Exercise therapy for diseases of the musculoskeletal system. Therapeutic exercise in traumatology

In traumatology, exercise therapy is widely used. The injury forces the patient to lie motionless on his back, on his stomach, on an inclined plane, in a hammock, etc. for a long time, which can cause congestion, pressure ulcers, constipation, interfering with treatment. The tasks of exercise therapy are: improving the general condition of the patient, as well as blood and lymph circulation, promoting the rapid resolution of edema and hematoma, restoring the function of the damaged organ, developing replacement movements in case of loss of the main movement, preventing the development of contractures.

General principles

The implementation of a set of exercises begins with the joints that are not captured by immobilization, gradually including exercises for the joints near the site of injury. Often exercises are performed with a symmetrical joint of a healthy limb, which reflexively affects the affected one. The complex includes general strengthening and special exercises. Exercise therapy is combined with physiotherapy, massage, which usually precede exercise therapy. When applying special exercises, the instructor first makes passive movements, then they use the severity of the limb itself (relaxation exercise), and only later does the patient move on to active movements, complicating them with exercises with projectiles. The entire treatment course is conditionally divided into 3 periods. The first period from the moment of injury to the entire time of immobilization (skeletal traction, plaster, surgical interventions).

Tasks of exercise therapy in this period - improving the general condition of the patient, fighting congestion, preventing the formation of stiffness in joints free from immobilization, promoting healing processes, increasing blood and lymph circulation.

The second period is the almost complete restoration of the integrity of the damaged organ, the replacement of circular plaster immobilization with a removable splint. The task of exercise therapy in this period is to restore the normal range of motion in all joints, improve the function of the damaged organ (start with simple exercises, gradually expand the range of motion and increase the overall load, develop new replacement skills if necessary).

The third period is the presence of residual effects of injury (muscle weakness, slight dysfunction).

The main tasks of exercise therapy - elimination of all residual phenomena, restoration of the necessary household and labor skills, development of endurance, speed, strength, accuracy of movements, etc. The set of exercises includes more complex gymnastic exercises and a number of applied exercises that prepare for work.

Exercise therapy for limb injuries

In the treatment of fractures of the bones of the hand and fingers, exercise therapy begins on the 2nd-3rd day. Movements are performed in the joints of the injured limb free from immobilization. In case of fractures of the metacarpal bones, attention is paid to the mixing and spreading of the fingers. In case of fractures of the fingers, after removal, the splints produce various movements with the fingers, especially with damaged phalanges. In case of a fracture of the wrist after removing the plaster cast, exercises for the radiocarpal joint are included - active movements in all directions with a slight emphasis on the hand, bringing and spreading the fingers, flexing and extending them, etc., without causing pain, then add exercises with sticks, medicine ball, maces.

Forearm bone injury

In case of injuries of the bones of the forearm, active movements for the fingers are allowed, exercises for the shoulder joint of the injured arm at the beginning with the help of a healthy arm (raising the arm up, circular movements). For the damaged area, rhythmic muscle contractions are performed under the bandage several times a day. When the callus gets stronger, the plaster cast is replaced with a removable splint and the complex of exercises includes active exercises at a slow pace, passive exercises are added and, if necessary, exercises on the apparatus. They also increase the overall load on the entire body, including general strengthening exercises at a faster pace.

Humerus fractures

In the first period, general strengthening exercises are used for the trunk and a healthy arm, exercises for the hand (flexion and extension of the fingers, raising the hand with straightened fingers, etc.).

Rice. 141. Exercises for fractures of the shoulder and forearm.

After removing the tire, exercises are performed in a lightweight starting position, exercises with the help of a gymnastic stick, which diverts the patient's attention from the injured limb and makes movements freer (Fig. 141).

hip fracture

From the first days, general strengthening exercises are carried out for the shoulder girdle, a healthy leg, for the toes of the damaged limb (extension and flexion of the foot 4-5 times), static muscle tension under a bandage up to 10 times a day. In the future, they are allowed to raise their legs, turn on their stomachs, get out of bed and, finally, walk on crutches. Before getting up, prepare the armpits for pressure with crutches. After removing the cast or stretching, active exercises in all joints begin.

When mobility is limited, passive movements in these joints are included. It is important to pay attention to the development of correct walking. When shortening a limb, orthopedic shoes should be worn.

Fractures of the leg bones

From the first days, they perform movements with the foot, fingers, in the hip joint. The main task of exercise therapy is the restoration of the supporting function of the limb.

Exercise therapy is used after the condition improves, including general tonic exercises, exercises for a symmetrical healthy limb. As the wound heals, exercises are performed for the muscles of the damaged area.

Therapeutic exercises actively help the normal development of scar tissue.

Exercise therapy for spinal fractures

In case of spinal fractures, the patient lies on his back, a wooden shield is placed under the mattress. With compression fractures of the vertebrae, the head end of the bed is raised by 20 cm (Fig. 142).

Rice. 142. The position of the patient on an inclined bed with straps.

They begin therapeutic exercises 3-4 days after the injury, including exercises for limbs and breathing exercises at the beginning. Gradually, the exercises complicate, increase the amplitude and strength of muscle tension, actively include exercises for the shoulder girdle, carefully train the extensors of the back (Fig. 143). For the pelvic girdle during this period, exercises with a large load are not carried out. If there are no contraindications, after 10-12 days, part of the exercises is done in the initial position lying on the stomach (Fig. 144).

Rice. 143 Exercises for fractures of the spine in the first days of training.

Rice. 144 Exercises for fractures of the spine, used during the first month of training.

In the second month of treatment, exercises with significant muscle effort are included in the complex of exercises.

Conduct exercises that develop the flexibility of the spine ("swallow", etc.). (Fig. 145). The tasks of exercise therapy in these patients are to develop a good muscular corset and strengthen the muscles and ligaments of the spine. The duration of the lesson in this period is 40-50 minutes with rest after each series of exercises. After 2 months, the patient is allowed to stand up, after teaching him the correct transition from a lying position to a standing position, without bending his back, the patient should not sit down.

Rice. 145. Exercises for fractures of the spine, used during the 2-3rd month of training.

Exercise therapy for pelvic fractures

In case of a fracture of the pelvic bones, it is important for the patient to give the correct position lying on his back, a roller is placed under the knee joints. Therapeutic exercises begin after 3-4 days. First, exercises are done for the shoulder girdle and muscles of the body, and careful movements with support are allowed for the legs. After 2 weeks, exercises for the legs with a heavy load are carried out, while the legs continue to lie on the roller. When the patient is allowed to stand up (from 3 weeks after fractures without displacement and unilateral, up to 2 months with a fracture with displacement and bilateral), some of the exercises are done while standing (Fig. 146).

Rice. 146. Exercises for fractures of the pelvic bones.

Therapeutic exercise for diseases of the joints

The goal of exercise therapy for diseases of the joints is to strengthen and improve the general condition of the patient, restore impaired mobility of the musculoskeletal system, improve the functioning of the cardiovascular, respiratory and other body systems. In the acute phase, rest is observed and exercise therapy is not used. In the subacute and chronic stages, they include careful movements for the affected joints, without causing pain, muscle relaxation exercises, light massage, passive and active swing movements, the starting position, first lying down, then lying down and sitting. Mechanotherapeutic devices are widely used to help develop mobility in the joints.

To prepare the patient for subsequent walking in case of damage to the joints of the legs, exercises are carried out for the muscles of the back, quadriceps muscles, for the muscles of the shoulder girdle, further include training in walking, develop the correct gait.

In rheumatoid arthritis, therapeutic exercises are included 6 months after the subsidence of acute events, given the presence of contraindications due to possible damage to the valvular apparatus of the heart. Start with exercises. at a slow pace and perform them without muscle effort, the number of repetitions is from 6-8 to 10-12. As the process subsides, exercises with gymnastic sticks, maces, blocks, ladders, etc. are widely included, which increases the range of motion, strengthens muscles. Exercises are repeated up to 10 times during the day.

The combination of gymnastics with thermal and water procedures and massage is more effective in classes.

Therapeutic exercise for spinal deformities

There are spinal deformities in the anterior-posterior (lordosis - forward curvature and kyphosis - backward curvature) and in the frontal (scoliosis - curvature to the side) plane. According to the form, scoliosis is divided into one-, two-, right- or left-sided, thoracic, lumbar, etc. (Fig. 147).

Rice. 147. Various forms of scoliosis.

I degree- a slight curvature of the spine, manifested by the incorrect standing of the shoulder blades and shoulder girdle. With active straightening, scoliosis disappears, i.e., the changes are functional in nature.

II degree- changes in the spine are more pronounced. There is countercurvature and development of the costal hump. Active straightening does not correct curvature. Hanging on the hands or on the Glisson loop (torso stretch) straightens the spine. With this degree of scoliosis, there is a shortening of the ligaments and a change in the intervertebral cartilage.

The method of exercise therapy for the I degree of scoliosis is the correct physical education in the family and school. Children should go in for physical education, swim on their chest, ski, play sports. For children with severe scoliosis, it is necessary to organize additional classes in therapeutic exercises.

III degree- the presence of persistent anatomical changes in the spine, the costal hump is pronounced, the chest and spine are deformed. Changes capture the bone tissue and the area of ​​curvature is motionless.

The tasks of corrective gymnastics are: increasing the mobility of the spine, reducing or eliminating its curvature, strengthening the muscles and ensuring a normal pelvic tilt, as well as the possible elimination of shortcomings in the body structure associated with the curvature of the spine, and consolidating the results of the correction.

The sets of exercises consist of gymnastic exercises in the initial position lying, sitting, standing on all fours, hanging, etc. Exercises are used with and without objects, on shells, exercises in traction of the spine on an inclined plane, gymnastic wall, in the Glisson loop, exercises in arching of the spine in places of curvature based on a roller, stuffed ball, exercises in balance with a load on the head.

Corrective exercises must be combined with general strengthening and breathing exercises.

In case of scoliosis of the II degree, exercise therapy includes general strengthening exercises, exercises for strength endurance, balance, resistance, as well as special exercises for posture. They do exercises with gymnastic sticks, balls, maces, exercises on the gymnastic wall, rings, bench. Starting positions often change: lying on the stomach, back, on the side, on all fours. Treatment should be persistent and long (at least 6 months) and it is carried out 3 times a week.

At home, you should do an independent set of exercises daily.

Preventive measures are of great importance: proper seating at a desk, appropriate furniture, a hard bed (a shield under a cotton pad).

Therapeutic exercise for flat feet

With flat feet, when the inner arch of the foot is lowered and the pronation of the foot is increased, the leading place in the treatment is therapeutic exercises, which strengthen the muscles and ligaments that support the arch, have a corrective effect on the vicious installation of the feet, fingers and the depth of the arches.

Therapeutic exercises are carried out in the initial position lying down, sitting, and then walking. In the starting position lying down. and sitting, they perform supination of the foot, grabbing various objects (balls, sticks) with their toes, walking with support on the outer edge of the foot, walking on an oblique surface, walking barefoot on loose soil, sand, climbing a pole and a rope with their grip on the inside of the feet.

Therapeutic exercise during amputations and the method of preparing the stump for prosthetics

The tasks of exercise therapy during amputations are to restore a significantly disturbed general condition of the patient, to prevent and eliminate contracture and atrophy of the stump, to maximize the strengthening and development of the muscles of a healthy limb, especially the leg, since an increased load falls on it when walking.

When amputating a leg, it is necessary to train the vestibular apparatus, since the patient creates altered conditions for maintaining the balance of the body. When amputating a hand, it is necessary to develop substitution abilities.

Therapeutic exercises are started in 1-2 days, starting with breathing exercises, exercises to strengthen healthy limbs, especially the trunk and feet, then include exercises for the remaining joints of the damaged limb (flexion, abduction to the side, circular movements, etc.). Gradually, resistance exercises are introduced into the complex. Exercises are carried out in the starting positions sitting and lying down. To prepare the stump of the lower limb for support, massage and gradual pressure of the stumps on the palm, pillow, bed, ball, sandbags, board covered with felt are carried out. The stump should be hardened with cold water. From the moment of receiving the prosthesis, all attention is directed to the full mastery of it and overcoming uncertainty. They start with mastering walking on the floor, then on an inclined plane, stairs, stepping over, jumping, walking in shoes with heels, since the prostheses are designed for such shoes.

