Exercise therapy for a pelvic fracture: what exercises should be done? Features of exercise therapy for acetabular injuries. Therapeutic exercise for stable uncomplicated spinal fractures

Exercise therapy for a fractured leg helps normalize blood circulation, restore muscle tone and full function of the limb after injury. By combining training with massage, you can quickly restore sensitivity to the injured leg, relieve swelling and return to an active life. However, you need to carefully develop the limb; not just any physical exercise is suitable for this.

Types of tibia fractures

Injuries to the shin bones are very diverse:

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

Each type of fracture requires different treatment methods. If the fracture is not displaced or has a slight discrepancy that does not require reposition, it is enough to apply a plaster cast from the fingers to the hip.

If the case is more serious - a displaced fracture of the tibia - it will be necessary to reduce it and then fix the leg with a plaster cast.

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

Exercise therapy for tibia fracture

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

Immobilizing a fracture with a plaster cast

After a cast has been applied to your leg, you should try to periodically keep it in vertical position. First exercise therapy exercises:

your leg can be placed on the floor, but you cannot lean on it;
the next day after applying the plaster, you can already sit up in bed;
after three days you can stand up, leaning on the back of a chair or bed;
After exercise, it is immediately recommended to keep your leg in exalted position. You can place a pillow or folded blanket under it.

These simple movements will help avoid lymph stagnation 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 to recover from a fracture should be performed under the supervision of a doctor.

When you can walk, you need to do this only while leaning on a plaster cast. This will affect the creation of axial load on 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 tibia to full and constant loads.

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

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

A shin fracture will quickly become a forgotten bitter experience only with light physical therapy loads.

Complex of therapeutic exercises after a tibia fracture

While lying on your back, bend your legs one by one knee joint. The exercise should be done with sliding movements of the foot along the bed. At first, it is enough to do 5 repetitions, 5 seconds on each leg.
Grasp with your toes, hold for 10-15 seconds and release small objects while lying on the bed. The patient’s task is to hold the object for as long as possible.
Lying on your back, perform circular movements with your feet and imitate walking.
Lying on your stomach, flex and extend the knee joint, move your leg back and to the side.
Lying on your side, try to move your leg to the side and hold it in this position for 5 seconds. Smoothly return back.
Sitting on a chair or in bed, slowly bend and straighten your toes. Roll the medicine ball back and forth with your fingers, while rolling your foot from toe to heel and vice versa.

Treatment of an ankle fracture using the Bubnovsky method

Recovery from an ankle fracture takes time and patience.

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

Bubnovsky’s treatment is a complete refusal of medications, other medications and surgical intervention. The body itself must direct all its energy to eliminate the problem in the process of comprehensive physical education.

Despite the skepticism of representatives of traditional medicine, Bubnovsky’s treatment method has repeatedly brought positive results.

You should choose recovery methods together with your doctor. In some cases, refusal to take medications can lead to prolonged inflammation and impaired mobility.

Elastic bandage to prevent the development of varicose veins

Because of constant pressure a plaster cast risks interfering with the free flow of blood and lymph in the leg. And if the victim has varicose veins, a special compression bandage should be used. It is imperative to ensure that it is not tightened tightly, and the bandage should be worn throughout the day.

If you plan to train at home, you should purchase a gymnastic mat in advance.

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

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

The video shows a complex of physical therapy for a fracture of the tibia with and without displacement.

Exercise therapy for pelvic fractures is an important part of treatment. It is necessary not only to immobilize damaged bones, but also to improve breathing and maintain muscle tone. Without gymnastics, complications may occur from different organs, A rehabilitation period after an injury it is much more difficult. Therefore, 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, top part torso and healthy leg. Are used and special exercises, for example, upward movement of the pelvis, which makes it possible to place a bedpan and greatly facilitates patient care.

How is a fracture treated?

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

A fracture is diagnosed using an x-ray. The rectum is also examined, and women are prescribed a gynecological examination. Bone fragments can damage internal organs. Then immobilization is carried out, its method depends on the type of fracture. If bone fragments are displaced, then skeletal traction is applied. For a bilateral fracture, the patient is placed in the Volkovich position: the patient lies on a hard bed with his knees apart, and special bolsters are placed under his 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 you start therapeutic exercises?

After the patient is removed from state of shock, you can begin performing special exercises for fractures of the pelvic bones. Typically, physical 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 respiratory congestion, constipation, weakness and muscle atrophy.

Periods of physical therapy complex

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

1st period. At an early stage of therapy, gymnastics is necessary to maintain normal metabolism, prevent a decrease in muscle tone and fast healing damage. Allowed breathing exercises, movements of the upper limbs, feet and toes.
2nd period. At this stage, the immobilization is usually removed. Gymnastics is aimed at strengthening the muscles of the waist, limbs and torso. Gradually they begin to train their joints and legs.
3rd period. During this period of treatment, the patient learns to walk. It is important to restore support function and joint mobility lower limbs.

Each period of exercise therapy after a pelvic fracture will be discussed in more detail 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 should remain on the bolsters. Special exercises for fractures of the pelvic bones include raising the hips (for using a bedpan). At first, this movement is performed under the supervision of an instructor, but from 4-6 days of illness the patient can do it independently.

On days 5-7, the patient can bend his leg at the knee. The thigh should lie on the cushion. If skeletal traction is used, 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 exercises, the room must be well ventilated. The head should be in a slightly elevated position. After 10-14 days, you can move on to the next stage of treatment.

Second period of exercise therapy

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

Typically, 2.5 weeks after injury, patients are allowed to roll over. From now 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 this, third period classes begin.

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. The 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 a 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 onto the back of a chair or bed. Then, supporting the patient by the hands, you need to gradually teach him to walk without limping.

Exercises for the first period

All exercises are done while lying on your back and keeping your legs on a bolster. 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:

Bending and straightening of the toes and hands (7-11 times each).
Circular movements of the foot. First, the exercises are performed with the healthy leg, then with the sick one. Next, they make movements with both limbs at the same time.
Grab small objects (balls, pencils) with your toes.
The feet rotate inward and outward, as well as flex and extend.
Bend your knees.
Pull each leg toward your stomach in turn.
Abduct each lower limb to the sides and return to the starting position. This exercise is contraindicated in case of injury to the symphysis pubis.
Raising each leg upright position up. This exercise for a pelvic fracture should be done while holding onto the edges of the bed.

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

Exercises for the second period

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

Raise straight legs back one at a time. Both limbs are raised while holding the headboard of the bed.
Spread and bring straight legs (contraindicated in case of damage to the symphysis pubis).
Raise your pelvis, leaning on your hands and toes.
Raising your legs with your knees bent.
Deflection of the body in the lower back, in a position on the stomach. The same exercise can be done on all fours.

For some types of pelvic fractures, the patient is carefully placed in a 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 injury healing. At feeling good and the 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. The following movements must be made:

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

Exercises for the third period

What exercises should be done for a pelvic fracture in the third period? These are movements of the legs and arms in a standing position. During the recovery stage, it is important to establish the patient’s correct gait. At first, elderly patients perform gymnastics while holding the headboard of the bed. The following exercises can be recommended:

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

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

Full restoration of ability to work occurs approximately 1.5-3 months after the fracture.

Features of exercise therapy for acetabular injuries

If the recess in the iliac region is damaged, the third period of treatment takes place over a long period of time. Patients are allowed to step on the affected leg later and have to use crutches for longer.

If plaster immobilization is used, then physical therapy is aimed at maintaining movements in the joint. A moderate load along the axis of the limb is needed when the patient is lying down, and when he begins to walk with crutches in a cast.

Walking with pelvic fractures

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

Walking without crutches is allowed approximately 3 months after the injury. To develop your legs, you need to walk daily. Their duration must be increased gradually. Special exercise machines called steppers will also help restore correct gait.

The rehabilitation process after a pelvic fracture occurs in different ways. Many patients manage to completely restore motor function. When damaged, most people remain disabled. It is not uncommon for patients to suffer from periodic pain for 1-2 years after injury. As for professional athletes, they usually do not return to training and competition after suffering an injury.

