Bruises and ligament damage. Ligament rupture. Anatomical structure of the ankle

A sprain is an incomplete rupture of certain fibers of the ligament apparatus. Sprained ligaments is not an entirely correct term, since it is not their stretching that occurs, but a partial rupture or tear of individual ligament fibers. IN in this case The motor activity of the anatomical segment is not disturbed and its immobilization is not observed.

The ligamentous apparatus is a dense elastic fiber that stabilizes the joint in the correct physiological position. Excessive stress on the joints can cause complete or partial rupture of the ligaments. In this case, the force exerted on them exceeds their elasticity and strength. The elbow and ankle joints are most often injured, and less often the knee joints.

These types of injuries often occur from trips, falls, or walking on snow, ice, or other slippery surfaces. Often the cause of injury is ill-fitting shoes. high heels, which causes the leg to turn inward.

This type of injury is often observed in athletes and is associated with the specifics of the sport. So, most often ligament injuries ankle joint develop in speed skaters, skiers and figure skaters. Discus and shot throwers, tennis players, basketball players and volleyball players experience injuries to the ligaments of the shoulder, elbow and wrist tunnels.

Factors that provoke the development of injury are:

overweight and obesity;
uncomfortable high-heeled and platform shoes;
previous injuries;
pathological changes bone structure(in older people);
development of arthritis and arthrosis;
infectious pathologists;
congenital and acquired abnormalities of the joints (flat feet).

Symptoms of a Sprain

Because the ligaments are threaded blood vessels And nerve endings, then their partial tear, and even more so a complete rupture, causes severe pain and immediate swelling of the soft tissues. There are painful sensations different intensity, this depends on the extent of the damage, and may appear immediately after the injury or the next day after it.

A sprained ligament is manifested by the following symptoms:

swelling in the area of the damaged joint;
formation of hematomas;
skin hyperemia;
local increase in temperature;
limitation of joint mobility.

It often happens that a person does not feel severe pain at the time of injury, he can move the joint and lean on it. This phenomenon is deceptive and contributes to the progression of the injury as the torn or torn ligaments become even more damaged.

Sprains must be differentiated from dislocations, subluxations and fractures. Dislocation is characterized by displacement and rupture of ligaments, and articular surfaces cease to touch completely with complete dislocation and partially with subluxation. A fracture is a fairly complex injury to bone tissue that requires urgent correction.

A sprain is often equated with a muscle strain. They can be distinguished by symptoms: signs of a sprain are characterized by pain that appears immediately after the injury. In this case we're talking about about ligament injuries. Painful sensations that appear after physical exercise the next morning or at night, indicate a muscle strain.

Degrees of sprain

There are three degrees of damage, which determine the severity of the injury.

First degree

This degree is mild and is characterized by minor pain that does not destabilize the joint or impair its mobility. The remaining symptoms are also mild and do not require serious treatment. With the first degree of damage, rest and gentle treatment are necessary.

Second degree

It is characterized by moderate fibril tearing, but in some cases the capsule is also damaged. There is severe pain, hematoma formation, and increasing swelling. The functions of the joint are limited because severe pain occurs when moving.

Third degree

The most severe degree of damage. There is a complete rupture of the tendon tissue, severe swelling, redness in the damaged area, extensive hematomas. The functions of the joint are impaired, its instability is noted (pathological mobility is observed). Third degree injuries need immediate attention surgical correction, and recovery after them lasts about six months.

Often, small nodules in the form of small pearls may form at the site of damage. Subsequently, these nodules come into contact with neighboring tissues and cause inflammation of the joint, which leads to constant chronic pain.

When the ligaments are completely torn, the nerve fibers, which leads to unpleasant tingling in the joint. Also, due to severe pain, vascular spasm occurs, which leads to impaired blood circulation and the development of degenerative processes in them.

Very often, people who have received such an injury do not seek qualified medical help from a doctor, but self-medicate. But untreated injury can have serious consequences. Therefore, you need to know which symptoms require urgent medical attention:

severe pain that interferes with the full functioning of the joint;
a feeling of numbness that occurs in the damaged joint;
formation of redness and hematoma of significant size;
the appearance of pathological mobility;
the appearance of crackling when palpating the injury site;
increased body temperature, which is accompanied by chills;
loss of ability to work.

First aid for sprains

When providing first aid, it is necessary to take into account that further treatment and recovery depends on how correctly the first aid. So what to do about a sprain?