Therapeutic exercise for stiffness and contracture of the joints

Therapeutic gymnastics is widely used for stiffness and contracture of the joints, along with thermal, water procedures, and surgical interventions.

The goal of exercise therapy is to improve blood circulation, strengthen muscles, and restore normal joint mobility. Early application of exercise therapy is necessary. They begin with careful movements in the joint that do not cause pain, apply general strengthening exercises for the trunk and intact limbs. With an increase in the amplitude of passive movements, they move on to active movements, exercises with resistance. Classes during the day are repeated several times with an instructor and independently.

Exercise therapy for diseases, injuries and injuries of the musculoskeletal system and nervous system

Lecture 3
exercise therapy for diseases
injuries and injuries
musculoskeletal
apparatus and nervous system
1. Exercise therapy for diseases of the musculoskeletal system
2. Exercise therapy for musculoskeletal injuries
3. Exercise therapy for diseases and injuries of the spine
4. Exercise therapy for diseases and injuries of the nervous system

Question 1. Exercise therapy for diseases of the musculoskeletal system

Tasks of exercise therapy:

normalization of the tone of the central nervous system;
activation of metabolism.
activation of blood and lymph circulation in the joint;
restoring or improving joint mobility
prevention of further dysfunctions and
muscle atrophy;
restoration of adaptation to domestic and labor
processes.

Arthritis

are diseases that are
is the inflammatory process,
located in the synovium
joint sheath, articular cartilage and
periarticular tissues

Tasks of exercise therapy:

General +
increase in range of motion up to
normal;
strengthening muscles in the affected area -
especially extensors;

Exercise therapy technique

1) Therapeutic massage, physiotherapy procedures (UVI,
ozokerite, paraffin and mud applications)
2) Therapeutic gymnastics:
I.p .: for the upper limbs - lying and sitting, for the lower - lying
passive movements for affected joints (starting with
gentle swings with a small amplitude)
relaxation of muscles in the area of ​​​​the diseased joint (relaxation
tense flexor muscles of the diseased limb contributes to
performing active movements with a healthy limb)
exercises in water (in the pool, bath) at a temperature of 28-29 ° C:
active movement,
with shells (ladder for developing movements in the joints
brushes, clubs, dumbbells weighing 0.5 kg), on the gymnastic wall;
simulators.
The pace of the exercises is slow or medium;
Number of repetitions - 12-14 times (14-16 times)
Duration of the lesson - 35-40 minutes (40-45 minutes)

Arthrosis

are diseases that are based on
metabolic-dystrophic process,
characterized by cartilage atrophy,
loss of bone tissue (osteoporosis),
neoplasm of bone tissue
calcium salts in periarticular tissues, ligaments,
joint capsule.

Tasks of exercise therapy:

General +
pain reduction;
relaxation of the abdominal muscles and
elimination of contracture;
an increase in the joint space;
reduction of the phenomena of aseptic synovitis
(inflammation of the synovial membrane);
strengthening of the periarticular muscles and increase
their endurance;

Exercise therapy technique

1) Exercises that strengthen the muscles of the back and abdomen.
2) Special exercises
i.p. - lying on your back:
active dynamic exercises for large muscle groups
healthy limb;
FU for the ankle joint and light movements in the hip
joint (with coxoarthrosis) of a sore leg in light conditions;
short-term (2-3 s) isometric tension of the gluteal
muscles.
I.p. - standing on a healthy leg (on a dais):
free swaying of a relaxed leg in various
directions.
isometric tension and subsequent relaxation
Dynamic exercises without weights and with weights (on
simulators or with weights) - the weight that the patient can
raise 25-30 times to fatigue; performed from 1 to 3-4 series
exercises with a rest interval of 30-60 s.
The pace of all exercises is slow;
The range of motion is painful.

10. Question 2. Exercise therapy for injuries of the musculoskeletal system

11. Injury

is a sudden impact on
human body external factors
environment (mechanical, physical,
chemical, etc.), leading to
violation of the anatomical
tissue integrity and functional
violations in them.

12. Traumatic illness

is a combination of general and local
pathological changes in the body
damage to the organs of support and movement

13. Harbingers of the development of a traumatic disease:

Syncope (syncope) - sudden loss of
consciousness due to insufficient
circulation in the brain.
Collapse is a form of acute vascular
insufficiency (decreased vascular tone or
circulating blood mass weakening of the heart
reduced venous blood flow
to the heart, lowering blood pressure, hypoxia of the brain)
Traumatic shock - severe
pathological process in
body as a response to severe
trauma.

14. Tasks of exercise therapy:

General tasks of exercise therapy:
normalization of the psycho-emotional state
sick;
accelerate the elimination of drugs from the body
funds;
improvement of metabolism, activity of the cardiovascular and respiratory systems, excretory organs;
prevention of complications (congestive pneumonia,
flatulence, etc.).
Special tasks of exercise therapy:
acceleration of resorption of hemorrhage and edema;
acceleration of the formation of callus (for fractures);
improvement of the process of regeneration of damaged tissues;
prevention of muscle atrophy
contract and stiffness in the joints;
prevention of adhesive process;
the formation of a soft, elastic scar.

15. Exercise therapy technique

ORU (for non-injured parts of the body);
breathing exercises: for bedridden patients -
in the ratio 1:1; for walkers - 1:2(3);
active physical exercises for the joints,
free from immobilization;
exercises for abdominal muscles in isometric
muscle mode of those parts of the body where they can
bedsores to form;
position treatment;
ideomotor exercises;
isometric muscle tension
immobilization.

16. Forms of exercise therapy:

1st period: UGG (5-7 min); LH (15-25 min);
self-study; walking down the corridor
(for example, on crutches).
2nd period: UGG, LG; self-study;
hiking; dosed walking, running,
swimming, etc.
3rd period: all available forms of exercise therapy
final restoration of lost
functions of the damaged segment and organism in
in general. He's in a rehab center
or in a sanatorium, or in a local clinic
residence (partially at home).

17. Exercise therapy technique

I.P. - various;
physiological load curve - two- or three-peak
multi-vertex
25% control, 75% outdoor switchgear and control room 25% control switchgear and remote control control and 75% control switchgear
Means of exercise therapy: - outdoor switchgear;
- breathing exercises in the ratio 1:2(3);
- passive and then active exercises for
joints of the affected part of the body (it is better to perform them
in warm water)
- treatment position;
- mechanotherapy;
- occupational therapy;
- choreotherapy;
- massotherapy.
Later:
- sports-applied exercises;
- training on simulators;
- natural natural factors.
Exercise pace:
slow and medium - for medium and large muscle groups;
fast - for small muscle groups.
The range of motion is medium (not causing pain).

18. Fractures

is an anatomical disorder
bone integrity caused
mechanical action and
accompanied by damage
surrounding tissues and damage
functions damage to a segment of the body.

19. Tasks of exercise therapy:

1st period:
improvement of blood and lymph circulation at the fracture site;
prevention of contractures, as well as muscle atrophy.
2nd period:
restoration of range of motion in the joint;
increased strength of the muscles of the shoulder girdle and shoulder (or
lower limbs);
elimination of puffiness (if any).
3rd period:
final restoration of muscle function and strength
shoulder girdle and upper or lower limb.
learning to walk with crutches and without support (with
lower limb fractures)

20. Fractures of the bones of the upper limbs

21. Method of exercise therapy for fracture of the clavicle

First period
1.
Classes in a fixing bandage (first week)
active finger movements
flexion and extension in the wrist and elbow joints (rotation
contraindicated due to possible displacement of fragments).
2.
FU without a scarf in the position of inclination towards the damaged collarbone:
pendulum movements in the shoulder joint with a small amplitude;
abduction (up to 80°) and adduction of the shoulder (after 2 weeks), above the horizontal -
in 3 weeks;
adduction and expansion of the shoulder blades.
Second period
special exercises - active movements in the shoulder joint above
horizontal;
swing exercises; exercises with objects;
mechanotherapy on block devices;
therapeutic massage of the muscles of the shoulder girdle; swimming.
Third period
load on weakened muscles from the affected collarbone;
exercises with objects, with a rubber bandage and an expander, with small
weights, on shells and simulators; swimming, skiing,
volleyball, basketball and other sports.
To training sessions with a fracture of the clavicle is allowed
start 6-8 weeks after the injury.

22. Fractures of the scapula

ORU and DU, exercises for fingers, wrist joint,
isometric muscle tension of the shoulder (depending on
fixing method).
FU on the scarf: for the elbow (flexion and extension, pronation and
supination, circular movements) and shoulder (raising the arm
forward-up to an angle of 90 ° and abduction to an angle of 90 °) of the joints.
Hand swings (10-14 days after injury)
With a fracture of the neck of the scapula
1st period (on the outlet bus):
exercises for fingers, wrist and elbow joints;
for the shoulder joint (15-20 days after injury).
2nd period (without tire) - in a month
movements in the shoulder joint (friendly with a healthy
hand),
exercises with objects and on block simulators (during
3-4 weeks.
The exercise therapy technique in the 3rd period is the same as for a clavicle fracture.
Restoration of movements and ability to work occurs after 2-2.5
month; sports capacity for work - 3 months after the fracture.

23. Fractures of the lower extremities

24. Methods of treatment:

conservative method - traction
(if the fracture is displaced) behind the calcaneus
bone, imposing in 2-3 weeks deaf
plaster cast - from the toes to
upper third of the thigh;
operational method - overlay
Ilizarov apparatus or
metal osteosynthesis with a nail or
metal plate;
immobilization.

25. Fractures of the diaphysis of the femur

Immobilization period - skeletal
traction (1.5-2 months)
Exercise therapy is prescribed on the 2nd day after the injury
ORU for an intact limb;
SA for injured limb: flexion and
extension of the fingers and feet; elevation of the pelvis
resting on the arms and foot of a healthy leg; maximum
relaxation of the thigh muscles.
A month after the injury, exercises are added to
tension of the thigh muscles (movement of the patella).
The duration of the lesson is 25-30 minutes (4-6 times per
day).

26.

Post-immobilization period
- after removal of skeletal traction
various I.P. (lying on back, sitting, standing
gymnastic wall, walking).
water exercises: squats; flywheels
movements, standing on a healthy leg; bending in
hip and knee joints.
Training period
(after 2-3 months until full recovery of movements during
all joints and normal gait (4.5-6 months))
running, jumping, jumping, stepping
jumping over obstacles
coordination and balance exercises
outdoor games,
swimming in the pool.
The duration of the lesson is 40-50 minutes (3-4 times a day).

27. Fractures of the bones of the lower leg

28. Exercise therapy technique - the same as for a hip fracture

Immobilization period (average 3-4 months)
remote control and outdoor switchgear
SU: active movements of the toes;
flexion and extension at the knee and hip
joints;
isometric tension of the muscles of the thigh and lower leg;
ideomotor exercises for the ankle
joint
3-5 days after the injury, the patient is allowed
move within the ward, and then the department
with the help of crutches.

29. Post-immobilization (functional) period

Tasks of exercise therapy:
restoration of movements in the ankle joint;
elimination of swelling of the injured leg;
prevention of traumatic flat feet, deformity
feet, growths of "spurs" (most often heel),
curvature of the fingers. For this purpose, immediately after the removal
plaster in shoes put a special arch support.
Exercise therapy technique
ORU for all muscle groups,
SU:
active finger movements (capturing small
items and their retention); foot movements, back and
plantar flexion of the foot, supination and pronation,
rolling the foot of a tennis ball;
different walking options: on toes, on heels, on
external or internal arches, forward with the back, sideways,
cross step, in a semi-squat, etc .;
exercises with the support of the foot on the crossbar; exercises for
exercise bike.
An ankle fracture can cause swelling anywhere in the foot.
To eliminate it, it is recommended to lie down for 10-15 minutes (3-4 times a day),
raising legs at an angle of 120-130 ° in

30. Damage to the knee joint

31. Damage to cruciate ligaments

With a partial rupture of the cruciate
ligaments, a plaster cast is applied (up to
middle third of the thigh) for 3-5 weeks.
With a complete rupture,
surgical replacement of ligaments with lavsan tape
or autoplasty.