Ministry of Education of the Russian Federation

Department " physical culture»

On the topic “Therapeutic physical education for fractures of the lower extremities”

Supervisor:

Khabarovsk 2004

1. Introduction………………………………………….………………..3

2. Story development of exercise therapy ………………………………………..….4

3. General Basics physical therapy…………………….……7

3.1. Classification physical exercise ……………………8

4. Forms and methods of physical therapy……………….……...13

5. Physiotherapy for injuries and some diseases of the movement apparatus……………………………….16

6. Exercise therapy for fractures of the lower extremities…………………..…19

6.1. Approximate complexes of therapeutic exercises……………...22

6.1.1. Exercises for the ankle and foot joints …………………………………………...22

6.1.2. Exercises for the knee joint……………………23

6.1.3. Exercise for all joints of the lower extremities...24

6.1.4. Some exercises in plaster immobilizing bandages; exercises preparing for walking…………………………….24

6.2. Mechanotherapy………………………………………………………...…25

7. References……………………………………………………………...…..30

1. Introduction.

Physiotherapy - an independent scientific discipline. In medicine, this is a treatment method that uses physical education for prevention, treatment, rehabilitation and supportive care. Exercise therapy forms in a person a conscious attitude towards physical exercise and, in this sense, has educational value; develops strength, endurance, coordination of movements, instills hygiene skills, hardening the body with natural factors. Exercise therapy is based on modern scientific data in the field of medicine, biology, and physical education.

The main means of exercise therapy are physical exercises used in accordance with the objectives of treatment, taking into account the etiology, pathogenesis, clinical features, functional state organism, degree of general physical performance.

Physiotherapy:

1. a natural biological method, as it uses the body’s inherent function of movement;

2. method nonspecific therapy, But at the same time individual species exercise can affect certain body functions;

3. method pathogenetic therapy, due to the ability of physical exercise to influence the reactivity of the body;

4. a method of active functional therapy, as it adapts the patient’s body to increasing physical activity;

5. method of maintenance therapy at stages medical rehabilitation in elderly people;

6. method rehabilitation therapy in complex treatment of patients.

7. Characteristic feature Exercise therapy is the process of training patients with physical exercises.

There are general and special training:

1. general training aimed at improving health and strengthening the patient’s body with the help of general strengthening exercises;

2. special training is carried out with exercises that specifically target the affected organ, the area of injury.

Massage - a method of treatment, prevention, rehabilitation after illnesses and recovery, which is a set of techniques of mechanical, dosed influence on various areas surface of the human body, produced by the hands of a massage therapist or special devices. For achievement positive result when using massage, it is necessary to differentiate its technique depending on the etiology, pathogenesis, clinical features, functional state of the central and nervous system (CNS), the nature of the influence various techniques on the body.

Exercise therapy and massage are widely used in combination with other methods for diseases and injuries, and can also be independent methods of treating many chronic diseases and the consequences of injuries: for paralysis, paresis, spinal curvature, emphysema, consequences of bone fractures, etc.

Exercise therapy is used in pre- and postpartum periods. Massage etc. physical exercise promotes better performance psychophysical development healthy children and are used in nurseries, kindergartens, and at home.

2. History of the development of exercise therapy.

Physical exercises for the purpose of treatment and prevention were used in ancient times, 2 thousand years BC in China and India. IN Ancient Rome And Ancient Greece physical exercises and massage were integral in everyday life, military affairs, and treatment. Hippocrates (460-370 BC) described the use of physical exercises and massage for diseases of the heart, lungs, metabolic disorders, etc. Ibn Sina (Avicenna, 980-1037) highlighted in his works the method of using physical exercises for sick and healthy, dividing loads into small and large, strong and weak, fast and slow. During the Renaissance (XIV-XVI centuries), physical exercise was promoted as a means to achieve harmonious development.

In Russia, outstanding clinicians such as M. Ya. Mudrov (1776-1831), N. I. Pirogov (1810-1881), S. P. Botkin (1831-1889), G. A. Zakharyin (1829-1897 ), A. A. Ostroumov. (1844-1908), gave important the use of physical exercises in treatment practice.

The works of P. F. Lesgaft (1837-1909), V. V. Gorinevsky (1857-1937) contributed to the understanding of the unity of mental and physical education for more perfect human development.

Discoveries of great physiologists - I. M. Sechenov (1829-1922), laureate Nobel Prize I. P. Pavlova (1849-1936), N. E. Vvedensky (1852-1922), who substantiated the importance of the central nervous system for the life of the body, influenced the development of a new approach to a comprehensive assessment of a sick person. Treatment of diseases gives way to treatment of the patient. In this regard, the ideas of functional therapy and exercise therapy are beginning to spread more widely in the clinic, being such a method, it has found recognition and wide application.

For the first time in the period 1923-1924. Exercise therapy. was introduced in sanatoriums and resorts. In 1926, I. M. Sarkizov-Serazini (1887-1964) headed the first department of exercise therapy at the Moscow Institute of Physical Culture, where the future first doctors and candidates of science (V. N. Moshkov, V. K. Dobrovolsky, D. A. Vinokurov, K. N. Pribylov, etc.).

Textbooks on physical therapy by I. M. Sarkizov-Serazini went through a number of editions. The first People's Commissar of Health N.A. Semashko (1874-1949) attached great importance to physical therapy. On his initiative, in the early 30s, departments were opened in a number of research institutes, departments of physical therapy were created in advanced training institutes for doctors and some medical universities. A major role in the organization of medical and physical education services belongs to B.A. Ivanovsky (1890-1941), since 1931, head of the department of medical supervision and physical therapy at the Central Institute for Advanced Medical Training.

In the 30s and 40s, monographs, manuals, and manuals on physical therapy were published (V.V. Gorinevskaya, E.F. Dreving, M.A. Minkevich, etc.).

During the Great Patriotic War physical therapy was widely used in hospitals.

In the 50s, medical and physical training clinics were created to provide medical support to those involved in physical education and sports, organizational and methodological guidance on physical therapy. Departments of physical therapy and medical supervision are organized in all medical universities, and classes in physical therapy and massage are held in medical schools.

In 1941, the department of therapeutic exercise and medical supervision at the Central Institute of Advanced Medical Training and the department of therapeutic exercise at the Institute of Physiotherapy - later at the Central Institute of Balneology and Physiotherapy of the USSR Ministry of Health - was headed by Corresponding Member of the USSR Academy of Medical Sciences V. N. Moshkov. The fruitful pedagogical and scientific activities of V. N. Moshkov have found wide recognition in the country and abroad; he is the founder modern school therapeutic physical education, he wrote monographs on all main areas of therapeutic physical education, trained a large number of doctors and candidates of science who headed departments, departments in universities and research institutes of the country.

In the 60-90s, the number of highly qualified specialists who defended doctoral and candidate dissertations increased significantly (E. F. Andreev, N. M. Badridze, I. B. Geroeva, N. A. Gukasova, S. A. Gusarova, V. A. Egairanov, O. F. Kuznetsov, B. A. Polyaev, S. D. Polyakov, N. N. Prokopyev, V. A. Siluyanova, Z. V. Sokova, O. V. Tokareva, N. V. Fokeeva, S. V. Khrushchev, A. V. Chogovadze and many others).

Currently, in Moscow, the department is successfully training specialists and conducting scientific work at the Russian State medical university(head of department B. A. Polyaev), Moscow State Medical and Dental University (head of department V. A. Epifanov), Russian Medical Academy of Postgraduate Education (head of department K. P. Levchenko) and other medical universities educational institutions Russia.

In a number of European countries, the term kinesitherapy has been adopted, rather than physical therapy. In connection with international conferences, scientific contacts with foreign specialists, and joint research, the Association of Kinesitherapy and Sports Medicine Specialists (president S.V. Khrushchev) is successfully functioning in Russia. The Association annually holds international conferences on current problems specialties.

3. General principles of physical therapy.

Exercise therapy classes provide healing effect only with proper, regular, long-term use of physical exercise. For these purposes, a methodology for conducting classes, indications and contraindications for their use, accounting for effectiveness, hygienic requirements to places of study.

There are general and specific methods of exercise therapy. General technique Exercise therapy provides rules for conducting classes (procedures), classification of physical exercises, dosage physical activity, the scheme of conducting classes in different periods course of treatment, rules for constructing a separate lesson (procedure), forms of application of exercise therapy, diagrams of movement modes. Private exercise therapy techniques are intended for a specific nosological form of the disease, injury and are individualized taking into account the etiology, pathogenesis, clinical characteristics, age, and physical fitness of the patient. Special exercises to influence the affected systems and organs must be combined with general strengthening exercises, which provides general and special training .

Physical exercise should not increase pain, since pain reflexively causes vasospasm and stiffness of movement. Exercises that cause pain should be carried out after preliminary relaxation of the muscles, at the moment of exhalation, in optimal starting positions. From the first days of classes, the patient should be taught proper breathing and the ability to relax muscles. Relaxation is easier to achieve after vigorous exercise muscle tension. With unilateral lesions of the limbs, relaxation training begins with a healthy limb. Musical accompaniment of classes increases their effectiveness.