First of all you need to:

Limit motor activity joint, provide it with complete rest. This way you can reduce pain syndrome and not make it worse further development injuries.
Apply a heating pad with ice (or whatever you have on hand) to the injured limb. A towel soaked in water can serve as a heating pad. cold water, a bottle of water from the refrigerator, etc. Cold will prevent the development of hematoma, swelling and redness. The damaged limb must be securely fixed using an elastic bandage or an ordinary bandage. If there is no bandage at hand, then a towel, shirt, piece of fabric, or scarf can serve as this.
Give the victim a painkiller injection or simply give an analgesic tablet.
Give limbs exalted position to prevent the increase in soft tissue swelling.
Two days after the injury, ice no longer needs to be applied; on the contrary, it is necessary to apply dry heat.

If all points are completed correctly, the patient will feel relief and less pain. Then the patient can be transported to a medical facility or wait for the ambulance to arrive. Symptoms depend on the extent and extent of damage, the patient’s age and condition skeletal system(presence or absence of osteopenia and osteoporosis). Recovery usually occurs within 15 days.

Often victims are treated independently at home and do not seek medical advice. But in some cases, without qualified medical care not enough. Non-compliance treatment recommendations, early and significant loads on the damaged area can lead to serious consequences and unforeseen complications.

Thus, home treatment not enough:

with an increase in body temperature;
if severe pain occurs in the damaged area;
when pain increases during limb movement;
if the skin on the limb has changed color;
if swelling and redness reappear;
if a few days after the injury the patient’s condition worsens.

If the above symptoms appear, you should immediately consult a doctor.

What should not be done if you suspect a ligamentous injury?

Apply to the damaged area for the first two days. warm compresses and warm the injury. You can warm the joint, take warm baths and apply dry heat only after 3-5 days.
Play sports and perform physical work through force, this can provoke a complete rupture of the ligamentous apparatus.
Rub the joint and massage in the first three days after the injury. Rubbing and massage are carried out only after complete cure V recovery period.
Consume alcohol, since the blood vessels can dilate, blood circulation increases and after a certain time the patient’s condition worsens.

Quickly eliminating the consequences of an injury is possible only with the mutual cooperation of the doctor and the patient, since the treatment is carried out in a complex, and the patient himself is not able to independently select correct treatment. Treat only at home and use prescriptions traditional medicine very arrogant and stupid, since this can delay recovery and contribute to the development of all sorts of complications.

Damage diagnostics

The damage is diagnosed based on external manifestations, symptoms, visual examination. For accuracy, instrumental studies are carried out:

X-ray examination;
Ultrasound examination (US) of the joint;
arthroscopy (diagnosis of the inside of the joint)

X-ray examination is not able to reflect the condition of soft tissues, but it will help to exclude fractures, which have similar symptoms to sprains, and sometimes accompany each other. Differential diagnosis is to accurately determine the nature of the injury. That is, it is necessary to determine whether a fracture or rupture has occurred connective tissue or dislocation.

When the connective tissue ruptures, pressing on the bone does not cause pain, but in the case of fractures, it is quite significant. Also, during a fracture, at the time of injury, a bone crunch is heard, and not a pop, as with a tear in the connective tissue. Painful sensations are not observed at night, as well as at rest, so a person is able to fully rest. When palpating the damaged area, crepitus is not heard, and gross deformation of the joint is indicated by displacement of bone fragments. When connective tissue ruptures, the deformation is not so severe and is formed due to swelling of the soft tissues.

When a dislocation occurs, there is shortening of the limb, deformation of the joint, and springy resistance when attempting to sudden movements. Dislocations are almost always accompanied by damage to the ligamentous apparatus.

Treatment of ligamentous injury

Treatment of injury is carried out in three directions:

drug treatment;
surgery;
physiotherapeutic treatment;
physical therapy (physical therapy);
massage.

Drug treatment

It is mandatory in the treatment of moderate to severe injuries. Drugs prescribed for oral administration NSAID groups(diclofenac, indomethacin, meloxicam, ibuprofen).

Anesthetics are also used local action novocaine and lidocaine. These drugs exist in the form of a spray, which is convenient for application and use. If unbearable painful sensations, then blockades are carried out with these drugs.

Warming ointments are very effective for local application based bee venom, snake venom and hot pepper. Such ointments produce a good warming effect, improve blood circulation, and relieve pain. Use ointments in rehabilitation period, after complete recovery. You need to be careful with these drugs, as they cause severe allergies.

