the weight of the load is 2 kg.

When developing the shoulder joint, the duration of the procedure and the weight of the load are limited, despite the participation in the movement of a large muscle group, since the standing position is tiring for the patient, while a heavy load contributes to increased pain.

Hip joint. When exercising this joint on the apparatus, it is possible to influence the muscles that rotate the thigh in and out. IP of the patient - lying down. The leg is fixed with splints and cuffs in the area of ​​the thigh and lower leg. The foot is fixed with a foot holder when it rotates outward, which contributes to the active rotation of the thigh inward; rotation of the foot inward promotes active rotation of the hip outward. The duration of the procedure is from 5 to 25 minutes, the weight of the cargo is from 1 to 4 kg.

Knee-joint. With the help of the apparatus, the flexors and extensors of this joint are affected. IP of the patient-sitting. It is necessary that the chair and the thigh support are on the same level. The thigh and lower leg are fixed with straps on a moving bracket with a stand. With the leg extended, the patient does active flexion, with the bent leg, active extension. The duration of the procedure is from 5 to 25 minutes, the weight of the load is immediately large - 4 kg, in the future it can be increased to 5 kg, but no more.

Ankle joint. When using the device for this joint, the flexors, extensors, abductors and adductors of the foot muscles are affected. IP of the patient - sitting on a high chair. The exercised foot is fixed on the bed-foot with straps, the second leg is on a stand 25-30 cm high. The patient is sitting, the knee is bent - active flexion of the foot, with the knee joint straightened - its active extension. In the same IP, abduction and adduction of the foot are performed. The duration of the procedure is from 5 to 15 minutes, the weight of the load is from 2 to 3 kg. When exercising the ankle joint, fatigue of the muscles of the lower leg occurs faster, and therefore an increase in the duration of the procedure and the mass of the load above those indicated is undesirable.

During mechanotherapy procedures, an increase in load can be achieved by changing the position of the load on the pendulum, lengthening or shortening the pendulum itself, changing the angle of the stand to support the exercised segment, which is fixed with a gear coupling.

Therapeutic exercises are carried out in a pool with fresh water with deforming osteoarthritis, water temperature 30-32°C. The tasks of the introductory section of the procedure are adaptation to the aquatic environment, identifying the degree of pain and limitation of movements, the ability to swim, duration 3-6 minutes. In the main section (10-30 min) the training tasks are carried out. The final section of the procedure - it is 5-7 minutes - is characterized by a gradual decrease in physical activity.

It is preferable to perform exercises from the IP: sitting on a hanging chair, lying on the chest, on the stomach, on the side, imitating "clean hangs"; the volume of general physical and special load during the procedure is changed due to the different depth of immersion of the patient in water, the rate of exercise, changes in the specific weight of exercises for small, medium and large muscle groups with varying degrees efforts. They also change the ratio of active and passive exercises, with elements of muscle relief and relaxation, with inflatable, foam plastic floating objects and projectiles, exercises on a hanging chair, with fins-gloves and fins for legs, with water dumbbells, exercises of a static nature that imitate “clean” hangs. "and mixed, isometric stresses, breathing exercises, pauses for rest, imitation of swimming elements by sports styles (crawl, breaststroke), subject to the principle of load dissipation. Passive exercises are carried out with the help of an instructor or using floating objects (rafts, inflatable circles, "frogs", etc.), exercises without support on the bottom of the pool. Active movements prevail in the water. The range of motion at the beginning of the procedure is limited to pain, sharp jerky movements are excluded. As a result of the procedure, pain, paresthesia, and convulsions should not be allowed to increase. The course of treatment consists of 10-17 procedures, the duration of the procedure is 15-20 minutes.

P r o t i v o p o c a z a n and remedial gymnastics in the pool:

• patients with a pronounced pain syndrome with symptoms of reactive secondary synovitis;
• the first 3 days after the puncture of the joint.