3.1. Classification of physical exercises

Physical exercises in exercise therapy are divided into three groups: gymnastics, applied sports and games.

Gymnastic exercises.

Consist of combined movements. With their help you can influence various systems the body and into individual muscle groups, joints, developing and restoring muscle strength, speed, coordination, etc. All exercises are divided into general developmental (general strengthening), special and breathing (static and dynamic).

1. General strengthening exercises

Used to heal and strengthen the body, increase physical performance and psycho-emotional tone, activate blood circulation and breathing. These exercises make it easier therapeutic effect special.

2. Special exercises

Selectively act on the musculoskeletal system. For example, on the spine - with its curvature, on the foot - with flat feet and injury. For a healthy person, exercises for the torso are general strengthening; for osteochondrosis and scoliosis, they are classified as special, since their action is aimed at solving treatment problems - increasing the mobility of the spine, correcting the spine, strengthening the muscles surrounding it. Leg exercises are general strengthening for healthy people, and after surgery on the lower extremities, trauma, paresis, joint diseases, these same exercises are classified as special. The same exercises, depending on the method of their application, can solve different problems. For example, extension and flexion in the knee or other joint in some cases is aimed at developing mobility, in others - to strengthen the muscles surrounding the joint (exercises with weights, resistance), in order to develop muscle-joint sense (accurate reproduction of movement without visual control) . Typically, special exercises are used in combination with general developmental exercises.

Gymnastic exercises are divided into groups:

· according to anatomical characteristics;

· by the nature of the exercise;

· by species;

based on activity;

· based on the objects and projectiles used.

Based on anatomical characteristics, the following exercises are distinguished:

· for small muscle groups (hands, feet, face);

· for medium muscle groups (neck, forearms, shoulder, lower leg, thigh);

· for large muscle groups (upper and lower limbs, torso),

· combined.

The nature muscle contraction exercises are divided into two groups:

· dynamic (isotonic);

· static (isometric).

A muscle contraction in which it develops tension but does not change its length is called isometric (static). For example, when actively lifting a leg up from the starting position while lying on his back, the patient performs dynamic work (lifting); when holding the leg raised up for some time, the muscles work in an isometric mode (static work). Isometric exercises are effective for injuries during immobilization.

Dynamic exercises are most often used. In this case, periods of contraction alternate with periods of relaxation.

Other groups of exercises are also distinguished by their nature. For example, stretching exercises are used to treat joint stiffness.

Based on type, exercises are divided into exercises:

· in throwing,

· for coordination,

· for balance,

· in resistance,

· hangs and supports,

· climbing,

· corrective,

· respiratory,

· preparatory

· ordinal.

Balance exercises are used to improve coordination of movements, improve posture, as well as to restore this function in diseases of the central nervous system and vestibular apparatus. Corrective exercises are aimed at recovery correct position spine, chest and lower extremities. Coordination exercises restore overall coordination of movements or individual body segments. They are used from different IPs with different combinations of movements of the arms and legs in different planes. Necessary for diseases and injuries of the central nervous system and after prolonged bed rest.

Based on activity, dynamic exercises are divided into the following:

· active,

· passive,

· for relaxation.

To facilitate the work of the flexor and extensor muscles of the arms and legs, exercises are performed in the IP lying on the side opposite to the limb being exercised. To facilitate the work of the foot muscles, exercises are performed in the IP on the side on the side of the limb being exercised. To facilitate the work of the adductor and abductor muscles of the arms and legs, exercises are performed in the IP on the back and abdomen.

To complicate the work of the flexor and extensor muscles of the arms and legs, exercises are performed in the IP lying on the back or stomach. To complicate the work of the adductor and abductor muscles of the arms and legs, exercises are performed in the IP lying on the side opposite to the limb being exercised.

To perform exercises with effort, resistance is applied by the instructor or a healthy limb.

Mentally imaginary (phantom), ideomotor exercises or exercises “sending impulses to contraction” are performed mentally and are used for injuries during immobilization, peripheral paralysis, and paresis.

Reflex exercises involve influencing muscles distant from those being trained. For example, to strengthen the muscles of the pelvic girdle and hips, exercises that strengthen the muscles of the shoulder girdle are used.

Passive exercises are those performed with the help of an instructor, without the patient’s volitional effort, in the absence of active muscle contraction. Passive exercises are used when the patient cannot perform active movement, to prevent stiffness in the joints, to recreate the correct motor act (for paresis or paralysis of the limbs).

Relaxation exercises reduce muscle tone and create conditions for relaxation. Patients are taught “volitional” muscle relaxation using swinging movements and shaking. Relaxation is alternated with dynamic and statistical exercises.

Depending on the gymnastic apparatus and equipment used, exercises are divided into the following:

· exercises without objects and equipment;

· exercises with objects and equipment (gymnastic sticks, dumbbells, clubs, medicine balls, jump ropes, expanders, etc.);

· exercises on apparatus, simulators, mechanical devices.

Sports and applied exercises.

Applied sports exercises include walking, running, crawling and climbing, throwing and catching a ball, rowing, skiing, skating, cycling, health path (metered climbing), hiking. Walking is the most widely used - for a wide variety of diseases and almost all types and forms of exercise. The amount of physical activity when walking depends on the length of the path, the size of the steps, the pace of walking, the terrain and difficulty. Walking is used before starting classes as a preparatory and organizing exercise. Walking can be complicated - on toes, on heels, walking in a cross step, in a half-squat, with high knees. Special walking - on crutches, with a stick, on prostheses - is used when the lower extremities are affected. Walking speed is divided into: slow - 60-80 steps per minute, medium - 80-100 steps per minute, fast - 100-120 steps per minute and very fast - 120-140 steps per minute.

Games.

Games are divided into four groups of increasing load:

· on site;

· sedentary;

· movable;

· sports.

4. Forms and methods of physical therapy.

A system of certain physical exercises is a form of exercise therapy; These are therapeutic exercises, morning hygienic exercises, independent exercises for patients on the recommendation of a doctor or instructor; dosed walking, health path, physical exercises in water and swimming, skiing, rowing, training on exercise machines, mechanical equipment, games (volleyball, badminton, tennis), small towns. In addition to physical exercise, exercise therapy includes massage, air and water hardening, occupational therapy, and physical therapy (horseback riding).

Hygienic gymnastics intended for sick and healthy. Carrying it out in the morning after a night's sleep is called morning hygienic gymnastics; it helps relieve inhibition processes and promote vigor.

Physiotherapy - the most common form of using physical exercises for treatment and rehabilitation purposes. The ability, through a variety of exercises, to purposefully influence the restoration of damaged organs and systems determines the role of this form in the exercise therapy system. Classes (procedures) are carried out individually for seriously ill patients, in small group (3-5 people) and group (8-15 people) methods. Patients are grouped into groups according to nosology, i.e. with the same disease; according to the location of the injury. It is wrong to group patients with different diseases into one group.

Each lesson is built according to a specific plan and consists of three sections: preparatory (introductory), main and final. The introductory section provides preparation for performing special exercises and gradually includes them in the load. The duration of the section takes 10-20% of the time of the entire lesson.

In the main section, classes solve problems of treatment and rehabilitation and use special exercises in alternation with general strengthening exercises. Duration of the section: - 60-80% of the total class time.

In the final section, the load is gradually reduced.

Physical activity is monitored and regulated by observing the body's responses. Pulse monitoring is simple and accessible. A graphical representation of the change in its frequency during an exercise is called a physiological load curve. The greatest increase in heart rate and maximum load is usually achieved in the middle of the session - this is a single-peak curve. For a number of diseases, it is necessary to reduce the load after an increased load and then increase it again; in these cases the curve may have several vertices. You should also count your pulse 3-5 minutes after exercise.

The density of classes is very important, i.e. time of actual exercises, expressed as a percentage of the total time of the lesson. In inpatients, the density gradually increases from 20-25 to 50%. At spa treatment in training mode in general groups physical training Class density of 80-90% is acceptable. Individual independent exercises complement the therapeutic exercises conducted by the instructor, and can subsequently be carried out only independently with periodic visits to the instructor to receive instructions.

Gymnastic method , carried out in therapeutic exercises, has become most widespread. The game method complements it when working with children.

Sports method used to a limited extent and mainly in sanatorium and resort practice.

When using exercise therapy, you should follow the principles of training, taking into account the therapeutic and educational objectives of the method.

· Individualization in methodology and dosage, taking into account the characteristics of the disease and the general condition of the patient.

· Systematic and consistent use of physical exercises. They start with simple ones and move on to complex exercises, including 2 simple and 1 complex new exercise in each lesson.