Absorbable gels and ointments help quickly eliminate hematomas and bruises, and also promote their softening and resorption. Are excellent preventive method preventing blood clots. I use ointments only if the bleeding has completely stopped and the tissues have recovered.

Surgery

Surgical treatment must be carried out in the first week after the injury; if this period is omitted, then it is carried out six weeks later. This is due to the fact that over six weeks a lot of blood and fluid accumulates in the joint cavity, which will interfere with the intervention and contribute to the development of infection.

View surgical intervention and the method of its implementation depends on the severity of the injury and its location. In some cases, autotransplantation is performed. For ligament transplantation, the patient's own (autologous) tissue taken from another organ is used. Very popular in Lately arthroscopy method, that is, they do not perform a large-scale tissue opening to access the necessary connections. After this procedure, the recovery period is significantly reduced.

Recovery period

The rehabilitation period allows you to restore mobility to the limbs, regardless of the chosen treatment method. Restoration is carried out in three directions.

Ligament damage joint is a very common injury, often combined with other injuries.

It occurs when the load on the ligamentous apparatus of the joint exceeds the elastic limit of the tissue. If this limit is significantly exceeded, ligament rupture may occur.

Ligament damage is characterized by acute, sharp local pain at the site of attachment of the ligament, as well as impaired limb function. There may also be excessive mobility in the joint (for example, the symptom " drawer» in case of damage to the cruciate ligaments knee joint). In case of significant damage, hemorrhage into the joint cavity (hemarthrosis) can be diagnosed. Ligament damage must be differentiated from dislocations, internal and periarticular fractures. There are 3 degrees of severity of ligament damage.

The most common injuries occur to the ligaments of the knee and ankle joints. Such injuries occur during sudden loads in physically unprepared people, or when training standards are exceeded in athletes.

If the ligaments of the ankle joint are damaged, a tight pressure bandage is applied as first aid and cold is applied over it. This helps stop bleeding at the tear site and reduce swelling and mobility of the ligament.

For the first degree of damage, it is recommended to wear pressure bandage for up to 2 weeks. After 2-3 days from the moment of injury, physiotherapeutic treatment is prescribed (magnetic therapy, ozokerite applications, massage). Recovery occurs within 2 weeks. In case of partial rupture of the ligaments, a plaster splint is applied for a period of at least 10 days. Physiotherapeutic procedures are prescribed and physical therapy. Recovery usually occurs within 3 weeks.

At first degree Individual fibers of the ligament are torn or torn. Clinically, this is manifested by slight swelling, lack of dysfunction and normal movements in the joint. This injury is often and incorrectly called a sprain. The term “stretching” only explains the mechanism of injury. The nature of this type of injury is expressed in ruptures of the ligament fibers and ruptures of the capillary vessels surrounding them.

In the second degree partial rupture of the ligament occurs. In this case, a significant part of the ligament fibers is torn. This damage is accompanied by swelling, pain and dysfunction in the joint. However, normal movements are maintained and pathological movements in the joint are not noted.

Third degree- this is a complete rupture of the ligament or separation of the ligament from the place of its attachment, manifested by pathological mobility, significant swelling and functional failure.

In case of third degree damage to the ankle ligaments, when the ligament is completely damaged, the patient must be hospitalized in the trauma department of the hospital. A plaster cast is applied to the joint for at least 2 weeks. Treatment in this case lasts about 1 month.

Treatment of ligament injuries knee joint surgery can be either conservative or surgical. Partial injuries to the knee ligaments are treated conservatively. The injury site is numbed. At large quantities a puncture is performed in the joint. A plaster splint is placed on the leg from the ankle to the upper third of the thigh.

Incomplete rupture of the medial collateral ligament is also treated conservatively.

If the lateral ligament is completely torn, it is necessary to surgical intervention, since its ends, as a rule, move away from each other and independent fusion becomes impossible. During the operation, a lavsan suture of the ligament or tendon repair is performed. In case of an avulsion fracture bone fragment a screw is fixed to the fibula. For partial ruptures of the cruciate ligaments of the knee joint, conservative treatment is carried out by applying a plaster cast for a period of at least 5 weeks. Complete ligament rupture is an indication for surgery.

To access the joint, use the classical method (through open access) or more modern methodology using an arthroscope. Arthroscopic operations are less traumatic.