32. Exercise therapy technique

1st period of LH classes (1-2 days after the operation).
In addition to exercises for healthy parts of the body,
exercises for the operated limb: movements of the toes, in
ankle and hip joints, isometric
muscle tension of the thigh and lower leg (from 4-6 to 16-20 times), which
patients should perform independently every hour.
2nd period (3-4 weeks after surgery)
exercises in i.p. lying on your back, later - lying on your side, on
stomach and sitting, so as not to cause stretching of the restored ligament.
To increase the range of motion in the knee joint,
position treatment or a small pull on the block is used
simulator: the patient lies on his stomach and with the help of a block
apparatus flexes the lower leg - training to increase strength and
endurance of the muscles of the injured limb.
to restore range of motion in the knee joint
use training on a bicycle ergometer and walking on a flat floor,
stepping over objects (medicine balls, fences) and walking
On the stairs.
In the 3rd period (3-4 months after the operation)
the task of exercise therapy is the complete restoration of the function of the knee joint and
neuromuscular apparatus.

33. Question 3. Exercise therapy for diseases and injuries of the spine

34.

35.

36. Fractures of the spine

37. Depending on the localization, there are:

body compression fractures
vertebrae
spinous and transverse fractures
processes;
vertebral arch fractures.

38. Treatment:

prolonged traction;
one-time or gradual
correction of deformity of the spinal column, with
subsequent imposition of a plaster corset;
combined method (traction and
plaster immobilization);
operational method (various ways
fixation of segments of the spinal column in the zone
damage).
Application of physical factors
(exercise therapy, massage and physiotherapy)
is mandatory

39. Tasks of exercise therapy

(immobilization period)
stimulation of regenerative processes in the damaged
segment;
improvement of psycho-emotional state and activity
the main systems of the body;
prevention of congestion, atrophy of the muscles of the body
limbs, neck.
preparation of the victim for vertical loads;
prevention of atrophy of the muscles of the trunk, neck and
limbs;
restoration of everyday skills and walking skills;
improvement of blood circulation in the fracture area - for
stimulation of regeneration.

40. Tasks of exercise therapy

restoration of mobility in
damaged spine;
strengthening the muscles of the back, neck and shoulder
belts;
elimination of coordination disorders;
adaptation to household and professional
loads

41. Example: Exercise therapy technique for fracture of the cervical vertebral bodies

42. Exercise therapy technique

(immobilization period)
In the first half
movements in the shoulder joints, head movements are prohibited
ORU for small and medium muscle groups
upper and lower limbs (without taking them off the plane of the bed),
static breathing exercises,
movements of the lower jaw (opening the mouth, movements to the right, to the left,
forward).
Exercises are performed at a slow pace (4-8 times)
In the second half
forward movement of the body is contraindicated
i.p. lying, sitting, standing;
exercises for balance and coordination of movements;
walking and walking exercises;
exercises to maintain correct posture.
Isometric exercises are used to strengthen the muscles of the neck.
muscle tension (from 2-3 to 5-7 s).
The number of repetitions - 3-4 times a day;
duration of the lesson - 15-20 minutes

43. Exercise therapy technique

(post-immobilization period)
and. n. lying down, then turn on and. n. sitting and standing
isometric tension of the neck muscles, including with
resistance
FU in keeping the head in an elevated position - in I.p. lying down
on the back, on the stomach and on the side
FU for the limbs (especially the upper ones) - hand movements
above the horizontal level, raising the shoulder girdle,
abduction of arms to the sides by 90 ° using various
weights
training on simulators
tilts and turns of the torso and head and circular movements
head
exercises for balance, coordination of movements,
formation of correct posture.

44. Question 4. Exercise therapy for diseases and injuries of the nervous system

45. MAIN CLINICAL MANIFESTATIONS

Motor
disorders
1. paralysis or
paresis
central
(spastic)
peripheral
(sluggish)
2. convulsions
3. athetosis
4. jitter
Disorders
sensitivity
anesthesia
hypoesthesia
hyperesthesia
neuralgia
ataxia
apraxia

46. ​​Paralysis (plegia) - wasting the possibility of voluntary muscle contraction

Paresis - partial loss of voluntary movements
called
central (spastic) - damage
central motor neuron
providing conscious control
muscle contraction.
2. peripheral (sluggish) - damage
peripheral motor neuron
caused by injury or disease of the spinal cord
brain, manifests itself at the level of innervation from
this segment
1.

47. Cramp (spasm) - involuntary contraction of a muscle or group of muscles, usually accompanied by sharp and aching pain.

Cramp (spasm) - involuntary
contraction of a muscle or group of muscles, usually
accompanied by sharp and aching pain.
clonic - rapidly alternating
muscle contraction and relaxation
tonic - long contractions
muscles

48. Athetosis is slow worm-like movements of the fingers, hand, torso.

Trembling is involuntary
rhythmic vibrations of the limbs
or heads.

49. Anesthesia - a decrease in the sensitivity of the body or part of it up to the complete cessation of perception of information about the environment

environment and
own state.
Hypothesia - partial decrease in sensitivity,
decrease in susceptibility to external stimuli,
weakening of perception by strength (these conditions are more often
observed in neurosis).
Hyperesthesia - a sharp increase
sensitivity to weak stimuli,
affecting the sense organs.

50. Neuralgia - pain that develops when sensory nerves of a traumatic or inflammatory nature are damaged in the area

innervation or
location of the nerve.

51. Ataxia - disorders of proprioceptive (muscle-articular) sensitivity leading to impaired coordination

relationships, accuracy of movements.

52. Apraxia ("inactivity, inaction") - a violation of purposeful movements and actions while preserving its components

elementary movements; occurs when
focal lesions of the cortex of large
cerebral hemispheres or conductive
tracts of the corpus callosum.
It is the loss of the ability to produce
planned and purposeful actions
while maintaining mobility
for their implementation, which previously
were performed automatically.

53. Aphasia is a systemic disorder (disorder) of already formed speech.

motor - impaired ability
turn concepts into words
sensory - impaired speech perception,
amnestic - loss of memory,
alexia - loss of the ability to read,
agraphia - loss of the ability to write
agnosia - impaired perception and
recognition of objects and persons.

54. 4.1 Exercise therapy FOR DISEASES OF THE PERIPHERAL NERVOUS SYSTEM

55. Neuritis is a disease of peripheral nerves that occurs as a result of:

traumatic injury,
infectious,
inflammatory diseases (diphtheria,
influenza, etc.)
avitaminosis (lack of vitamins
group B)
intoxication (alcohol, lead)
metabolic disorders (diabetes).

56. Tasks:

stimulation of regeneration processes and
disinhibition of parts of the nerve located in
a state of oppression;
improvement of blood supply and trophic processes
in the lesion to prevent the formation
adhesions and cicatricial changes;
strengthening paretic muscles and ligamentous apparatus;
prevention of contractures and stiffness in the joint;
rehabilitation through
normalization of motor functions and development
compensatory devices.

57. Treatment:

position treatment
massage
physiotherapy (electrophoresis)
muscle electrical stimulation
physiotherapy
mechanotherapy - execution
exercise with special
simulators and devices.

58. Exercise therapy technique

Position treatment
It is carried out dosed throughout the entire period
- with the exception of FU classes (from 2-3 minutes to 1.5 hours)
splints are used to support the limb,
special "laying", corrective positions
using orthopedic and prosthetic products
(devices, braces, special footwear).
Physiotherapy
passive and ideomotor exercises
combination of passive and active exercises
movements in the same joints of a symmetrical limb
FU in warm water on simulators
Watch for voluntary movements
selecting the optimal starting positions, and
strive to support the development of active movements

59. Neuritis of the facial nerve - acute development of paralysis or paresis of facial muscles

Neuritis of the facial nerve acute development of paralysis
or mimic paresis
muscles

60.

61. Clinic:

the affected side becomes flabby, lethargic;
blinking of the eyelids is disturbed, not completely
the eye closes;
the nasolabial fold is smoothed;
the face is asymmetrical, constricted into a healthy
side;
speech is slurred;
the patient cannot wrinkle his forehead, frown
brows;
there is a loss of taste, leprosy.

62. Tasks:

improvement of blood circulation in the face
(especially on the side of the lesion), neck and
the entire collar zone;
restoration of the function of mimic muscles,
impaired speech;
prevention of contractures and
friendly movements;
maximum possible recovery
facial symmetry

63. Exercise therapy technique

Position treatment
Adhesive tension
Physiotherapy

64. Treatment by position

During sleep:
i.p. - lying on the side (on the affected side);
Daytime:
total duration from 30-60 minutes (2-3 times per
day) up to 4-6 hours a day
sit for 10-15 minutes (3-4 times a day),
bowing his head in the direction of defeat, supporting
her back of the hand (with support on the elbow);
pull muscles from healthy side to side
lesions (from bottom to top) with a handkerchief,
while trying to restore the symmetry of the face.

65. Adhesive tension:

carried out within 8-10 hours.
carried out with healthy
side to the patient
anti-draught
healthy side muscles
strong fixation of free
the end of the patch to
special helmet-mask
(individually)

66. Therapeutic gymnastics

class duration - 10-12 minutes (2 times a day)
day)
FU are performed in front of a mirror, with the participation
exercise therapy instructor
isolated tension of mimic muscles
muscles of the healthy side and muscles surrounding
mouth gap.
self-study 2-3 times a day
Special exercises:
for training mimic muscles (raise eyebrows
up, frown, puff out cheeks, whistle, etc.)
to improve articulation (pronounce sounds,
sound combinations, words containing these
sound combinations, by syllables)
SU alternate with restorative and respiratory

67. Neuritis of the ulnar nerve

Causes:
nerve compression in the ulna
joint that occurs in humans, work
which is connected with the support of the elbows (about
machine, table, workbench)
when sitting for a long time, putting your hands on
chair armrests.

68. Clinic

the brush hangs down;
no supination of the forearm;
impaired function of the interosseous muscles of the hand,
due to which the fingers are claw-like bent
("clawed brush");
the patient cannot pick up and hold objects.
atrophy of the interosseous muscles of the fingers and muscles
palms on the side of the little finger;
hyperextension of the main phalanges of the fingers,
flexion of the middle and nail phalanges;
it is impossible to spread and adduct the fingers.

69. Treatment by position:

a splint is applied to the hand and forearm
the brush is given the position of the possible
extension in the wrist joint,
the fingers are given a bent position;
forearm and hand are hung on a scarf
in the position of flexion in the elbow joint (under
angle 80°)

70. Exercise therapy technique (on the 2nd day after bandaging).

passive gymnastics,
gymnastics in water;
massage
muscle electrical stimulation
When active movements appear:
active gymnastics
elements of occupational therapy (plasticine modeling,
clay),
learning to grasp small objects
matches, nails, peas, etc.).

71. 4.2 Exercise therapy for diseases of the central nervous system

72. The signal system is a system of conditioned and unconditional reflex connections of the higher nervous system of animals (humans) and

Signal system
- this is a system of conditioned and unconditional reflex connections of the higher nervous system
animals (humans) and the environment.
The first is the sensation
perceptions, representations (signals
occur under the influence of the sense organs)
The second is the emergence and development of speech
(signals are converted to characters in direct
sense of the word).

73.

Second signal system
First signal system

74. Neurosis

is long and pronounced
deviation of the higher nervous
activities from the norm due to
overstrain of nervous processes and
changes in their mobility.