· Regularity of exposure.

· Duration of classes ensures the effectiveness of treatment.

· Gradual increase in physical activity during the treatment process to ensure a training effect.

· Diversity and novelty in the selection of exercises - are achieved by updating them by 10-15% with repeating 85-90% of the previous ones to consolidate the results of treatment.

· Moderate, prolonged or fractional loads are more appropriate to use than increased loads.

· Maintain a cyclic pattern of alternating exercises with rest.

· The principle of comprehensiveness - provides for an impact not only on the affected organ or system, but also on the entire body.

· Visualization and accessibility of exercises - especially necessary in exercises with lesions of the central nervous system, with children and the elderly.

· Conscious and active participation of the patient is achieved by skillful explanation and selection of exercises.

5. Therapeutic exercise for injuries and some diseases of the movement apparatus.

Injuries to the musculoskeletal system cause disturbances in the anatomical integrity of tissues and their functions, accompanied by both local and general reactions from various body systems.

When treating fractures, fragments are repositioned to restore the length and shape of the limbs and fixed until bone fusion occurs. Immobility in the damaged area is achieved by fixation, traction, or surgery.

More often than others, in 70-75% of patients with fractures, the fixation method is used by applying fixing bandages made of plaster and polymer materials.

When using traction (extension method), the limb is stretched using weights to compare fragments for from several hours to several days (the first repositioning phase). Then, in the second retention phase, the fragments are held until they are completely consolidated and relapses of their displacement are prevented.

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

Physiotherapy - an obligatory component of complex treatment, as it helps restore the functions of the musculoskeletal system and has a beneficial effect on various body systems based 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 on the first day of injury when severe pain disappears.

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

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

I period (immobilization).

In the first period, fusion of fragments occurs (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, and 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. All intact segments and non-immobilized joints on the injured limb are included in the movement process. Static muscle tension in the area of injury and movement in immobilized joints (under a plaster cast) is used for good condition fragments and their complete fixation. The risk of displacement is less when connecting fragments with metal structures, bone pins, or plates; when treating fractures with the help of Ilizarov, Volkov-Oganesyan and others, it is possible to more early dates include active muscle contractions and movements in adjacent joints.

The solution of general problems is facilitated by general developmental exercises, breathing exercises of a static and dynamic nature, exercises for coordination, balance, with resistance and weights. Lightweight IP and exercises on sliding planes are used first. Exercise should not cause or increase pain. For 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 act on segments of the damaged limb, free from immobilization, starting the effect above the site of injury. In patients undergoing skeletal traction, massage of the healthy limb and extrafocal massage on the damaged one begin on the 2-3rd day. All massage techniques are used, especially those that help relax the muscles on the affected side.

Contraindications : purulent processes, thrombophlebitis.

II period (post-immobilization).

The second period begins after removal of the plaster cast or traction. The patients developed the usual callus, but in most cases the muscle strength was reduced and the range of motion in the joints was limited. During this period, exercise therapy is aimed at further normalizing trophism in the area of injury for the final formation of callus, eliminating muscle atrophy and achieving a normal range of motion in the joints, eliminating temporary compensation, and restoring posture.

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

Active agents are used for the affected limb. gymnastic exercises in lightweight, IP, which alternate with relaxation exercises for muscles with increased tone. To restore muscle strength, exercises with resistance, objects, or against a gymnastic wall are used.

Massage is prescribed for muscle weakness, hypertonicity and is carried out using a suction technique, starting above the site of injury. Massage techniques are alternated with elementary gymnastic exercises.

III period (recovery).

In the third period, exercise therapy is aimed at restoring the full range of motion in the joints and further strengthening the muscles. General developmental gymnastic exercises are used with greater load, supplemented with walking, swimming, physical exercise in water, and mechanotherapy.

6. Exercise therapy for fractures of the lower extremities.

For cervical fractures femur Therapeutic exercises begin on the 1st day, using breathing exercises. On the 2-3rd day, include abdominal exercises. 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 the healthy limb. In patients with a plaster cast, static muscle exercises are used on the 8-10th day hip joint. In the second period, it is necessary to prepare for walking and, when the fragments heal, to restore walking. Exercises are prescribed to restore muscle strength. First, with the help, and then actively, the patient performs abduction and adduction, raising and lowering the leg. They teach walking with crutches and then without them. In the third period, the restoration of muscle strength and full joint mobility continues.

At surgical treatment- osteosynthesis - the length of time the patient remains on bed rest is significantly reduced. 2-4 weeks after surgery, you are allowed to walk with the help of crutches. To walk the patient in bed, exercises are used for the hip joint, asking him to sit down with the help of various devices (straps, “reins”, fixed bars above the bed).

For fractures of the diaphysis and distal femur in the first period, special exercises are used for joints free from immobilization. For the damaged segment, ideomotor and isometric exercises are used. For fractures of the femur and tibia 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 measured. In the second period, the volume of exercises is expanded, taking into account the strength of the callus and the state of reposition. In the third period, with good fusion, walking is trained, gradually increasing the load.

In case of periarticular and intra-articular fractures of the distal femur, it is necessary to strive for an earlier restoration of movements in the knee joint. With correct reposition and impending fusion, first use isometric exercises, then active ones - flexion and extension of the leg, raising the leg (with a short-term switch off of the load traction (with skeletal traction). The load is increased very gradually, slowly. During exercises for the knee joint, the area of the femur fracture fixed with hands and 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 with Ilizarov and other apparatuses, in the first days, isometric exercises are used in the area of the operated segment and exercises for all non-immobilized joints.

At open injuries 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 surgery. For 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 uninjured joints and the healthy leg. In patients without immobilization, exercises with a small amplitude are used for the knee joint using the healthy leg in the IP lying on its side. For the ankle and hip joints, use active exercises, supporting the thigh with your hands. In the second period, mainly active exercises are used with caution in the area of the knee joint with axial load to restore walking. In the third period, supporting function and walking are restored.

For fractures of the shin bones, when treated with 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 as you raise and lower your pelvis. In patients after osteosynthesis, walking with crutches is allowed early, stepping on the affected leg and the load on it is gradually increased (axial load). In the second period, exercises are continued for full support and restoration of the range of motion in the ankle joint. Exercises are used to eliminate foot deformities. Period III exercises 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 feet. In case of fractures of the tibial condyles, very carefully, only after 6 weeks do they allow the weight of the body to be loaded on the knee joint. With osteosynthesis, exercises for the knee and ankle joint are prescribed in the 1st week, and axial loads are prescribed 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 movements in the knee and hip joints, in the absence of contraindications, exercises with pressure on the plantar surface. Supporting the foot when walking with crutches is allowed if correct positioning feet. In the second period, exercises are used to strengthen the muscles of the arch of the foot. In the third period, correct walking is restored.

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

6.1 Approximate complexes of therapeutic exercises.

6.1.1. Exercises for the ankle and foot joints.

IP - lying on your back or sitting with your legs slightly bent at the knee joints. Flexion and extension of the toes (actively passive). Flexion and extension of the foot of the healthy leg and the patient leg alternately and simultaneously. Circular movements in the ankle joints of the healthy leg and the diseased leg alternately and simultaneously. Rotation of the foot inward and outward. Extension of the foot with increasing range of motion using a band with a loop. The pace of exercise is slow, medium or varying (20-30 times).

IP - the same. The toes are placed one on top of the other. Flexion and extension of the foot with resistance provided by one leg while the other moves. Slow pace (15-20 times).

IP - sitting with legs slightly bent at the knee joints. Grasping small objects (balls, pencils, etc.) with your toes.

IP - sitting: a) feet of both legs on a rocking chair. Active flexion and extension for the healthy and passive for the patient. The pace is slow and medium (60-80 times), b) the foot of the sore leg on a rocking chair. Active flexion and extension of the foot. The pace is slow and medium (60-80 times).

IP - standing, holding the bar of the gymnastic wall, or standing with your hands on your belt. Raising on the toes and lowering the entire foot Raising the toes and lowering the entire foot. The pace is slow (20-30 times).

IP - standing on the 2-3rd rail of the gymnastic wall, grip with your hands at chest level. Spring movements on the toes, try to lower the heel as low as possible. The pace is average (40-60 times).

6.1.2. Exercises for the knee joint.

IP - sitting in bed. The leg muscles are relaxed. Grasping the patella with your hand. Passive displacements to the sides, up, down The pace is slow (18-20 times).

IP - lying on your back, the sore leg is bent, supported by your hands on your thigh or resting on a bolster. Flexion and extension of the EG knee joint with the heel lifted off the bed. The pace is slow (12-16 times).