To restore damaged cruciate ligaments, grafts from one's own tissue are used. The most popular grafts are bone-ligament-bone autografts from the middle third of the patellar ligament, quadriceps tendon stretch with one bone block, and popliteal tendon autografts.

After surgery to restore the cruciate ligaments, a short period of rest for the joint is recommended, fixation with a removable orthosis, unloading when walking with crutches for 10-12 days. After removal of the sutures, from 12-14 days, movement in the joint is restored and partial load is carried out with body weight with a gradual smooth increase in load to the usual one. From 3-4 weeks the patient is allowed light exercise. The main restriction during this period is refusal to play team sports (football, basketball, hockey, tennis) for up to 6 months after surgery. This time is necessary for the complete growth of the restored ligament. After this period, the patient returns to his usual loads and activities.

According to statistics, ligament injuries account for up to 85% of all household injuries.

Ligaments in the human body perform a fastening function; they connect muscles to bones and bones to each other. Because of excessive load A sprain or even rupture occurs. It is worth noting that this injury is one of the most common. Sometimes it is enough to just make one careless movement and a person will receive a similar injury; athletes especially often suffer from it.

Symptoms

To provide first aid to a person or, you need to know the symptoms and mechanisms of sprains. If you are involved in any kind of sport, then this information will be even more useful to you. Sprains typically occur due to overuse. Small tears form in the ligament tissue, causing pain to the person. If a person received serious injury, it may break completely.

When sprained, the symptoms will be as follows:

Strong pain;
- swelling;
- bruise;
- redness;
- impossibility of movement.

However, only a doctor can more accurately determine the nature of the injury by conducting X-ray examination joint If during an injury a person felt some kind of click or crunch, and then it became simply impossible to move the foot, then Great chance that this is a turning point. It may be accompanied by sprain or rupture of ligaments.

How to give first aid

The more competent and timely the treatment is provided, the greater the chances for a quick and successful recovery. First aid consists of certain actions. First of all, shoes and socks are removed in order to completely eliminate any pressure on the sore leg. It is desirable that she be completely immobilized. The leg should be slightly elevated, for example, by placing a folded blanket or some kind of support under it, this way you can improve blood circulation.

It is necessary to apply ice to the sore spot, but this should be done correctly. Place the ice on a dry cloth for literally twenty minutes, then take a break for the same amount of time and put the ice on again. This procedure must be performed within the first two hours after injury. If ice is not applied in time, the recovery process will be longer. Next, you need to tightly bandage the damaged joint. elastic bandage. If necessary, you can take some painkiller tablet.

From an anatomical point of view, it has the most complex structure. And such an idea of nature is quite amenable to logical explanation. After all, it is this part of the leg that is entrusted with a very important - supporting - function, which the joint copes with ideally. But if everything is so good, why then is damage to the ankle ligament the diagnosis that a traumatologist makes to his patients more often than others?

Anatomical structure of the ankle

The ankle joint is formed by the talus and tibia bones and has a block-like shape. The angle of its mobility during extension and flexion reaches 90°. Both on the outside and on inside it is strengthened by ligaments. The internal, which in medicine is known as the deltoid or medial, connective tissue of the ankle is located from the medial malleolus towards the calcaneal, talus and externally, its shape is as close as possible to a triangle.

But as for the external ligaments of the ankle joint, there are three of them. They all come from two of them attached to the talus and one to the heel. It is because of their location that they are called the posterior and anterior talofibular and calcaneofibular ligaments.

Age characteristic feature This supporting joint is its mobility. Moreover, in adults it is more mobile towards the plantar surface, in children - towards back side feet.

Ankle injury - a problem for athletes or an ailment that awaits everyone?

Do not think that damage to the ankle ligament is a problem only for athletes who subject their bodies to great physical stress. After all, from total number Of traumatology patients who have been diagnosed with this, only 15-20% were injured during training. Classify the rest by age group, occupation or gender is simply impossible. And this is quite logical, since anyone can stumble, make a sudden wrong movement, twist their leg, or simply jump off a step unsuccessfully.

Quite often, modern “fashionistas” are also diagnosed with ankle joint problems, for whom beauty is much higher on the list of priorities than convenience and health. They choose shoes based not on comfort and correct fit of the foot, but on price, heel height, color or fashion trends. Such incorrectly selected accessories of a woman's wardrobe, matching a handbag, dress or eye color, often become the cause of injury, the name of which, according to medical terminology, is damage to the ankle ligament.