75. Reasons:

processes of excitation and inhibition;
relationships between the cortex and subcortex;
normal relationship 1st and 2nd
signal systems.
psychogenic disorders (experiences,
various negative emotions, affects,
anxiety, phobias (fears)
constitutional predisposition.

76. Clinic:

neurotic reactions usually occur
on relatively weak, but long-term
active stimuli that cause
to permanent emotional
voltage.
overexertion of major nerves
processes - excitation and inhibition,
excessive requirement for mobility
nervous processes.

77. Forms of neuroses:

1) neurasthenia
2) psychasthenia
3) hysteria

78.

Neurasthenia (asthenic neurosis)
- characterized by weakening
processes of internal inhibition,
increased mental and physical
fatigue, distraction,
decrease in performance.

79. Tasks of exercise therapy for neurasthenia:

active process training
braking;
normalization (strengthening)
excitatory process.

80. Exercise therapy technique for neurasthenia

in the morning hours
duration from 10 minutes to 15-20 minutes
to music: soothing, moderate and
slow tempo, combining major and
minor sound
minimum load increases
gradually.
simple complex coordination exercises
sports games with simplified rules
(volleyball, table tennis, croquet, golf,
small towns) or elements of various games
walks, hiking, fishing

81. Psychasthenia (compulsive disorder)

is the predominance of the 2nd signaling system with
congestive excitation in the cerebral cortex
brain.
Neurosis characterized by obsessive
conditions: self-doubt,
constant doubts, anxiety,
suspiciousness.

82. Tasks of exercise therapy for psychasthenia:

process activation
life;
"loosening" of the pathological
inertia of cortical processes;
bringing the patient out of the oppressed
moral and mental state,
facilitating communication with others.

83. Exercise therapy technique for psychasthenia

well-known exercises of an emotional nature,
performed at a fast pace without emphasis on accuracy
their implementation;
correcting errors by showing the correct
performance by any of the patients;
psychotherapeutic training, clarification of the importance
doing exercises to overcome feelings
unreasonable fear;
game method of conducting classes,
performing exercises in pairs;
the methodologist's voice and musical accompaniment should be
cheerful.
This category of patients is characterized by a slow pace: at first, from
60 to 120 movements per minute, then from 70 to 130 and on
subsequent classes - from 80 to 140. In the final part
classes, it is necessary to slightly reduce the load and its
emotional coloring.

84. Hysteria (hysterical neurosis)

is the predominance of the function of the subcortex and
influence of the 1st signaling system.
Impaired cortical coordination and
subcortex promotes increased
excitability, mood swings,
mental instability, etc.

85. Tasks of exercise therapy for hysterical neuroses:

decrease in emotional excitability;
development in the cerebral cortex
inhibitory process;
creation of sustainable calm
moods.

86. Method of exercise therapy for hysteria

the pace of movements is slow;
exercises for attention, accuracy of performance,
coordination and balance;
simultaneous execution of various movements
left and right hand or foot;
balance exercises, jumping, throwing,
whole combinations of gymnastic exercises.
games (relay races, towns, volleyball);
Methodist voice and musical accompaniment
should be calm (commands are slow,
smooth);
predominantly a method of explaining, not showing
exercises.

87. Questions for independent work:

1. Exercise therapy for brain disorders
blood circulation
2. Exercise therapy for injuries
peripheral nerves
3. Exercise therapy for myopathy.
4. Exercise therapy for cerebral palsy

The manual is intended for students of faculties of physical culture who master this discipline within the framework of the curriculum (classroom and extracurricular classes, educational practice), employees of health-improving and rehabilitation centers, centers of adaptive physical culture, teachers of preschool and school educational institutions of various profiles, methodologists of exercise therapy and specialists of many professional directions for conducting physical education sessions, physical education breaks and other motor forms for the purpose of general physical education and relieving fatigue in the classroom. The manual is also addressed to parents, adults of all ages, adolescents who are conscious of their health.

Book:

Exercise therapy and massage for injuries of the lower extremities

Exercise therapy and massage for injuries of the lower extremities

Pelvic fractures- the most severe injuries of the musculoskeletal system, often accompanied by the development of traumatic shock and damage to internal organs. The causes of damage to the pelvic bones are compression in the anteroposterior or lateral directions.

Distinguish: isolated fractures of one of the pelvic bones, multiple fractures of the pelvic bones, one- and two-sided fractures, open and closed, with displacement, without displacement, with and without discontinuity of the pelvic ring, acetabular fracture, vertical fractures of the pelvic bones in front and behind, rupture pubic joint, combined injuries.

The nature of the fracture and the method of immobilization affect the method of exercise therapy. Most pelvic fractures are sticky heel symptom(inability to lift the leg from the bed because of the sharp pain). When rendering first aid the victim is placed on a flat hard base (shield) in the “frog” position: under the knees there is a roller 60–80 cm in diameter, the angle of flexion at the knee corresponds to 140 °, the knees are separated, the heels are connected.

At rupture of the pubic symphysis legs on the roller are laid parallel in a half-bent position.

For fractures offset skeletal or adhesive traction is performed.

At multiple fractures a long and wide towel is brought under the pelvis, the ends of which are crossed in front through a slot and thrown through the side metal bars with a load of 2–3 kg.

At uncomplicated rupture of the pubic symphysis and isolated fracture of the pelvic bones, exercise therapy begins on the 2nd day after the injury (in case of complications - on the 4-6th day) and is carried out in three periods in accordance with the characteristics of the motor mode of rehabilitation of the victim.

First period lasts from the beginning of immobilization to a coup on the stomach (approximately 10-16 days). Exercise therapy contributes to: raising the emotional tone, relaxing the pelvic muscles for optimal comparison of fragments, stimulating the muscles of the legs, resorption of tissue decay products in the area of ​​damage, improving the functioning of the respiratory system, blood circulation, and excretion. Performed: breathing exercises in combination with general developmental and special (flexion and extension of the toes, movements in the ankle joint in all directions, pulling the legs to the stomach for the first 2-4 days without leaving the bed), walking lying down, raising the knees (with a rupture of the pubic joint allowed only 4-6 months after the injury). Static muscle tension of the affected area, pelvic elevation and exercises on all joints of a healthy part of the body are also used. Two weeks later, it is permissible to perform extension in the knee joint with raising the lower leg, then lifting and abducting the hip. The time of therapeutic exercises is 20-30 minutes, the repetition of exercises is 6-10 times, alternation with breathing exercises is 2:1. Upon reaching the optimal strength of the muscles of the lower extremities, the victim is able to raise your legs above the roller painlessly. From this moment, a coup on the stomach is possible. The roller can be removed.

Second period(functional) lasts from the moment of turning over on the stomach until getting up and walking. For therapeutic exercises, the starting positions are used: lying on the stomach (on a pillow), standing on all fours and half-fours. The duration of therapeutic exercises is 40–60 minutes. 4–8 weeks after the injury, a test is performed: lying on your back, you need to raise two straightened legs up, bend at the knee joints, straighten in weight, spread apart, bring them together and return to their original position. If the test is painless, you are allowed to stand up.

Third period lasts from the moment you get up until you are allowed to sit. During this period, posture, gait, general physical performance, household skills are restored. Starting positions for therapeutic exercises: standing, walking, at the gymnastic wall. It is allowed to walk on toes, on heels, in a semi-squat, forward with your back, sideways. It is allowed to sit down if the victim walks for 2 hours without pain and discomfort in the area of ​​the fracture. Therapeutic gymnastics lasts 40-60 minutes, 3-4 times a day. Ability to work is restored after 1.5–2 months.

An approximate set of physical exercises for rupture of the pubic joint and fracture of the anterior half-ring of the pelvis (the first days after surgical treatment)

Breathing is free.

1. I. p.- lying on your back, arms along the body. Spread your arms to the sides - inhale. I. p.- exhale. 5–6 times.

2. I. p.- too. Dorsal and plantar flexion of the feet. 6–8 times.

3. The right hand is extended along the body, the left is raised up. Change of hand positions. 6–8 times.

4. Hands along the body. Alternate bending of the legs in the knee joints (the foot slides along the plane of the bed), the hips do not tear off the roller. 6–8 times.

5. Rotational movements of the feet. 8-10 times.

6. Squeezing and unclenching the fingers. 10-12 times.

7. Isometric tension of the muscles of the lower leg. 2–3 s.

8. Alternate or simultaneous flexion and extension of the toes. 10-15 times.

9. Tilts, turns of the head. 6–8 times.

10. Raising your hands up - inhale. Lowering - exhale.

Massage for fractures in various parts of the lower extremities It is carried out starting with a massage of the muscles of the lower back. Stroking (1-2 types), squeezing (1-2 types); both techniques must be performed in the direction from the ilium to the line that connects the angles of the shoulder blades.

Massage on the long muscles of the back (from the sacrum to the lower corners of the shoulder blades) must be performed first on one and then on the other side of the back. Massage of the muscles located along the spinal column - rectilinear stroking of the muscles with the pads of the index and middle fingers and other types of impact on the areas between the spinous processes.

Lumbar massage: stroking with a rectilinear tubercle and thumb pad; rubbing (circular with the pad of the thumb, circular with the pads of four fingers, circular beak-shaped, circular with the base of the palm).

Massage in the pelvic area and a healthy limb. It is recommended to massage the muscles of the pelvis and the muscles of a healthy limb in accordance with the generally accepted methodology. But the number of receptions should be reduced.

At foot fracture on the injured leg, massage should be performed on the muscles of the thigh, knee joint and lower leg. After removing the splint, it is necessary to do the following techniques: stroking, rubbing the foot, vibration in the fracture area. It is necessary to use both active and passive movements.

At leg bone fracture massage techniques should be carried out on the muscles of the thigh, in areas located above and below the fracture area. 7 days after the injury to the limb, it is possible, by making a hole in the plaster, to carry out vibration at the fracture site with the help of fingers or an apparatus. After removing the plaster, massage should be done on the entire limb.

At hip fractures you need to do a massage of the abdomen, chest, massage of areas below and above the fracture site. Stroking and rubbing the muscles of the lower thigh should be carried out. 21 days after a hip fracture, vibration should be performed on the damaged area, having previously made a hole in the plaster. After removing the plaster, massage should be done on the entire limb. Massage helps to fight the residual effects of bone fractures, such as muscle atrophy, contractures, slowing down the formation of callus, the formation of excess callus, late edema.

At acetabular fracture skeletal traction is carried out with a knitting needle for the condyles of the thigh, the leg from the injured side is placed in a special tire with a load of up to 5–8 kg. Exercise therapy begins on the 2nd day after immobilization and is carried out in three periods.

V first period The main tasks of exercise therapy are: optimization of the psycho-emotional state, relaxation of the muscles of the damaged part of the body to relieve pain, normalization of the internal organs. In therapeutic exercises, general developmental exercises are used in combination with breathing and special ones. The latter include flexion and extension of the toes (up to 10 times), dorsal and plantar flexion of the foot, raising and lowering the pelvis with support on the hands and on the healthy leg, flexion and extension at the knee, and movements of the patella. Class time - 15-20 minutes, repetition - 3-4 times a day. The first period lasts from the moment of injury to the removal of traction (a callus is visible on an x-ray).

Second period rehabilitation by means of exercise therapy lasts from removing traction to learning to walk without support. The main task is to teach walking with support (on a crutch, on a stick). Within 4 months after the injury, it is not allowed to lean on the leg from the injured side, then you can start slightly, then stand on a full foot. The support mode when walking is based on the sensation of pain. Therapeutic exercises include exercises for all joints of both limbs separately or in common. In addition, exercises are performed in the starting position while standing on crutches. Leg movements from the injured side are allowed in the form of: swings, abduction, adduction, circular movements, flexion and extension in the knee and hip joints. In the same initial position, after 4 months, one should try to raise the injured limb and pull it to the stomach. If this movement is performed without pain, then you can carefully step on the foot.