IP - sitting on the edge of the bed, legs down: a) flexion and extension of the sore leg at the knee joint with the help of the healthy one. The pace is slow (10-20 times); b) active alternating flexion and extension of the legs at the knee joints. The pace is average (24-30 times).

IP - lying on your stomach. Bending the affected leg at the knee joint while gradually overcoming the resistance of a load weighing from 1 to 4 kg. The pace is slow (20-30 times).

IP - standing with support on the headboard. Raise the sore leg bent at the knee joint forward, straighten it, and lower it. The pace is slow and medium (8-10 times).

6.1.3. Exercises for all joints of the lower limb.

IP - lying on your back, the patient’s foot resting on a medicine ball. Rolling the ball towards the body and into the IP. The pace is slow (5-6 times).

IP - lying on your back, holding the edges of the bed with your hands. "Bike". The pace is medium to fast (30-40 times).

IP - standing facing the headboard with support from your hands: a) alternately raising your legs forward, bending them at the knee and hip joints. The tempo is slow (8-10 times); b) half squat. The tempo is slow (8-10 times); c) deep squat. The pace is slow (12-16 times).

IP - standing, sore leg one step forward. Bend the affected leg at the knee and tilt the torso forward to a “lunge” position. The pace is slow (10-25 times).

IP - standing facing the gymnastics wall. Wall climbing on toes with additional spring squats on the toe of the sore leg. The pace is slow (2-3 times).

IP - hanging with your back to the gymnastic wall: a) alternate and simultaneous raising of the legs bent at the knee joints; b) alternate and simultaneous raising of straight legs. The pace is slow (6-8 times).

6.1.4. Some exercises in plaster immobilizing bandages; exercises that prepare you for walking.

IP - lying on your back (high plaster hip cast). Tension and relaxation of the quadriceps femoris (“patella play”). The pace is slow (8-20 times).

IP - the same, holding the edges of the bed with his hands. Foot pressure on the instructor's hand, board or box. The pace is slow (8-10 times).

IP - lying on your back (high cast). With the help of an instructor, turn onto your stomach and back. The pace is slow (2-3 times).

IP - the same, arms bent in elbow joints, the healthy leg is bent at the knee joint with support on the foot. Raising the sore leg. The pace is slow (2-5 times).

IP - lying on your back, on the edge of the bed (high plaster hip cast). Leaning on your hands and lowering your sore leg over the edge of the bed, sit down. The pace is slow (5-6 times).

IP - standing (high plaster hip cast), holding the headboard of the bed with one hand or hands on the belt. Bend the torso forward, placing the sore leg back on the toe and bending the healthy one. The pace is slow (3-4 times).

IP - standing on a gymnastic bench or on the 2nd rail of a gymnastic wall on a healthy leg, the patient is freely lowered: a) rocking the affected leg (12-16 movements); b) copying the figure eight with the sore leg (4-6 times).

IP - walking with the help of crutches (without leaning on the sore leg, stepping lightly on the sore leg, loading the sore leg). Options: walking with one crutch and a stick, with one crutch, with one stick.

6.2 Mechanotherapy.

It is advisable to use pendulum-type devices with loads of various weights.

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

The main tasks of mechanotherapy:

Increased range of motion in affected joints;

· strengthening weakened hypotrophied muscles and improving their tone;

· improvement of the function of the neuromuscular system 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, determine the degree of muscle wasting of the limb visually and by measuring it with a centimeter, as well as the severity of pain at rest and during movement.

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

Indications for the use of mechanotherapy:

· restriction of movements in joints of any degree;

· wasting of the muscles of the limbs;

· contractures.

Contraindications:

presence of ankylosis.

In accordance with the systematization of exercises on mechanotherapeutic 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 gentle and training; mainly of a training nature; in the final one, learning elements are added to continue independent studies therapeutic exercises at home.

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

In case of ankylosis of the joints, mechanotherapy for these joints is not advisable, but nearby non-ankylotic joints with for preventive purposes should be trained on the apparatus as early as possible.

When using mechanotherapy, you should adhere to the principle of sparing the affected organ and gradually implementing the training.

Before the procedure, the patient must be explained the importance of mechanotherapy. It must be carried out in the presence of medical personnel, which can simultaneously monitor several patients exercising on different devices. The mechanotherapy room should have either an hourglass or a special signal clock.

The mechanotherapy procedure is carried out with the patient sitting near the apparatus (with the exception of procedures for shoulder joint which are carried out with the patient standing and for the hip joint, which are carried out in a lying position).

The patient's position on the chair should be comfortable, with support on his back, all muscles should be relaxed, breathing should be voluntary.

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 range of motion, including frequent pauses for rest. The duration of the first procedure is no more than 5 minutes, and in the presence of significantly severe pain - no more than 2-3 minutes. In severely ill patients, the first mechanotherapy procedures can be carried out without a load in order to make it easier for the patient to receive 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 therapeutic exercises procedure. Gradually exercise all affected joints.

In the first days, the mechanotherapy procedure is carried out once a day, exercising all affected joints, subsequently - 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 the duration of the procedure and the weight of the load used. The degree of hypotrophy of the muscles being exercised, the severity of the pain syndrome, the tolerability of the procedure should be taken into account, and for those patients in whom these symptoms are less pronounced, the load can be increased more actively.

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

Knee-joint . Using the device, the flexors and extensors of this joint are affected. The patient's IP is sitting. It is necessary that the chair and thigh support are at the same level. The thigh and lower leg are secured with straps on a moving bracket with a stand. With the leg extended, the patient does active flexion, and with the leg bent, 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 are affected. The patient's IP is sitting on a high chair. The exercised foot is fixed on the footrest bed using straps, the second leg is on a stand 25-30 cm high. The patient sits, the knee is bent - active flexion of the foot, with the knee joint straightened - 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 lower leg muscles occurs faster, and therefore increasing the duration of the procedure and the weight 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 secured using a gear coupling.

Therapeutic gymnastics is carried out in a fresh water pool for deforming osteoarthritis, water temperature 30-32°C. Objectives of the introductory section of the procedure - adaptation to aquatic environment, identifying the degree of pain and limitation of movement, swimming ability, duration 3-6 minutes. In the main section (10-30 min) the training tasks are carried out. The final section of the procedure - it lasts 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, simulating “clean hangs”; the volume of general physical and special load during the procedure is changed due to different depths of the patient’s immersion in water, the pace of exercises, changes in the specific gravity of exercises for small, medium and large muscle groups with varying degrees of effort. They also change the ratio of active and passive exercises, with elements of relief and relaxation of muscles, with inflatable, foam floating objects and equipment, exercises on a hanging chair, with fins-gloves and fins for feet, with water dumbbells, exercises of a static nature, simulating “clean” hangs "and mixed, isometric stress, breathing exercises, rest breaks, imitation of elements of swimming in 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 rings, “frogs”, etc.), exercises without support on the bottom of the pool. Active movements prevail in water. The range of movements at the beginning of the procedure is limited to the point of pain; sudden jerking movements are excluded. As a result of the procedure, increased pain, paresthesia, and convulsions should not be allowed. The course of treatment consists of 10-17 procedures, the duration of the procedure is 15-20 minutes.

Contraindicated therapeutic exercises in the pool:

· patients with severe pain syndrome with symptoms of reactive secondary synovitis;

· the first 3 days after joint puncture.

Bibliography.

1. Big medical encyclopedia. / Ed. B.V. Petrovsky - M.: “Sov. Encyclopedia", 1980 – vol. 13.

2. V. A. Epifanova “Therapeutic physical culture. Directory". – M.: “Medicine”, 1988.

3. Vydrin V. M., Zykov B. K., Lotonenko A. V. Physical culture of university students. – M.: 1996.

4. Demin D.F. Medical supervision during physical exercise classes. – St. Petersburg: 1999.

5. Kots Ya.M., Sports physiology. – M.: Physical culture and sport, 1986.

6. I. L. Krupko. Guide to traumatology and orthopedics - Leningrad: “Medicine”, 1976.

7. G. S. Yumashev. Traumatology and orthopedics. – M.: “Medicine”, 1977.

8. A. N. Bakulev, F. F. Petrov “Popular medical encyclopedia.” – St. Petersburg: 1998.

9. Petrovsky B.V. “Popular medical encyclopedia.” – Tashkent, 1993.

10. Encyclopedia of health. / Ed. V.I. Belova. – M.: 1993.

11. N. M. Amosov, Y. A. Bendet. Human health - M.: 1984.

At least one tenth of the total number of all fractures are fractures of the tibia. Moreover, if appropriate treatment has not been carried out, this can lead to very serious consequences, at a minimum - loss of ability to work. Physical therapy plays a significant role in therapy.