As for the children, they suffer from of this disease not that rare either. After all, little fidgets are in constant motion. In addition, their joints and bone tissue They are not yet fully strengthened, so they are easy to injure.

Who should watch out for ankle injuries?

Damage to the ankle ligaments is not always the result of trauma alone. In 20-25%, as evidenced medical practice, doctors call the causes of the disease anatomical predisposition and chronic diseases. Most often, connective tissue injuries occur in people with high supination, or arches, with different limb lengths, as well as in those who suffer from ligamentous weakness, muscle imbalance and various neuromuscular disorders.

Therefore, everyone who is included in this risk category should approach the choice of shoes with special care and carefully dose physical exercise on the musculoskeletal system.

first degree

Depending on the severity of connective tissue damage, the disease is divided into three main degrees. The first, and easiest, is the rupture of single fibers, which does not violate the stability of the joint. In this case, the victim experiences pain of low intensity, which can be relieved with analgesics in the form of tablets and ointments. There may be slight swelling at the site of injury, but there are no signs of hyperemia at all.

Clinical manifestations of second degree injury

If a person has second-degree damage to the ligaments of the left ankle joint (or right), the symptoms will be more pronounced. The victim experiences quite severe pain, skin mild bruises and bruises appear. Such a partial injury does not affect the stability of the joint, but a person with an injury is practically unable to walk.

Symptoms characteristic of third degree damage

The third degree of injury to connective structures can rightfully be called the most severe. After all, such damage to the ligaments of the right ankle joint (or left - it doesn’t matter) implies a complete rupture of all fibers without exception. Characteristic symptoms are acute pain of high intensity, disturbance motor function, as well as instability of the joint itself. In addition, subcutaneous hemorrhages of various sizes immediately appear at the site of injury, which after some time are accompanied by severe swelling.

Should you refuse medical care?

Despite the fact that the first two degrees of injury to the ankle ligaments are not classified as severe and do not require specific treatment, an examination by a doctor will not be superfluous. After all, pain of moderate intensity, swelling and hyperemia are symptoms not only of damage to connective tissues. Such clinical picture It is also typical for cracks and fractures of bone tissue, the treatment of which is best carried out under medical supervision. Therefore, it is so important that a specialist clearly diagnoses the injury and prescribes an appropriate course of therapy.

Let us also note that even if a person has partial damage to the ankle ligaments, he needs the advice of a professional - this will speed up the recovery process. Therefore, regardless of the degree of connective tissue injury, you should not refuse professional medical care.

First aid for torn ankle ligaments

If a crunch or crackling sound is heard when the connective tissue is damaged, there is practically no doubt that the fibers of the ligament have ruptured. In addition, in this case, any movement that the victim tries to make is accompanied by acute pain, and swelling or bruising immediately appears at the site of injury. To improve the patient’s condition before he is examined by a doctor, it is necessary to correctly provide first aid to the victim.

First, you immediately need to immobilize the injured limb. The patient should be seated, or better yet, positioned so that the ankle is above the level of the heart. This position will allow, if there is complete damage to the ankle ligament, to prevent internal hemorrhage.

Secondly, in the area of damage you should do cold compress, or better yet, add pieces of ice. The victim is then given a painkiller and a decision is made on how to transport him to the nearest emergency room. If damage to the ankle ligaments (symptoms described above) is accompanied by severe hyperemia, unbearable pain and extensive swelling, it is better to call ambulance. Doctors will immediately put a splint on the leg and take the patient to the hospital, where they will conduct a full diagnosis.

Treatment of first degree ligament damage

An injury of this severity usually does not require drug treatment. The main essence of the process is to fix the damaged joint and take painkillers, if necessary. In other words, a patient diagnosed with first-degree ankle ligament damage can continue to lead a normal lifestyle. However, during the recovery period, doctors recommend reducing physical activity if possible and applying a tight bandage to the damaged joint.

As a rule, complete recovery occurs within 10-12 days.

How are second-degree ligament injuries treated?

Treatment for grade 2 injuries will take significantly longer than a sprain. In addition, during this period the patient should not only limit physical activity, but also undergo a course of complex therapy, which will help to quickly recover from such a disorder as damage to the ankle ligaments. The consequences of the disease, if the doctor’s recommendations are strictly followed, will not bother the patient, but self-medication in such situations can cause many problems, and even after a few years the person will not be able to forget about the injury.