V third period with the help of exercise therapy, movement in full and a normal gait should be restored. To do this, they perform walking without support, at a different pace, with cross steps, in a semi-squat, back forward, sideways. Jumping, jumping, running are allowed 7 months after the injury. A person's ability to work is restored 6-8 months after the injury, and sports training is possible after 8 months. For all types of fractures of the pelvic bones in the third period, therapeutic water gymnastics: walking with support on the handrail, turns in the hip joint, abduction of the leg, squats, pulling up the legs, alternately raising the legs. In the presence of multiple fractures of the pelvic bones, the presence of displacement of bone fragments, a significant rupture of the pubic joint, the fracture is fixed with metal plates under conditions of surgical intervention. After the operation, the exercise therapy technique is similar to that described above.

Hip fractures occur during a fall or impact on the greater trochanter. It occurs more often in older people. These fractures are divided into intra-articular, extra-articular, impacted, with displacement. Skeletal traction is performed for the tibial tuberosity with a load of 3 kg, the leg is placed in a special splint. Rehabilitation by means of exercise therapy begins on the 2nd-3rd day after the injury and is carried out in three periods.

First period lasts until the formation of a bone callus at the fracture site (X-ray data) on average 1.5–3 months. Thanks to exercise therapy during this period, hemorrhage at the site of injury resolves, blood and lymph flow normalizes, muscle atrophy is prevented, emotional tone normalizes, and the functional state of all body systems improves. General developmental exercises alternate with breathing and special ones: flexion and extension of the fingers, feet, movement of the patella, raising the pelvis on a healthy leg and arms. Skeletal traction after two weeks is replaced by the imposition of a plaster cast. At the same time, exercises are added with a turn to the side, with walking on crutches without relying on the injured leg. With any type of immobilization, ideomotor exercises are performed and in sending impulses to the knee and ankle joints, tension of the quadriceps femoris muscle. Exercises are repeated up to 10 times and performed 3-4 times a day.

Second period begins with the removal of the plaster cast and ends with the moment of walking without relying on crutches. In the process of exercise therapy, walking is taught using crutches or a stick, mobility is restored in all joints of the limb, muscles are strengthened, including the injured limb, stability and coordination are developed, and walking up the stairs is carried out. They use different starting positions when performing exercise therapy: lying on their back, on a healthy side, standing with and without crutches, at the gymnastic wall, sitting, walking. The duration of this period is approximately 1-2 months.

V third period Exercise therapy solves the problem of complete restoration of the function of the injured limb in walking without support and up the stairs. Perform exercises on all joints in full. Old people are not allowed to run and jump.

At intra-articular fracture or displaced hip fractures an operation is performed to fix the fracture site with a metal nail. Exercise therapy is carried out in three periods and begins on the 1st-2nd day after the operation.

First period lasts until the stitches are removed (from 10 days to 1.5 months). Respiratory, general developmental and special exercises are used (fingers, ankle joint work, isometric tension of the thigh muscles is performed). Passive exercises are also performed with the leg straightened at the knee and hip joints and slightly bent (by 30–40 °). On the 4-5th day, it is allowed to sit down, independently raise, bend, straighten the limb. On the 8-10th day, walking on crutches is included, without stepping on the foot.

Second period in exercise therapy is aimed at working out walking with crutches on the stairs, then with a stick and even without support. Active movements are performed in all joints in the affected limb.

Third period similar to above.

Innovative exercise therapy complex for hip fracture (first period)

I. p.- lying on your back, arms along the body. Breathing is free. Classes are held 3-4 times during the day.

1. Raise your hands up - inhale, return to and. P.

2. Dorsal and plantar (light, without tension) flexion of the feet. Repeat 10-12 times.

3. Meditative (slow, without tension) alternating (4-5 times on each leg) and simultaneous (6-8 times) flexion and extension of the legs in the knee joints (feet slide along the plane of the bed). Repeat 10-12 times.

4. Tilts of the torso to the right and to the left, hands slide along the torso. Repeat 6-8 times.

5. Alternate turns of the head to the right and left - inhale; and. P.- exhale. Repeat 10-12 times.

6. Isometric tension of the thigh muscles 3–5 s – inhale. Relaxation 8-10 s. Repeat 8-10 times.

7. Meditative diaphragmatic breathing. 20–25 s.

8. Alternate flexion (inhalation), extension (exhalation) of the arms in the elbow joints and raising straight arms above the head (inhalation), and. P.- exhale. 15–20 times.

9. I. p.- the same, holding on to the "Balkan frame". Pulling up the torso (inhale, hold the breath for 1–2 s), and. P.- exhale. Repeat 8-10 times. Relaxation 10 s.

10. I. p.- too. Raising the pelvis (inhale, hold the breath for 1–2 s), and. P.- exhale. Repeat 6-8 times.

11. Meditative diaphragmatic (deep) breathing. 15–20 s.

12. I. p.- lying on your back, hands in front of the chest. Turning the head to the right while straightening the arms forward-left (inhale), and. P.- exhale. The same on the other side. Repeat 6-8 times on each side.

13. I. p.- lying on the stomach. Alternate flexion (inhalation) and extension (exhalation) of the legs in the knee joints. Repeat 8-10 times with each leg.

14. I. p.- the same, hands in front of the chest, palms down. Leaning on your hands, slowly straighten your torso - inhale; return to and. P.- exhale.

15. I. p.- too. Leaning on your hands, slowly straighten your torso (inhale), turn your head to the left, then to the right (hold your breath for 2–3 s), and. P.- exhale. Repeat 5-6 times.

16. I. p.- lying on your back, arms along the body. Squeeze (inhale) and unclench (exhale) the fingers of the hands in combination with paradoxical diaphragmatic breathing (the stomach retracts on inspiration, protrudes on exhalation). 10-12 times.

17. I. p.- lying on your back, arms bent at the elbow joints. Bend in the thoracic spine (inhale), fix the extreme position for 1–2 s, and. P.- exhale. Repeat 4-5 times.

18. I. p.- lying on your back, arms along the body. Spread your arms to the sides - inhale; return to and. P.- exhale. The pace is calm, repeat each exercise 8-12 times, do not hold your breath.

Diaphyseal hip fracture occurs upon impact, falling, bruising, squeezing, bending, twisting. Fractures are possible in the upper, middle and lower third of the thigh. Treatment is possible in a conservative way (skeletal traction) and operational (metallosynthesis, Elizarov apparatus), etc. Exercise therapy consists of three periods and begins 1–2 days after the injury. The method of exercise therapy depends on the method of treatment.

At conservative version it is almost similar to an extra-articular fracture of the femoral neck.

First period begins on the 2nd day of applying skeletal traction. Therapeutic exercises include general developmental, respiratory and special exercises: ideomotor, in sending impulses to a healthy limb, exercises with the fingers of an injured leg, static tension of the thigh muscles, lifting the pelvis based on a healthy leg and arms, maximum relaxation of the thigh muscles. The ability to raise a straight leg painlessly indicates the appearance of callus. This is a sign of the end of the first period (approximately 1.5–2 months), exercise therapy sessions last 25–30 minutes and are repeated 4–6 times a day.

Second period lasts until the restoration of movements in the joints of the injured leg (about 1.5 months). Crutches are used at first without resting on the leg on a flat place, on the stairs, then with support on a stick. You can apply exercises in different starting positions. Therapeutic swimming for 40-50 minutes is very effective.

Third period begins with walking without support until complete recovery in all joints and normal gait. Running, jumping, stepping over obstacles, exercises for coordination, balance, correct posture, swimming in the pool are allowed. Ability to work is restored in 4.5-6 months.

At surgical treatment diaphyseal fracture of the femur (osteosynthesis with a metal rod or plates), the leg is placed in a special splint and rehabilitation begins with exercise therapy. On the 2nd day, passive movements of the affected limb are performed in the knee and hip joints with fixation of the thigh and lower leg, active movements in the ankle and fingers. On the 3-4th day, it is permissible to passively raise the straightened leg to step height, and after another 2-3 days, it is allowed to sit in bed. On the 8-10th day after the removal of the stitches, it is allowed to independently raise and lower the straightened leg, bend and straighten it at the knee and hip joints, sit down, hang the legs out of bed, stand and walk using crutches with a light touch of the floor with the injured leg. After three weeks, support on the leg while walking is acceptable. Therapeutic swimming from the 9-10th day after the removal of stitches. The final fusion occurs in 4-6 months. Sports performance is restored in a year.

Knee joint injuries occur as a result of: impact, bruising, falling, squeezing, twisting, jumping on straight legs. Distinguish damage: contusion of the meniscus, patella, soft tissues of the joint, tear and rupture of the above formations, as well as ligaments, joint bags, damage to the bone condyles of the tibia, femur. When damaged, there are: pain, swelling, deformity, hemorrhage into the joint cavity (hemarthrosis), dysfunction of movement, deformation and pathological mobility of the patella. Fractures of bone formations (condyles) are compared by skeletal traction behind the calcaneus for a period of 2.5 weeks to 1.5 months in accordance with the nature of the fracture. Exercise therapy begins on the 2nd day and is carried out in three periods.

V first period(acute period of injury) remedial gymnastics solves problems similar to other types of injuries and includes general developmental, breathing and special exercises (active movements of the fingers, patella, raising the pelvis based on a bent healthy leg and arms, ideomotor exercises in sending impulses, exercises on all joints of a healthy limbs).

After removing the skeletal traction, a plaster splint is applied from the fingers to the gluteal fold for 1–1.5 months. The victim is taught to walk on crutches, first without relying on the leg, then relying on it. Exercises in the hip joint in all planes are added to the previous exercises. It is recommended to fight edema 3-4 times a day to lie for 10-20 minutes with raised legs.

Second period begins after the removal of the plaster splint. The main task is to develop the knee and ankle joints, restore the support of the foot. A variety of starting positions are used: lying on your back, on your stomach, on your side, standing on all fours, sitting with your leg down, walking, at the gymnastic wall.

V third period Exercise therapy is aimed at restoring the functions of the whole organism, at training walking in different versions, running.

At patella fracture without displacement a plaster splint is applied from the fingertips to the upper third of the thigh for 3-4 weeks. Exercise therapy is carried out for the same three periods. In case of a displaced fracture, the patella is sutured, then a splint is applied and a similar exercise therapy scheme is applied. With a multi-comminuted fracture, the patella is removed.

Meniscal injury. Falling, jumping from a height, squatting, standing up abruptly lead to bruises, tears, tears, and meniscus fractures. There is pain, swelling of the knee, movements in the knee joint and any load on the leg is very painful. The limb is fixed with a deep plaster splint from the fingers to the upper third of the thigh for 3-4 weeks. In case of rupture or crushing, the meniscus is removed partially or completely. The technique of exercise therapy is similar to the technique described above. Sports training is resumed 4–6 months after a meniscal injury, 6–8 months after a lateral ligament injury, 10–12 months after a cruciate ligament injury, 4–6 months after patella removal, 3–12 months after condylar injury .

List of innovative special exercises in the post-immobilization period in case of damage to the knee joint

I. p.- lying on your back, arms along the body. Breathing is free.

1. Dorsiflexion and plantar flexion of the feet (6-8 times);

2. Isometric simultaneous tension of the muscles of the thigh, lower leg, foot (inhale, hold the breath for 2–3 s), and. P.- exhale. Repeat 4-5 times.

3. In a meditative state, alternate flexion and extension of the legs in the knee joints, sliding the foot along the bed. 10–15 s.

4. Meditative alternating abduction and adduction of the leg, sliding it along the bed. 10–15 s.

5. In a meditative state, simultaneous rotations in different directions with the feet. 15–20 s.

6. Bending the legs at the knee joints, grabbing small objects with the toes of the feet. Hold them for 5–7 s (4–5 times).

7. Meditative imitation of walking on the bed (8-10 s) followed by relaxation. 15–20 s.

I. p.- lying on your stomach, hands at chest level. Breathing is free.

8. Alternate (with a small amplitude) flexion and extension of the legs at the knee with fixation in the extreme bent position for 1–2 s. Repeat 6-8 times.