Physical therapy for tibia fractures is divided into three stages. The first of them is devoted to solving the following problems:

Elimination of edema.
Raising muscle tone.
Acceleration of restoration of lymph and blood circulation in the leg.
Increased joint mobility.

During this period, general developmental, various movements aimed at developing joints, breathing and special exercises alternate (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 of the toes and the legs themselves in the hip joint, such as extension and flexion, adduction and abduction, various rotation exercises).

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

At the second stage of rehabilitation for existing injuries and injuries of the ankle joint, the main goals of physical therapy change to the following:

Elimination of swelling of the affected leg.
Restoring the ability to move and all functions of the ankle joint.
Prevention and prevention of complications such as curvature of fingers, growth of “spurs” (most often observed in the area calcaneus), traumatic flat feet, foot deformity, etc.

In the first days, all physical therapy exercises are performed in lighter conditions, that is, with the help of roller carts, sliding planes, block installations, etc. Exercises that involve muscle tension alternate with relaxation exercises and breathing exercises. At this stage, in addition to breathing and general developmental exercises for the injured limb, many different exercises are added for the development and restoration of the ankle joint. These exercises are performed from various starting positions - on the stomach, sitting, on the side, lying on your back, resting your feet on the floor, sitting with your feet in weight, sitting while supporting the sore leg with the help of the healthy one, on all fours, etc.

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

Starting position - lying on your back:

Flexion and extension of the feet at the sole.
Alternating adduction and abduction of the straightened leg to the side along the bed.
The “bicycle” exercise is performed with both legs at the same time.
Internal and external rotation of the injured leg.
Extension and flexion of toes.
Extension and bending of the legs at the knee, both simultaneous and alternating.
Tension of the thigh muscles for 4-5 seconds.
Internal rotation of the feet.

Starting position - lying on your stomach:

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

Starting position - sitting on a chair:

Grasping small objects with your toes and holding them for a short time.
Alternating extension and bending of the legs at the knees, both simultaneous and alternating.
Medicine ball exercises.

All exercises are performed without excessive tension in a calm, measured rhythm. Each exercise is repeated 7-8 times. Breathing may be arbitrary.

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

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

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

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Ministry of Education of the Russian Federation

On the topic “Therapeutic physical education for fractures of the lower extremities”

Introduction

1. History of the development of exercise therapy

5.1 Approximate complexes of therapeutic exercises

5.1.3 Exercise for all joints of the lower extremities

5.2 Mechanotherapy

Bibliography

Introduction

Physiotherapy is an independent scientific discipline. In medicine, this is a treatment method that uses physical education for prevention, treatment, rehabilitation and supportive care. Exercise therapy forms in a person a conscious attitude towards physical exercise and, in this sense, has educational value; develops strength, endurance, coordination of movements, instills hygiene skills, hardening the body with natural factors. Exercise therapy is based on modern scientific data in the field of medicine, biology, and physical education.

The main means of exercise therapy are physical exercises, used in accordance with the objectives of treatment, taking into account the etiology, pathogenesis, clinical features, functional state of the body, and the degree of general physical performance.

Physiotherapy:

1. a natural biological method, since it uses the body’s inherent function of movement;

2. a method of nonspecific therapy, but at the same time, certain types of exercises can affect certain functions of the body;

3. method of pathogenetic therapy, due to the ability of physical exercise to influence the reactivity of the body;

4. a method of active functional therapy, as it adapts the patient’s body to increasing physical activity;

5. method of maintenance therapy at the stages of medical rehabilitation in elderly people;

6. method of restorative therapy in complex treatment of patients.

7. A characteristic feature of exercise therapy is the process of training patients with physical exercises.

There are general and special training:

1. general training is aimed at improving health and strengthening the patient’s body with the help of general strengthening exercises;

2. special training is carried out with exercises that specifically target the affected organ, the area of injury.

Massage is a method of treatment, prevention, rehabilitation after illness and recovery, which is a set of techniques of mechanical, dosed influence on various areas of the surface of the human body, performed by the hands of a massage therapist or special devices. To achieve a positive result when using massage, it is necessary to differentiate its technique depending on the etiology, pathogenesis, clinical features, functional state of the central and nervous system (CNS), and the nature of the influence of various techniques on the body.

Exercise therapy is used in the pre- and postpartum periods. Massage etc. physical exercises contribute to improved psychophysical development of healthy children and are used in nurseries, kindergartens, and at home.

1. History of the development of exercise therapy

physical therapy plaster gymnastics

Physical exercises for the purpose of treatment and prevention were used in ancient times, 2 thousand years BC in China and India. In Ancient Rome and Ancient Greece, physical exercise and massage were integral in everyday life, military affairs, and treatment. Hippocrates (460-370 BC) described the use of physical exercises and massage for diseases of the heart, lungs, metabolic disorders, etc. Ibn Sina (Avicenna, 980-1037) highlighted in his works the method of using physical exercises for sick and healthy, dividing loads into small and large, strong and weak, fast and slow. During the Renaissance (XIV-XVI centuries), physical exercise was promoted as a means to achieve harmonious development.

In Russia, outstanding clinicians such as M. Ya. Mudrov (1776-1831), N. I. Pirogov (1810-1881), S. P. Botkin (1831-1889), G. A. Zakharyin (1829-1897 ), A. A. Ostroumov. (1844--1908), attached great importance to the use of physical exercises in treatment practice.

The works of P. F. Lesgaft (1837-1909), V. V. Gorinevsky (1857-1937) contributed to the understanding of the unity of mental and physical education for more perfect human development.

The discoveries of great physiologists - I. M. Sechenov (1829-1922), Nobel Prize laureate I. P. Pavlov (1849-1936), N. E. Vvedensky (1852-1922), who substantiated the importance of the central nervous system for the life of the body - influenced the development of a new approach to the comprehensive assessment of a sick person. Treatment of diseases gives way to treatment of the patient. In this regard, the ideas of functional therapy and exercise therapy are beginning to spread more widely in the clinic, being such a method, it has found recognition and wide application.

Textbooks on physical therapy by I. M. Sarkizov-Serazini went through a number of editions. The first People's Commissar of Health N.A. Semashko (1874-1949) attached great importance to physical therapy. On his initiative, in the early 1930s, departments were opened in a number of research institutes, departments of physical therapy were created in institutes for advanced training of doctors and some medical universities. A major role in the organization of medical and physical education services belongs to B.A. Ivanovsky (1890-1941), since 1931, head of the department of medical supervision and physical therapy at the Central Institute for Advanced Medical Training.

In the 30s and 40s, monographs, manuals, and manuals on physical therapy were published (V.V. Gorinevskaya, E.F. Dreving, M.A. Minkevich, etc.).

During the Great Patriotic War, physical therapy was widely used in hospitals.

In 1941, the department of therapeutic physical education and medical supervision at the Central Institute of Advanced Medical Training and the department of therapeutic physical education at the Institute of Physiotherapy - later at the Central Institute of Balneology and Physiotherapy of the USSR Ministry of Health - was headed by Corresponding Member of the USSR Academy of Medical Sciences V. N. Moshkov. The fruitful pedagogical and scientific activity of V. N. Moshkov has found wide recognition in the country and abroad, he is the founder of the modern school of physical therapy, he wrote monographs on all the main areas of physical therapy, trained a large number of doctors and candidates of science who headed departments and departments in universities and research institutes of the country.

Currently in Moscow, the department is successfully training specialists and conducting scientific work at the Russian State Medical University (head of department B. A. Polyaev), Moscow State Medical and Dental University (head of department V. A. Epifanov), Russian Medical Academy of Postgraduate education (head of department K.P. Levchenko) and other medical higher educational institutions of Russia.

2. General basics of physical therapy

Exercise therapy exercises have a therapeutic effect only with proper, regular, long-term use of physical exercises. For these purposes, a methodology for conducting classes, indications and contraindications for their use, taking into account effectiveness, and hygienic requirements for training places have been developed.

There are general and specific methods of exercise therapy. The general methodology of exercise therapy provides rules for conducting classes (procedures), classification of physical exercises, dosage of physical activity, a scheme for conducting classes at different periods of the course of treatment, rules for constructing a separate lesson (procedure), forms of application of exercise therapy, and diagrams of movement modes. Private exercise therapy techniques are intended for a specific nosological form of the disease, injury and are individualized taking into account the etiology, pathogenesis, clinical characteristics, age, and physical fitness of the patient. Special exercises to influence the affected systems and organs must be combined with general strengthening exercises, which provides general and special training.