As a rule, if the connective tissue of the ankle is partially torn, the patient is given a plaster splint that fixes the leg for 3 weeks. To relieve pain, a painkiller is prescribed in tablet form. This could be one of the drugs such as Nurofen, Ibuprofen or Ketorol. From the third day of treatment, physiotherapeutic procedures can be added to speed up the healing process.

Third degree ligament injuries: treatment features

You should know that if the doctor determines that the patient has complex damage to the ankle ligaments, treatment will take at least 5-6 weeks. It is also worth saying that it is carried out in a hospital setting, since it requires surgical intervention, during which the torn connective tissues are sewn together, blood is pumped out of the joint, after which the medicine “Novocain” or other similar drugs is injected into its cavity.

After surgery, the patient is put in a cast on the leg for 3-5 weeks and prescribed a course of medications that have an anti-inflammatory and analgesic effect. From 3-4 days of treatment to complex therapy include physiotherapeutic procedures that improve blood circulation in areas of injury and stimulate protective functions the body as a whole.

Consequences of ankle injuries

It is wrong to say that damage to the ankle ligaments (photos of damaged areas posted on stands outside the traumatologist’s office frighten many patients, which is understandable) is always fraught with serious complications. After all, treatment started on time and compliance with all doctor’s instructions allows for the complete restoration of connective tissue. Exceptions are those cases when patients ignore the recommendations of specialists or are treated independently, exclusively with the help of traditional medicine. The consequence of such carelessness and irresponsible attitude towards one’s health most often becomes instability of the ankle joint. And this can cause repeated injury to connective and bone tissues.

Therefore, before treating ankle ligament damage, the patient must clearly understand that compliance medical recommendations During the period of therapy and rehabilitation his health depends.

That's what they call closed mechanical damage muscles, ligaments and joints with a violation of their anatomical integrity. Such injuries are most often ruptures, sprains (distortion). The most commonly observed sprain of the ankle or knee joint, which consists of a tear of individual fibers of the ligaments with hemorrhage into their thickness or a rupture of the meniscus (in the knee joint).

Symptoms of development of ligament and muscle injuries

Victims report pain in the joint when moving, swelling. During examination, patients are diagnosed with local pain on palpation and bruising, which can occur 2-3 days after injury. When ligaments are torn, more intense pain, difficulty moving the affected limb, often hemarthrosis. The phenomena of stretching subside after 5-10 days, and in case of rupture they continue for 3-4 weeks.

Main trauma syndromes:

hemodynamic disorders (blood supply or circulatory disorders),

functional disorders,

hemorrhages (hematomas).

Features of treatment of ligament and muscle injuries

Treatment can be conservative or surgical depending on the nature of the damage. With any treatment option, painkillers and hemostatic measures are carried out, and the affected part of the body is provided with rest using immobilization. Also, depending on the location and nature of the injury, immobilization can be different in type (soft bandages, removable splints, circular plaster casts) and in terms of duration (1-6 weeks).

Conservative treatment injuries - tight bandaging of the joint, rest, cold for 2 days, then thermal procedures. During surgical treatment, after removing the plaster splint, therapeutic exercises, massage and physiotherapy.

Physical methods Therapy for ligament and muscle injuries is aimed at restoring the function of muscles (myostimulating methods) and ligaments (fibromodulating methods), for which it is necessary to relieve pain (analgesic methods), restore impaired blood and lymph circulation of damaged tissues (vasodilator and lymphatic drainage methods), stimulate reparative regenerative processes (reparative and regenerative methods). Physiotherapy begins 1-2 days after injury, including after surgical treatment. If there is a removable splint, it can be removed during the procedures. These tasks help to realize following methods physiotherapy:

Analgesic methods: local cryotherapy, electrophoresis of anesthetics, SUV irradiation in erythemal doses.

Vasoconstrictor method: cooling compress.

Lymphatic drainage methods: alcohol compress, massotherapy.

Vasodilating methods: galvanization, electrophoresis of vasodilators, infrared irradiation, low-frequency magnetic therapy, thermotherapy (paraffin and ozokerite therapy), fresh local baths, red laser therapy, ultratonotherapy.

Myostimulating methods: diadynamic therapy, amplipulse therapy, interference therapy, transcutaneous electrical neurostimulation, underwater shower massage.

Fibromodulating methods for treating ligament and muscle injuries: ultrasound therapy, peloidotherapy.

Anti-inflammatory methods: UHF, microwave therapy.