9. Alternate abduction of the straight leg back (inhale), and. P.- exhale. (4–5 times).

10. Alternate meditative abduction of the straight leg to the side for 10–15 s.

I. p.- lying on a healthy side. Breathing is free.

11. Raising and bending the injured leg with the help of a healthy one (inhale, hold the breath for 2–3 s), and. P.- exhale. Repeat 6-8 times.

12. Take the straight leg to the side, hold for 2–3 s (inhale). Return to and. P.- exhale. Repeat 5-7 times.

I. p.- sitting, emphasis with hands behind.

13. Flexion and extension of the toes (10-15 times).

14. Feet on the medicine ball, slowly rolling it back and forth, left and right, deep breathing. 20–30 s.

15. Movements with straight legs as when swimming in the crawl style for 6-10 s, smoothly turning into the breaststroke style (10 s) with subsequent relaxation. 10–15 s. Repeat 2-3 times.

16. Rolling from heel to toe (8-10 times).

17. Bending the leg at the knee with the help of a healthy one (6-8 times).

Contraindicated exercises that stretch the ligamentous apparatus of the joint (swinging movements, squats, etc.). Axial load on the injured limb is not yet allowed. Showing water exercises. Moving the patient on crutches.

An innovative set of exercises after meniscectomy (removal of the meniscus in the knee joint). 2 days after surgery

I. p.- Lying on your back. Breathing is free.

1. Raise your hands up (inhale), return to and. P.(exhalation). 15–20 times.

2. In a state of meditation, simultaneously perform dorsal and plantar flexion of the feet 15–17 times for a healthy, injured limb performs flexion with a small amplitude (until a slight sensation of pain appears); relaxation - 20 s.

3. In a state of meditation, flexion and extension of the arms in the elbow joints with the simultaneous sending of impulses to the damaged joint. 25–30 s.

4. In a state of meditation, a slight rhythmic contraction of the thigh muscles of a healthy limb in combination with a similar ideomotor work of the injured leg. 25–30 s.

5. I. p.- the same, hands to shoulders. In a state of meditation, the torso turns to the left, to the right. When turning - inhale, and. P.- exhale. 15–20 s.

6. Flexion and extension of a healthy leg in the knee joint with simultaneous sending of impulses to the damaged joint. 15–20 s.

7. Flexion and extension of the toes. 10–12 s.

8. Raise a straight healthy leg (inhale) and hold the breath for 3–5 s. I. p.- exhale. When performed, synchronously send impulses to the damaged limb. Repeat 8-10 times.

9. Abduction and adduction of a healthy leg with a simultaneous similar ideomotor load on the injured leg. Breathing is free. 10–15 s.

10. In a state of meditation, with the help of an instructor, abduction and adduction of the sore leg. 10-12 times. Deep breathing.

11. Imitation of walking of a healthy leg on the bed with a simultaneous similar ideomotor load on the injured limb. 20–25 s.

12. I. p.- the same, hands in front of the chest. Meditative diaphragmatic breathing with successive spreading of the arms to the sides (inhale), and. P.(exhale), arms arched forward and up (inhale), and. P.- exhale, hands to the shoulders to the position of a right angle with the body (inhale), and. P.- exhale. Repeat 4–5 times, followed by a transition to a state of meditative relaxation. 1–1.5 min.

Approximate set of physical exercises after meniscectomy (on the 4th day after surgery)

In the complex below, one can enter innovative changes, similar to the previous complex, taking into account the patient's condition. The operated leg is still in Beler's splint on the 4th day. A cotton-gauze roller can be placed under the knee joint to relax the muscles of the thigh and lower leg. From the 5th day, exercises are carried out without a splint.

I. p. - lying on your back. Breathing is free.

1. Raise your hands up (inhale), return to the starting position (exhale) (4-5 times);

2. Dorsal and plantar flexion of the feet (4-5 times).

3. Flexion and extension of the arms in the elbow joints (6-8 times).

4. Rhythmic contraction of the thigh muscles 4-5 times.

5. Hands to the shoulders, torso turns to the right and left (4-5 times).

6. Flexion and extension of a healthy leg in the knee joint (6-8 times).

7. Flexion and extension of the toes (8-10 times).

8. Raise a straight healthy leg and hold for 5–7 s (5–6 times).

9. Holding on to the "Balkan frame", sit on the bed. Return to and. P.(4–5 times).

10. Abduction and adduction of a healthy leg (5-6 times).

11. With the help of an instructor, raise the operated leg, take it to the side, return to and. P.(4–5 times).

12. Imitation of walking with a healthy leg on the bed (8-10 times).

11. Hands in front of the chest. Spread your arms to the sides (inhale), return to and. P.(exhale) (4-5 times).

An innovative list of special exercises in the second period after surgery on the meniscus, lateral and cruciate ligaments of the knee joint

Breathing is free.

1. I. p.- Lying on your back. Sequentially raising the arms to the sides, up (inhale), and. P.- exhale. Run 10-15 s.

2. I. p.- too. Alternately raising straight legs, toe "on yourself". 10 times. The pace is average.

3. I. p.- too. Alternate abduction of straight legs in the plane of the floor. 8-10 times. The pace is slow.

4. I. p.- too. Raising two straight legs, socks “on oneself” (inhale, hold the breath for 2–3 s), and. P.- exhale. The pace is slow, repeat 8-10 times.

5. I. p.- Lying on your back. Light stretching (contraction and relaxation) of the quadriceps femoris muscle of the injured leg. In the process of execution, fix the contraction (4–5 s) followed by relaxation for 5–6 s. The pace is slow.

6. I. p.- too. Simultaneous abduction of straight legs along the lying plane. 4–8 times. The pace is average.

7. I. p.- too. Raising straight legs, perform a cross movement (2-3 times) - inhale, lowering with the same cross movements - exhale. 4–8 times. The pace is slow. Deep breathing.

8. I. p.- too. Raising straight legs, abduction and adduction (on weight), return to and. P. 4–8 times. The pace is average.

9. I. p.- too. Raising the injured straight leg, toe “on oneself” (inhale), flexion and extension in the knee joint in weight (holding the breath for 1–2 s), and. P.- exhale. 8-10 times. The pace is slow.

10. I. p.- too. Raising and lowering straight legs, socks “on oneself” with simultaneous breeding and mixing crosswise. 4–8 times. The pace is average.

11. Meditative general relaxation. 25–30 s.

12. I. p.- too. Raising the injured straight leg, toe “on oneself” to an angle of 90 ° in the hip joint with support with hands intertwined “in a lock” in the popliteal region (inhale); flexion and extension of the leg in the knee joint in weight (holding the breath for 2–3 s), and. P.- exhale. The pace is slow. Repeat 10-15 times without leading to pain.

13. I. p.– sitting, feet on the floor. Stepping forward (until full extension of the legs in the knee joints) and backward (up to an angle of 90 ° in the knee joints). 10–20 times. The pace is average.

14. I. p.- too. Without taking your feet off the floor, alternately and simultaneously rearranging socks and heels to the side and to and. P. Repeat 8-10 times for each movement option. The pace is average.

15. I. p.- the same, fingers "locked" under the knee of the injured leg. Raise the leg with your hands and, on weight, perform pendulum movements in the knee joint. 20–30 times. The pace is average. After returning to and. P. general relaxation. 25–30 s.

16. I. p.- too. Without lifting the feet from the floor, alternate and simultaneous movements of the socks and heels in opposite and similar directions. 8-10 times for each option. The pace is average.

17. I. p.- sitting, legs extended. Raising straight legs (exhale), lowering - inhale. 10-12 times. The pace is slow. Classical diaphragmatic breathing. 25–30 s.

18. I. p.- Lying on your back. Meditative alternating raising the legs to an angle of 15 ° and lowering. It is performed within 1.5–2 minutes. Breathing is slightly deepened.

Variable exercises for a similar pathology

Breathing is free.

1. I. p.- Lying on your back. In a state of relaxation, simultaneous slow raising and lowering of straight legs to a height of no more than 45 ° in the hip joint. 8-10 times.

2. I. p.- sitting, feet on the floor. Raise the injured leg with your hands (fingers are intertwined “in a lock” under the knee) and perform circular movements with a small amplitude in the knee joint in both directions. 8-10 times. The pace is average.

3. I. p.- sitting, legs straight. Alternately bending the legs to the stomach (exhale), extension (inhale). 6-8 times with each leg. The pace is slow.

4. I. p.- too. Simultaneous flexion of the legs to the stomach and extension. 6–8 times. The pace is slow, bending the legs (exhale), unbending (inhale).

5. I. p.- sitting on a high stool, legs in weight. Free swinging of the legs, changing the position of the legs. 10–20 times. The pace is average.

6. I. p.- too. Circular movements of the injured leg in the knee joint in both directions. 10–20 times. The pace is slow.

7. I. p.- too. Simultaneous swaying of the legs forward and backward. 10–20 times. The pace is slow.

8. I. p.- too. Simultaneous circular movements in the knee joints. 10–20 times. The pace is slow.

9. I. p.- sitting, the injured leg lies on the lower third of the healthy leg. Pendulum movements in the knee joint of the injured leg with the help of a healthy one. 10–20 times. The pace is slow. The amplitude of movements is maximum, without pain.

10. I. p.- sitting, a healthy leg lies on the lower third of the lower leg of a diseased leg. Pendulum movements in the knee joint of the injured leg with the help of a healthy one (pressing on the lower leg when flexing). 10–20 times. The pace is slow. Exercise should not cause pain.

11. I. p.- standing, hands on the back of a chair or on the rail of the gymnastic wall. Without lifting the foot of the injured leg from the floor, alternately move the toe and heel outward (legs to the sides) and inward (legs together). The pace is slow.

12. I. p.- too. Half squat. 4-10 times. The pace is slow.

13. I. p.- too. Without taking your feet off the floor, simultaneously move your toes, then your heels to the outside (legs to the sides and inward - legs together). 10–20 times. The pace is slow. Perform the exercise without tension and pain.

14. I. p.- too. Swing movements of the injured leg forward, backward, to the side. The pace is slow.

15. I. p.- too. Swing movements with a straight damaged leg with a gymnastic wall rail or on a chair seat. 6-10 times. The pace is slow.

16. I. p.- the same, legs apart. Bending the knee of the injured leg, transfer the weight of the torso to it. The same for a healthy leg. 4-10 times. The pace is slow.

17. I. p.- the same, legs apart wider. Circular movements of the body in both directions. 4-10 times. The pace is slow.

18. I. p.- the same, the injured leg on the rail of the gymnastic wall, on a bench or on a chair. Flexion and extension of the injured leg at the knee joint. 4-10 times. The pace is slow.

19. I. p. Walking: normal, sideways, backwards, cross step, in a semi-squat, on a wide and narrow area of ​​​​support, with movements. 10-20 steps in each option. The pace is average.

Fracture of the intercondylar tuberosity of the tibia

is fixed with a back plaster splint from the fingertips to the upper third of the thigh for 2–4 weeks. The exercise therapy technique for developing the knee joint is similar to the technique described above.

Knee ligament injuries possible with athletes, circus and ballet performers. There are damages: sprain, tear, tear. As a rule, these injuries are accompanied by: pain, dysfunction, swelling. There may be fluid in the joint. Damage to the lateral ligaments is observed when jumping on an abducted leg. At the same time, unnatural lateral mobility in the joint is noted. The joint is punctured and a posterior plaster splint is applied for 3-4 weeks. When the cruciate ligaments are torn, there is unnatural mobility in the joint forward (anterior cruciate) or backward (posterior cruciate).

Exercise therapy begins the next day after immobilization of the joint and is carried out in three periods: acute period of injury(immobilization period), functional and training. Exercise therapy consists of respiratory, general developmental and special exercises: contraction of the quadriceps femoris muscle (exercises are performed with a healthy limb in full), flexion and extension of the fingers, ideomotor movements, movements in the hip joint, walking on crutches without relying on the leg (10–14 days) . All exercises are performed at a slow and medium pace without jerks and without pain.