Physical exercise should not increase pain, since pain reflexively causes vasospasm and stiffness of movement. Exercises that cause pain should be carried out after preliminary relaxation of the muscles, at the moment of exhalation, in optimal starting positions. From the first days of classes, the patient should be taught proper breathing and the ability to relax muscles. Relaxation is more easily achieved after vigorous muscle tension. With unilateral lesions of the limbs, relaxation training begins with a healthy limb. Musical accompaniment of classes increases their effectiveness.

2.1 Classification of physical exercises

Physical exercises in exercise therapy are divided into three groups: gymnastics, applied sports and games.

Gymnastic exercises.

Consist of combined movements. With their help, you can influence various systems of the body and individual muscle groups, joints, developing and restoring muscle strength, speed, coordination, etc. All exercises are divided into general developmental (general strengthening), special and breathing (static and dynamic).

1. General strengthening exercises

Used to heal and strengthen the body, increase physical performance and psycho-emotional tone, activate blood circulation and breathing. These exercises facilitate the therapeutic effect of special ones.

2. Special exercises

Selectively act on the musculoskeletal system. For example, on the spine - with its curvature, on the foot - with flat feet and injury. For a healthy person, exercises for the torso are general strengthening; for osteochondrosis and scoliosis, they are classified as special, since their action is aimed at solving treatment problems - increasing the mobility of the spine, correcting the spine, strengthening the muscles surrounding it. Exercises for the legs are general strengthening for healthy people, and after surgery on the lower extremities, injury, paresis, joint diseases, these same exercises are classified as special. The same exercises, depending on the method of their application, can solve different problems. For example, extension and flexion in the knee or other joint in some cases is aimed at developing mobility, in others - to strengthen the muscles surrounding the joint (exercises with weights, resistance), in order to develop muscle-joint sense (accurate reproduction of movement without visual control ). Typically, special exercises are used in combination with general developmental exercises.

Gymnastic exercises are divided into groups:

· according to anatomical characteristics;

· by the nature of the exercise;

· by species;

based on activity;

· based on the objects and projectiles used.

Based on anatomical characteristics, the following exercises are distinguished:

· for small muscle groups (hands, feet, face);

· for medium muscle groups (neck, forearms, shoulder, lower leg, thigh);

· for large muscle groups (upper and lower limbs, torso),

· combined.

Based on the nature of muscle contraction, exercises are divided into two groups:

· dynamic (isotonic);

· static (isometric).

Dynamic exercises are most often used. In this case, periods of contraction alternate with periods of relaxation.

Other groups of exercises are also distinguished by their nature. For example, stretching exercises are used to treat joint stiffness.

Based on type, exercises are divided into exercises:

· in throwing,

· for coordination,

· for balance,

· in resistance,

· hangs and supports,

· climbing,

· corrective,

· respiratory,

· preparatory

· ordinal.

Balance exercises are used to improve coordination of movements, improve posture, as well as to restore this function in diseases of the central nervous system and vestibular apparatus. Corrective exercises are aimed at restoring the correct position of the spine, chest and lower extremities. Coordination exercises restore overall coordination of movements or individual body segments. They are used from different IPs with different combinations of movements of the arms and legs in different planes. Necessary for diseases and injuries of the central nervous system and after prolonged bed rest.

Based on activity, dynamic exercises are divided into the following:

· active,

· passive,

· for relaxation.

To perform exercises with effort, resistance is applied by the instructor or a healthy limb.

Depending on the gymnastic apparatus and equipment used, exercises are divided into the following:

· exercises without objects and equipment;

· exercises with objects and equipment (gymnastic sticks, dumbbells, clubs, medicine balls, jump ropes, expanders, etc.);

· exercises on apparatus, simulators, mechanical devices.

Sports and applied exercises.

Applied sports exercises include walking, running, crawling and climbing, throwing and catching a ball, rowing, skiing, skating, cycling, health path (metered climbing), hiking. Walking is most widely used for a wide variety of diseases and almost all types and forms of exercise. The amount of physical activity when walking depends on the length of the path, the size of the steps, the pace of walking, the terrain and difficulty. Walking is used before starting classes as a preparatory and organizing exercise. Walking can be complicated - on toes, on heels, walking in a cross step, in a half-squat, with high knees. Special walking - on crutches, with a stick, on prostheses - is used when the lower extremities are affected. Walking speed is divided into: slow - 60-80 steps per minute, medium - 80-100 steps per minute, fast - 100-120 steps per minute and very fast - 120-140 steps per minute.

Games are divided into four groups of increasing load:

· on site;

· sedentary;

· movable;

· sports.

3. Forms and methods of physical therapy

Hygienic gymnastics is intended for the sick and healthy. Carrying it out in the morning after a night's sleep is called morning hygienic gymnastics; it helps relieve inhibition processes and promote vigor.

Therapeutic gymnastics is the most common form of using physical exercises for the purposes of treatment and rehabilitation. The ability, through a variety of exercises, to purposefully influence the restoration of damaged organs and systems determines the role of this form in the exercise therapy system. Classes (procedures) are carried out individually for seriously ill patients, in small group (3-5 people) and group (8-15 people) methods. Patients are grouped into groups according to nosology, i.e. with the same disease; according to the location of the injury. It is wrong to group patients with different diseases into one group.

In the final section, the load is gradually reduced.

The density of classes is very important, i.e. time of actual exercises, expressed as a percentage of the total time of the lesson. In inpatients, the density gradually increases from 20-25 to 50%. During sanatorium-resort treatment on a training regimen in groups of general physical training, the density of classes of 80-90% is acceptable. Individual independent exercises complement the therapeutic exercises conducted by the instructor, and can subsequently be carried out only independently with periodic visits to the instructor to receive instructions.

The gymnastic method, carried out in therapeutic gymnastics, has become most widespread. The game method complements it when working with children.

The sports method is used to a limited extent and mainly in sanatorium and resort practice.

When using exercise therapy, you should follow the principles of training, taking into account the therapeutic and educational objectives of the method.

· Individualization in methodology and dosage, taking into account the characteristics of the disease and the general condition of the patient.

· Systematic and consistent use of physical exercises. They start with simple ones and move on to complex exercises, including 2 simple and 1 complex new exercise in each lesson.

· Regularity of exposure.

· Duration of classes ensures the effectiveness of treatment.

· Gradual increase in physical activity during the treatment process to ensure a training effect.

· Diversity and novelty in the selection of exercises are achieved by updating them by 10-15% with repeating 85-90% of the previous ones to consolidate the results of treatment.

· Moderate, prolonged or fractional loads are more appropriate to use than increased loads.

· Maintain a cyclic pattern of alternating exercises with rest.

· The principle of comprehensiveness - provides for an impact not only on the affected organ or system, but also on the entire body.

· Visualization and accessibility of exercises - especially necessary in exercises with lesions of the central nervous system, with children and the elderly.

· Conscious and active participation of the patient is achieved by skillful explanation and selection of exercises.

4. Therapeutic exercise for injuries and some diseases of the movement apparatus

Injuries to the musculoskeletal system cause disturbances in the anatomical integrity of tissues and their functions, accompanied by both local and general reactions from various body systems.

More often than others, in 70-75% of patients with fractures, the fixation method is used by applying fixing bandages made of plaster and polymer materials.

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

Therapeutic exercise is an essential component of complex treatment, as it helps restore the functions of the musculoskeletal system and has a beneficial effect on various body systems based 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 on the first day of injury when severe pain disappears.

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

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

I period (immobilization).

In the first period, fusion of fragments occurs (formation of primary bone callus) after 60-90 days. Special objectives of exercise therapy: improve trophism in the area of injury, accelerate fracture consolidation, help prevent muscle atrophy, joint stiffness, and 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. All intact segments and non-immobilized joints on the injured limb are included in the movement process. Static muscle tension in the area of injury and movement in immobilized joints (under a plaster cast) is used when the fragments are in good condition and are completely fixed. The risk of displacement is less when connecting fragments with metal structures, bone pins, or plates; when treating fractures with the help of Ilizarov, Volkov-Oganesyan and others, it is possible to include active muscle contractions and movements in adjacent joints at an earlier time.

Contraindications: purulent processes, thrombophlebitis.

II period (post-immobilization).

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

For the affected limb, active gymnastic exercises are used in light, IP, which alternate with relaxation exercises for muscles with increased tone. To restore muscle strength, exercises with resistance, objects, or against a gymnastic wall are used.

III period (recovery).