Vasodilator methods for healing ligament and muscle injuries

Ultratonotherapy in the treatment of ligament and muscle injuries. Exposure of tissue to alternating current with a frequency of 22 Hz and high voltage (4-5 kV) induces conduction currents in them. The transformation of energy into heat creates conditions for vasodilator effect with increased venous and lymphatic drainage. Prescribed from 2-3 days after injury. The impact on the joint is carried out using a labile technique around the circumference of the joint, with an output power of the 8-10th stage, for 10-15 minutes, daily; course of treatment of injuries is 10-12 procedures.

Red laser therapy. The radiation energy is absorbed by tissues at a depth of 3 - 4 cm with the activation of local vasoactive peptides (NO synthase), as a result of which in the irradiated tissues dilatation of microcirculatory vessels occurs, activation of thermomechanosensitive receptors with a reaction of increased microcirculation and trophism. Radiation with a wavelength of 0.628 microns, PES power up to 10 mW/cm2 is used, from the 2-4th day, remotely, using a labile technique - along the lateral surfaces of damaged ligaments and muscles, along the joint space, in fields for 2 - 3 minutes per field , up to 4-5 minutes per procedure, daily; course of treatment is 10-12 procedures.

Myoneurostimulating methods for relieving ligament and muscle injuries

Prescribed during functional treatment after cessation of immobilization.

Diadynamic therapy in the treatment of ligament and muscle injuries. Due to the coincidence of the frequency of current transmissions with the frequency of myofibril contractions, diadynamic currents rhythmically excite them and activate metabolism. Produce therapeutic effect on the body with currents OB, CP and OR (increasing strength) with of different durations bursts and pauses with a gradual increase and decrease in amplitude with pauses lasting 2-4 s, daily; course of treatment is 8 - 10 procedures.

Ampipulse therapy. Sinusoidal modulated currents excite muscle efferents and cause contraction skeletal muscles. The myostimulating effect of these currents depends on the frequency and depth of their modulation. The most pronounced myostimulating effect has the PP current (sending a current with different modulation - pause), less pronounced - the IF currents (alternating frequencies: alternating current with a frequency of 150 Hz and modulated with a frequency of 10-100 Hz) and IF current (alternating frequencies - pauses 150 Hz , modulated currents with a frequency of 10-100 Hz with a pause between their cycles. The strength of the currents increases with a decrease in frequency and an increase in the depth and frequency difference of the modulated oscillations, as well as the periods of their sending - pause. They are aimed at enhancing the tone and contractility of muscles, increased elasticity and extensibility of ligaments and tendons, obstruction overeducation connective tissue.

The stimulating effect of SMT in the treatment of injuries increases when switching from an alternating mode of influence (1) to a straightened mode (II mode). Activate muscle blood flow and trophic effects on muscles, improve microcirculation muscle tissue and its oxygenation. Currents of PM and PP or PP and PP are applied sequentially to the affected muscles with a modulation depth of 50-75% and a decreasing or increasing modulation frequency, daily; course of treatment is 8-12 procedures.

Transcutaneous electrical nerve stimulation. Rhythmic influence pulse current, duration (0.1 - 0.2 ms) and frequency (20-400 pulses/s) of which are comparable with the duration and frequency nerve impulses in?-fibers, leads to an increase in the afferent flow in them with an increase in adaptive-trophic sympathetic influences. This enhances reparative processes in the tissues of the joint, and muscle fibrillation under the influence of pulsed current activates blood supply processes and helps resolve functional disorders, increasing the range of motion in the joint. Active electrode placed on the motor points of the corresponding nerve trunks, the second - above the belly of the muscle; a transverse technique is possible. It is effective in maintaining pain, since along with myostimulating and trophic it gives an analgesic effect. The duration of the procedure is 20-30 minutes with a frequency of 10-40 pulses/s [close to the frequency optimum of autonomic (p-) fibers], also adjusting the pulse duration of 20-50 μs, daily; course of treatment is 8-14 procedures.

Underwater shower massage normalizes muscle tone and strengthens them contractile function, activates local blood and lymph flow. This allows you to increase the range of motion in the joints. Carry out after removing the plaster cast with water at a temperature of 36-38 ° C, for 5 - 10 minutes, daily; course of treatment is 10-12 procedures.

Physioprophylaxis is associated with preventing the formation of joint contractures, muscle atrophy, long terms restoration of functions, which is what the above-described methods of treating the main syndromes (except pain) are aimed at.