After removing the splint, it begins second period rehabilitation by means of exercise therapy. Therapeutic gymnastics is performed in the kneecap or the knee joint is bandaged. Exercises are similar to exercises for a fracture in the knee joint. In case of damage to the cruciate ligaments, a circular plaster bandage is applied from the fingers to the upper third of the thigh for 2-6 weeks. The technique of exercise therapy is similar to the described technique. V third period exercises are performed for all joints of both limbs.

An approximate scheme for constructing a therapeutic gymnastics lesson in the second period after surgery for damage to the lateral ligaments of the knee joint

Introductory part of the lesson

Methodical instructions: dynamic breathing at a slow pace, free, medium pace.

The main part of the lesson. I. p.- lying on your back: breathing exercises; exercises for the quadriceps femoris of the injured leg; rest pause; lifting straight legs separately, together, crosswise, abduction of straight legs alternately and together (first on the floor plane, then on weight); rest pause; flexion and extension of the injured leg at the knee joint (the leg is bent at the hip joint at an angle of 90°) with support by the hands (“locked”) in the popliteal region; rest pause. 10–12 min. Breathing of a dynamic nature at an average pace, free. The pace of the exercises is slow and medium. Exercises should not cause pain and breath holding.

I. p.- sitting, legs bent at the knee joints, standing on the floor: breathing exercises; stepping forward and backward; without taking your feet off the floor, move your toes and heel alternately and together outward and inward. With the help of hands closed “in a lock” under the knee joint, pendulum movements of the lower leg forward, backward, circular movements in both directions; flexion and extension of the leg, pulling it to the stomach. Rest pause. 5–7 min. Breathing of a static and dynamic nature at an average pace, free. The pace of the exercises is slow and medium. Exercise should not cause pain.

I. p.- sitting on a high stool: breathing exercises; free swinging of the knees separately and together, forward and backward, circular movements in both directions; pendulum movements in the knee joint of the injured leg, putting it on the lower third of the healthy leg, but putting the healthy leg on the lower third of the lower leg of the injured leg and gently pressing the healthy leg on the damaged leg when bending; rest pause. 5–7 min. Breathing of a static and dynamic nature at a slow pace, free. The pace is slow and medium. Relax the muscles of the lower leg as much as possible, make sure that the range of motion of the healthy leg does not exceed the range of motion of the injured leg. Exercise should not cause pain.

I. p.- standing, holding hands on the back of a chair or a gymnastic wall; breathing exercises; without lifting the feet from the floor, move the socks and heels separately and together, outward and inward; rest pause; semi-squatting or squatting with support on hands; rest pause; alternate swinging movements of the legs with placing on the rail of the gymnastic wall (changing the level) or the seat of the chair; rest pause; transferring body weight to a bent knee, changing the position of the legs; circular movements of the body in both directions; rest pause; flexion and extension of the injured leg in the knee joint with support on the rail of the gymnastic wall or on the chair seat; rest pause. 12–15 min. Breathing exercises of a static and dynamic nature at an average pace. Exercise should not cause pain, shortness of breath and breath holding.

I. p.- standing: breathing exercises; walking - normal, sideways, back forward, cross step, in a semi-squat, for coordination and balance on a wide and narrow area of ​​\u200b\u200bsupport. Rest pause. 5–7 min. Breathing exercises of a static and dynamic nature at an average pace. Exercise should not cause pain, shortness of breath and breath holding.

The final part of the lesson

I. p.- standing and sitting: breathing exercises; exercises for medium and small muscle groups; rest pause, exercises to relax the muscles of the whole body. Breathing exercises of a static and dynamic nature. The pace is slow. Maximum relaxation of the muscles of the whole body.

An approximate list of exercises for damage to the lower leg (post-immobilization period)

I. p.- Lying on your back. Breathing is free. Repeat 6-8 times.

1. Flexion and extension of the toes.

2. Dorsal and plantar flexion of the foot.

3. Alternate and simultaneous flexion and extension of the legs in the knee joints.

4. Alternate abduction and adduction of a straight leg, sliding it along the plane of the bed.

5. Isometric tension of the thigh muscles (2–3 s).

6. Imitation of cycling (alternately with a sick and healthy leg).

7. Circular movements of the feet.

8. External and internal rotation of the leg.

I. p.- lying on the stomach.

9. Alternate flexion and extension of the legs in the knee joints.

10. Alternate abduction and adduction of the leg.

11. Movement of the legs as in the style of "breaststroke".

I. p. - sitting on a chair.

12. Alternate flexion and extension of the legs at the knees.

13. Grasping and holding small objects with toes for 3–5 s.

14. Feet on the medicine ball. Rolling the medical ball with your feet back and forth.

15. Calm pace, repetitions 6-8 times, voluntary breathing.

Ankle fracture. There are fractures: internal, external, both ankles with displacement and without displacement. Ankle fractures are caused by rotational movements in the ankle joint with excessive amplitude, twisting of the foot, rotation of the lower leg with a fixed foot. A combination of ankle fractures with subluxation of the foot is possible. For fractures without displacement, a plaster bandage with a stirrup is applied from the fingertips to the knee joint. Exercise therapy begins on the 2nd day, is carried out in three periods. Crutches supported by a stirrup are used.

V first (acute) period(before removing the plaster cast) exercise therapy helps restore blood and lymph flow at the site of injury, reduces swelling, restores muscle tone, restores joint mobility (initially free from plaster), stimulates the sending of impulses to the affected joint when performing ideomotor exercises. Special exercises should be carried out in combination with respiratory and restorative. Exercises are performed in all joints free of plaster, while strengthening the quadriceps femoris muscle. Walking on crutches is acceptable on a flat surface and on stairs. The sets of exercises are repeated 3-4 times a day for 20-30 minutes.

Second (functional) period starts from the moment the plaster is removed. Exercise therapy is aimed at restoring mobility in the ankle joint, combating edema, preventing post-traumatic flat feet, foot deformities, the formation of heel spurs, and curvature of the fingers. Shoes for the affected limb must have an individual arch support. In addition to general strengthening and breathing exercises, exercises are performed for the ankle joint in all planes from any starting positions: walking on toes, on heels, on the inner and outer edges of the foot, back forward, sideways, crosswise, in a semi-squat, relying on the crossbar, on simulators . To reduce swelling several times a day for 15–20 minutes, the legs are raised in the supine position. A set of exercises performed after position treatment. They do exercises with fingers, feet, pulling the legs to the stomach, raising straight legs to the angle position, contracting the thigh muscles. It is recommended to perform self-massage of the legs several times a day, with an emphasis on the ankle joint and calcaneus. It is permissible while walking to bandage the leg with an elastic bandage from the fingers to the knee joint, which should be removed during the period of therapeutic exercises and massage. In addition, it is desirable to carry out therapeutic exercises in water, do foot baths (up to the level of the knee joint at a temperature of 36–37 ° C) at night.

V third training period it is necessary to fully restore movement in all joints of the lower limb and the working capacity of the body. Running, jumping and other loads are acceptable, while the affected joint is recommended to be fixed with an elastic bandage. Also, as in the second, in the third period, therapeutic swimming is used. In case of a displaced ankle fracture, the fragments are repositioned (osteosynthesis), a plaster “boot” is applied from the fingers to the knee. The tasks and methodology of exercise therapy are similar to those described above for ankle fractures without displacement.

An approximate list of exercises for ankle fractures.

Second period

When the ankle is fractured, swelling of the foot is formed anywhere. To combat swelling, it is recommended to lie down for 10-15 minutes 3-4 times a day, raising the legs at an angle of 120-130 ° in the hip joints. 5 minutes later, perform special exercises. Breathing is free.

1. Contraction of the quadriceps femoris muscle - 20-30 times. The pace is slow.

2. Flexion and extension of the feet - 10-20 times. The pace is slow.

3. Flexion and extension of the fingers - 10-20 times. The pace is slow. Pause for rest 1–2 min.

4. Flexion and extension of the fingers - 10-20 times, the pace is average.

5. Circular movements of the feet - 10 times in each direction. The pace is average.

6. Flexion and extension of the feet with a maximum amplitude - 10-20 times. The pace is average.

7. Alternately bending the legs to the stomach (socks on yourself) - 10-20 times with each leg. The pace is average.

8. Breeding and bringing together the toes of the legs with a maximum rotation of the entire leg - 10 times. The pace is average.

9. Alternately raising straight legs to an angle of 90 ° in the hip joints (socks on oneself) - 10 times with each leg. The pace is average.

10. Contraction of the quadriceps femoris muscle - 20-30 times. The pace is slow.

11. Raising a directly injured leg to an angle of 90 ° in the hip joint with simultaneous flexion and extension of the fingers and foot in weight - 10 times. The pace is average.

12. Rest in a prone position with legs raised - 5-10 minutes.

Fractures of the bones of the foot and toes arise due to an unsuccessful jump, a fall from a height, a fall of weight on the foot. In case of a fracture without displacement, a plaster bandage with a stirrup is applied for 4–8 weeks (calcaneus fracture), 18–21 days (metatarsal fractures), 6–8 weeks (multiple metatarsal fractures). In case of displaced fractures, the fragments are compared and a plaster cast is applied. The exercise therapy technique is similar to that for ankle fractures. It is recommended to use an arch support within 2 years after the removal of the plaster cast.

Achilles tendon injury occurs in athletes, circus and ballet performers when jumping and jumping on toes. Characteristic signs of damage: sharp pain in the tendon and calf muscle and weakening (tear of the tendon) or loss (rupture of the tendon) of the plantar flexion of the foot. A plaster cast is applied with moderate plantar flexion (in case of rupture, the tendon is pre-sutured) for 4-5 weeks. Exercise therapy begins on the 2nd-3rd day and is carried out in three periods.

V the first period in addition to general developmental and breathing exercises, exercises are carried out for the toes of the affected leg, ideomotor exercises in sending impulses, movements in all joints free of plaster. From the 2-3rd day, walking on crutches is allowed without relying on the leg.

Second period begins with the removal of plaster. Movements in the ankle are added to the previous exercises, it is possible in warm water, without pain with a gradual increase in dorsiflexion or plantar flexion. Walking on crutches, walking with a stick.

V third period use exercises at the gymnastic wall or holding on to a support, lifting on toes, rolling from heel to toe. Sports and labor performance is restored 6-8 months after the injury.

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In case of damage to the musculoskeletal system (MSA), both anatomical and functional disorders often occur, which limit the possibilities of self-service, providing household needs, and ability to work. Often they lead to disability. Often, disability is noted with injuries of the spine, intra- and periarticular injuries, injuries of the hand and fingers.

According to the Control and Expert Commission (CEC), the reasons for the decrease or disability in 26% of cases are not morphological, but functional changes that have developed as a result of an injury. This may be due to shortcomings in the organization and methods of treating patients with musculoskeletal injuries: untimely, late onset, irregularity, low intensity of rehabilitation measures, or insufficient use of a complex of all rehabilitation means. Sometimes its role is underestimated in the postoperative period, which reduces the effectiveness of surgical intervention, and sometimes makes it unjustified.

Disturbances that develop with damage to the musculoskeletal system can be conditionally divided into manifestations of the general and local response of the body to the pathological process. So, due to the severity of injuries, metabolic processes can be disrupted, the body's reactivity, exercise tolerance, etc. may decrease. Injury, as well as a forced mode of limited motor activity that is unusual for the patient, lead to disruption of the activity of individual organs and systems. In a number of cases, the transferred injuries of the musculoskeletal system provoke the activation of a latent pathological process. Due to a significant change in the functions of organs and systems, the old mechanisms for their compensation cannot cope with the load.

The leading place among the dysfunctions observed in case of injuries of the musculoskeletal system are movement disorders that reduce the performance of the upper limbs, the support ability of the lower ones, which limit the statodynamic function of the spine. The severity of these disorders is associated with the severity of damage, the duration of hypokinesia or akinesia, immobilization, bed rest, as well as the nature of local changes. We are talking about the restructuring of damaged tissues (the formation of a scar, callus, etc.), as well as secondary changes in intact and unaffected tissues (muscle hypotrophy, wrinkling and thickening of the articular bag, osteoporosis, etc.). Often, both general and local disorders that develop with damage to the musculoskeletal system are caused by pain.