5. Exercise therapy for fractures of the lower extremities

For fractures of the femoral neck, therapeutic exercises begin on the 1st day, using breathing exercises. On the 2-3rd day, include abdominal exercises. 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 the healthy limb. In patients with a plaster cast, static exercises for the muscles of the hip joint are used on the 8-10th day. In the second period, it is necessary to prepare for walking and, when the fragments heal, to restore walking. Exercises are prescribed to restore muscle strength. First, with the help, and then actively, the patient performs abduction and adduction, raising and lowering the leg. They teach walking with crutches and then without them. In the third period, the restoration of muscle strength and full joint mobility continues.

With surgical treatment - osteosynthesis - the length of time the patient remains on bed rest is significantly reduced. 2-4 weeks after surgery, you are allowed to walk with the help of crutches. To walk the patient in bed, exercises are used for the hip joint, asking him to sit down with the help of various devices (straps, “reins”, fixed bars above the bed).

In case of periarticular and intra-articular fractures of the distal femur, it is necessary to strive for an earlier restoration of movements in the knee joint. With correct reposition and impending fusion, first use isometric exercises, then active ones - flexion and extension of the leg, raising the leg (with a short-term switch off of the load traction (with skeletal traction). The load is increased very gradually, slowly. During exercises for the knee joint, the fracture area The hips are secured with hands and cuffs.

For 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 surgery. For 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 uninjured joints and the healthy leg. In patients without immobilization, exercises with a small amplitude are used for the knee joint using the healthy leg in the IP lying on its side. For the ankle and hip joints, use active exercises, supporting the thigh with your hands. In the second period, mainly active exercises are used with caution in the area of the knee joint with axial load to restore walking. In the third period, supporting function and walking are restored.

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 down with a raised leg, movements are used in the ankle joint, active movements 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 if the foot is positioned correctly. In the second period, exercises are used to strengthen the muscles of the arch of the foot. In the third period, correct walking is restored. For all injuries, water exercises, massage, and physiobalneotherapy are widely used.

5.1 Approximate complexes of therapeutic exercises.

5.1.1 Exercises for the ankle and foot joints

IP - the same. The toes are placed one on top of the other. Flexion and extension of the foot with resistance provided by one leg while the other moves. Slow pace (15-20 times).

IP - sitting with legs slightly bent at the knee joints. Grasping small objects (balls, pencils, etc.) with your toes.

IP - sitting: a) feet of both legs on a rocking chair. Active flexion and extension for the healthy and passive for the patient. The pace is slow and average (60-80 times), b) the foot of the sore leg on a rocking chair. Active flexion and extension of the foot. The pace is slow and medium (60-80 times).

IP - standing on the 2-3rd rail of the gymnastic wall, grip with your hands at chest level. Spring movements on the toes, try to lower the heel as low as possible. The pace is average (40-60 times).

5.1.2 Exercises for the knee joint

IP - sitting in bed. The leg muscles are relaxed. Grasping the patella with your hand. Passive displacements to the sides, up, down The pace is slow (18-20 times).

IP - lying on your stomach. Bending the affected leg at the knee joint while gradually overcoming the resistance of a load weighing from 1 to 4 kg. The pace is slow (20-30 times).

IP - standing with support on the headboard. Raise the sore leg bent at the knee joint forward, straighten it, and lower it. The pace is slow and medium (8-10 times).

5.1.3 Exercises for all joints of the lower limb

IP - lying on your back, the patient’s foot resting on a medicine ball. Rolling the ball towards the body and into the IP. The pace is slow (5-6 times).

IP - lying on your back, holding the edges of the bed with your hands. "Bike". The pace is medium to fast (30-40 times).

IP - standing facing the head of the bed with support from your hands: a) alternately raising your legs forward, bending them at the knee and hip joints. The tempo is slow (8-10 times); b) half squat. The tempo is slow (8-10 times); c) deep squat. The pace is slow (12-16 times).

IP - standing, sore leg one step forward. Bend the affected leg at the knee and tilt the torso forward to a “lunge” position. The pace is slow (10-25 times).

IP - standing facing the gymnastics wall. Wall climbing on toes with additional spring squats on the toe of the sore leg. The pace is slow (2-3 times).

5.1.4 Some exercises in plaster immobilizing bandages; exercises to prepare for walking

IP - lying on your back (high plaster hip cast). Tension and relaxation of the quadriceps femoris (“patella play”). The pace is slow (8-20 times).

IP - the same, holding the edges of the bed with his hands. Foot pressure on the instructor's hand, board or box. The pace is slow (8-10 times).

IP - lying on your back (high cast). With the help of an instructor, turn onto your stomach and back. The pace is slow (2-3 times).

IP - the same, arms are bent at the elbow joints, the healthy leg is bent at the knee joint with support on the foot. Raising the sore leg. The pace is slow (2-5 times).

IP - lying on your back, on the edge of the bed (high plaster hip cast). Leaning on your hands and lowering your sore leg over the edge of the bed, sit down. The pace is slow (5-6 times).

IP - standing (high plaster hip cast), holding the headboard with one hand or hands on the belt. Bend the torso forward, placing the sore leg back on the toe and bending the healthy one. The pace is slow (3-4 times).

5.2 Mechanotherapy

It is advisable to use pendulum-type devices with loads of various weights.

The main tasks of mechanotherapy:

Increased range of motion in affected joints;

· strengthening weakened hypotrophied muscles and improving their tone;

· improvement of the function of the neuromuscular system of the exercised limb;

· increased blood and lymph circulation, as well as tissue metabolism of the affected limb.

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

Indications for the use of mechanotherapy:

· restriction of movements in joints of any degree;

· wasting of the muscles of the limbs;

· contractures.

Contraindications:

presence of ankylosis.

In accordance with the systematization of exercises on mechanotherapeutic 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 gentle and training; mainly of a training nature; in the final stage, elements of training are added to continue independent exercises at home.

Mechanotherapy is prescribed simultaneously with therapeutic gymnastics procedures. It can be used in the subacute and chronic stages of the 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, and low-grade fever are not contraindications for mechanotherapy. In case of a pronounced exudative component in the joint with hyperemia and an increase in the temperature of the skin above it, with pronounced activity of the rheumatoid process, mechanotherapy procedures are added with great caution, only after 4-6 procedures of therapeutic exercises at a minimum dosage and with its gradual increase. The same conditions should be observed in case of significant limitation of mobility in the joint.

In case of ankylosis of the joints, mechanotherapy for these joints is not advisable, but nearby non-ankylotic joints should be trained on devices as early as possible for preventive purposes.

When using mechanotherapy, you should adhere to the principle of sparing the affected organ and gradually implementing the training.

Before the procedure, the patient must be explained the importance of mechanotherapy. It must be carried out in the presence of medical personnel, who can simultaneously monitor several patients exercising on different devices. The mechanotherapy room should have either an hourglass or a special signal clock.

The mechanotherapy procedure is carried out with the patient sitting in front of the apparatus (with the exception of procedures for the shoulder joint, which are carried out with the patient standing, and for the hip joint, which are carried out in a lying position).

The patient's position on the chair should be comfortable, with support on his back, all muscles should be relaxed, breathing should be voluntary.

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 range of motion, including frequent pauses for rest. The duration of the first procedure is no more than 5 minutes, and in the presence of significantly pronounced pain syndrome, no more than 2-3 minutes. In severely ill patients, the first mechanotherapy procedures can be carried out without a load in order to make it easier for the patient to receive 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.

While observing the general principles of mechanotherapy procedures, it should be individualized for different joints.

Knee-joint. Using the device, the flexors and extensors of this joint are affected. The patient's IP is sitting. It is necessary that the chair and thigh support are at the same level. The thigh and lower leg are secured with straps on a moving bracket with a stand. With the leg extended, the patient does active flexion, and with the leg bent, 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 are affected. The patient's IP is sitting on a high chair. The exercised foot is fixed on the footrest bed using straps, the second leg is on a stand 25-30 cm high. The patient sits, the knee is bent - active flexion of the foot, with the knee joint straightened - 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 lower leg muscles occurs faster, and therefore increasing the duration of the procedure and the weight 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 secured using a gear coupling. Therapeutic gymnastics is carried out in a fresh water pool for deforming osteoarthritis, water temperature 30-32°C. The objectives of the introductory section of the procedure are adaptation to the aquatic environment, identifying the degree of pain and limitation of movements, swimming skills, duration 3-6 minutes. In the main section (10-30 min) the training tasks are carried out. The final section of the procedure - it lasts 5-7 minutes - is characterized by a gradual decrease in physical activity.

· patients with severe pain syndrome with symptoms of reactive secondary synovitis;

· the first 3 days after joint puncture.

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