When compiling a rehabilitation program for various disorders of the motor function, it is convenient to divide the solution of the problems that have arisen into a number of successive periods, having previously formulated one or several special tasks.

At the first acquaintance with the patient, having studied in detail the features of the traumatic injury, the general condition of the patient, it is possible to predict the result in advance: complete restoration of the musculoskeletal system function, partial restoration (improvement), functional or anatomical defect. In accordance with this, the goal is formulated, which is achieved when the program is executed at the appropriate stage (period).

When designing a rehabilitation program, consider the following:
. the general condition of the patient, his psychological status;
. the state of the bone tissue (the severity of callus, osteoporosis) and the correct comparison of bone fragments;
. the nature of immobilization (gypsum bandage, skeletal traction, osteosynthesis);

The condition of the skin, tendons, capsular-ligamentous apparatus, muscle tissue, blood vessels and nerves;
. localization of the injury (upper, lower limbs, pelvic bones, spine) and its nature (open or closed, near- or intra-articular injuries);
. the presence of damage to the nerve trunks and blood vessels associated with bone trauma.

Only with the integrity of all the listed structures (bone, ligaments, muscles, nerves, tendons) can we speak of functional disorders.

In traumatology practice, it is customary to distinguish three main periods:

• immobilization lasting until the moment of fracture consolidation or the formation of a connective tissue scar having sufficient mechanical strength;
• post-immobilization- from the moment of removal (cessation) of immobilization to improvement of the skin condition, tissue trophism, restoration of range of motion, muscle tone, etc.;
• restorative- until the full restoration of the working capacity of the ODA, or compensation for a functional defect.

With surgical methods of treatment, they speak of the early postoperative period (corresponding to the post-immobilization period) and the late postoperative period (often called the recovery period). In each period of treatment, a goal must be set, specific tasks defined and appropriate means selected.

Immobilization period

The purpose of the functional treatment of the immobilization period is to provide conditions for the maximum possible motor activity of the patient and the preservation of the function of the injured limb.

Treatment goals: activation of blood circulation in the injured limb; preservation of mobility in joints free from immobilization, with surgical methods of treatment - adjacent to the operated segment; maintaining muscle tone of the injured limb; prevention of hypostatic complications in bed rest; learning to walk using crutches with a plaster cast or external fixation device.

The choice of means of rehabilitation

The choice of means of rehabilitation depends on the nature of immobilization. However, it should not be forgotten that even with the most reliable (stable) type of fixation, there is a possibility of displacement of bone fragments, which can lead to improper union (post-traumatic deformity) or nonunion of the fracture (formation of a false joint). At the same time, in case of damage to the joints and tendons, late movements are the cause of the formation of post-traumatic contractures.

Fixed assets: general developmental exercises for intact limbs; position treatment (elevated position for the damaged segment); dynamic exercises for the joints of the injured limb free from immobilization, performed in light conditions; isometric tensions of individual muscles (muscle groups) of varying intensity and duration, provided that the fragments are compared; ideomotor movements; physical exercises in the aquatic environment with stable bone or intraosseous osteosynthesis after postoperative wound healing; walking in case of damage to the belt of the upper limbs; learning to walk with crutches for injuries of the lower extremities.

The duration of the immobilization period is determined by the generally accepted terms for the consolidation of fractures of various localization.

M.B. Tsykunov

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Introduction

Therapeutic exercise for traumax musculoskeletal system

Methods for assessing the musculoskeletaldevice and self-control

Clinical and physiological effects of physical exercises

Approximate set of physical exercises

flat foot

Scoliosis

Conclusion

Bibliography

Introduction

Physical exercise is essential at any age. From adolescence to old age, a person is able to perform exercises that strengthen his body, have the most diverse effects on all its systems. They give rise to a feeling of cheerfulness and special joy, familiar to everyone who systematically goes in for any kind of sport.

The musculoskeletal system consists of the skeleton and muscles. Human muscles are divided into three types: smooth muscles of internal organs and blood vessels, characterized by slow contractions and great endurance; striated muscles of the heart, the work of which does not depend on the will of a person, and, finally, the main muscle mass - striated skeletal muscles, which is under volitional control and provides us with the function of movement.

The muscles of our body are good wizards. Performing their work, they simultaneously improve the functions of almost all internal organs, primarily the cardiovascular and respiratory systems.

The muscular system does not function in isolation. All muscle groups are attached to the bone apparatus of the skeleton through tendons and ligaments.

Skeletal muscles are the main apparatus by which physical exercises are performed. Well-developed muscles are a reliable support for the skeleton. For example, with pathological curvature of the spine, deformities of the chest (and the reason for this is weakness of the muscles of the back and shoulder girdle), the work of the lungs and heart becomes more difficult, the blood supply to the brain worsens, etc. Trained back muscles strengthen the spinal table, unload it, taking part of the load on themselves, prevent "falling out" of the intervertebral discs, slipping of the vertebrae.

Physical training also contributes to the development and strengthening of bones, tendons and ligaments. Bones become stronger and more massive, tendons and ligaments are strong and elastic. The thickness of the tubular bones increases due to new layers of bone tissue produced by the periosteum, the production of which increases with increasing physical activity. More calcium, phosphorus, and nutrients accumulate in the bones. But the stronger the skeleton, the more reliably protected the internal organs from external damage.

The increasing ability of muscles to stretch and the increased elasticity of the ligaments improve movements, increase their amplitude, and expand the possibilities of human adaptation to various physical work.

Therapeutic exercise for injuries of the musculoskeletal system

Therapeutic physical culture (LFK) is a scientific, practical, medical and pedagogical discipline that studies the theoretical foundations and methods of using physical culture for the treatment, recovery and prevention of various diseases. The specificity of exercise therapy in comparison with other methods of treatment lies in the fact that it uses physical exercises as the main therapeutic agent - a significant stimulator of the vital functions of the human body. One of the most characteristic features of this method is the application of physical exercises to patients in conditions of active and conscious participation in the treatment process of themselves.

Therapeutic physical training is an obligatory component of complex treatment, as it helps to restore the functions of the musculoskeletal system, has a beneficial effect on various body systems according to the principle of motor-visceral reflexes.

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

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

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

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

I period (immobilization).

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

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

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

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

Contraindications: purulent processes, thrombophlebitis.

II period (post-immobilization).

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

When applying physical exercises, it should be borne in mind that the primary callus is not yet strong enough. In this period, the dosage of general strengthening exercises is increased, various IPs are used; prepare to get 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.

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

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

III period (recovery).

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

Methods for assessing the musculoskeletal system and self-control over it.

Physical exercises strengthen health and noticeably improve the physical development of a person only if the exercises are carried out with the necessary load. Self-control in the process of training helps to establish the required level of load, which is based on a person’s observations of the general state of health, etc., and in our case, we will pay special attention to the musculoskeletal system. There are several indicators by which you can determine the state of the musculoskeletal system: muscle tone, body stability, flexibility, muscle strength, speed, agility, etc. In order to assess the state of the system at the time of the start of training, several methods can be used.

First, it is worth determining the state of muscle tone, which is determined by simple palpation. So, in people who do not go in for sports, the muscles are soft and flabby, the tone is sharply reduced. A static stability study should also be carried out. The body stability test is performed as follows: the athlete becomes in the main stance - the feet are shifted, the eyes are closed, the arms are extended forward, the fingers are spread apart (complicated version - the feet are on the same line, toe to heel). The time of stability and the presence of hand trembling are determined. In trained people, the stability time increases as the functional state of the neuromuscular system improves. It is also necessary to systematically determine the flexibility of the spine. Physical exercises, especially with a load on the spine, improve blood circulation, nutrition of the intervertebral discs, which leads to the mobility of the spine and the prevention of osteochondrosis. Flexibility depends on the state of the joints, extensibility of the ligaments and muscles, age, ambient temperature and time of day. When practicing sports swimming, mobility in various joints is of great importance. The measurement of mobility in the ankle, knee and hip joints is usually carried out using a goniometer, which allows you to evaluate the mobility in degrees. Mobility in the shoulder joints is determined by twisting straight arms behind the back, holding a gymnastic stick, while measuring the distance between shoulder width and grip width. A simple moving bar device is used to measure spinal flexibility. The mobility of the spine is determined by bending forward without bending the legs at the knee joints, while measuring the distance between the fingertips of straightened hands and the supporting surface. Strength endurance can be judged when performing pull-ups, push-ups, etc. The speed strength of the leg muscles gives an idea of ​​a long jump from a place, as well as a jump up from a place. The speed of the motor reaction to a certain extent can be assessed using simple tests. For example, you can take a coin in your left hand and, opening your fingers, drop it, trying to catch it with your other hand, located 30-40 cm below the first.

To determine agility, you can use, for example, throwing a ball into a basket or other exercises.

There are several physiological methods for determining the intensity of the load. The direct method is to measure the rate of oxygen consumption (l/min) - absolute or relative (% of maximum oxygen consumption). All other methods are indirect, based on the existence of a relationship between the intensity of the load and some physiological indicators. One of the most convenient indicators is the heart rate. The basis for determining the intensity of the training load by heart rate is the relationship between them, the greater the load, the greater the heart rate. To determine the intensity of the load in different people, not absolute, but relative heart rate indicators are used (relative heart rate as a percentage or relative working gain as a percentage).

Relative working heart rate (% HRmax) is the ratio, expressed as a percentage, of the heart rate during exercise and the maximum heart rate for that person. Approximately HRmax can be calculated by the formula:

HRmax (beats / min) \u003d 220 - the age of the person (years).

It should be borne in mind that there can be quite significant differences in HRmax for different people of the same age. In some cases, people with a low level of physical fitness.

HRmax (bpm) = 180 - human age (years) bpm.

When determining the intensity of training loads by heart rate, two indicators are used: threshold and peak heart rate. Threshold heart rate is the lowest intensity below which no training effect occurs. Peak heart rate is the highest intensity that should not be exceeded as a result of a workout. Approximate indicators of heart rate in healthy people involved in sports can be: threshold - 75%, peak - 95% of the maximum heart rate. The lower the level of physical fitness of a person, the lower the intensity of the training load should be. As fitness increases, the load should gradually increase, up to 80-85% of the maximum oxygen consumption (up to 95% of the heart rate).

Zones of work by heart rate beats / min.

up to 120 - preparatory, warm-up, main exchange.

up to 120-140 - restorative - supporting.

up to 140-160 - developing endurance, aerobic.

up to 160-180 - developing speed endurance

more than 180 - the development of speed.

Clinical and physiological effects of physical exercises

The therapeutic effect of physical exercises is manifested in the form of four main mechanisms:

1.) The tonic effect of physical exercise. Excitation of the central nervous system and increased activity of the endocrine glands stimulate vegetative functions, i.e. improve the activity of the cardiovascular, respiratory and other systems, increase metabolism and various protective reactions, including immunobiological ones. The tonic effect of physical exercises is greater, the more muscle mass is involved in the movement, and the greater the tension.

2.) Trophic action (tissue nutrition). Muscular activity stimulates metabolic, redox, regenerative processes in the body. Due to this, the products of inflammation dissolve faster, and in case of fractures, the formation of callus is accelerated.

3.) Mechanisms for the formation of compensation. Physical exercises contribute to an increase in the size of a segment or a paired organ, increasing their function, involving the muscles that were not previously involved in the performance of movements that were not inherent in them. Compensation can be temporary or permanent. Temporary, after illness, disappear. The latter occur when a function is irretrievably lost.

4.) Function normalization mechanisms. The main action of the movement dominant is characterized by a general stimulation of physiological functions. The dominant of the functioning musculoskeletal system has a general tonic effect on the patient's body, contributes to a better manifestation of trophic processes, restoration of the function of the affected system. The normalization of the function occurs under the action of a constantly increasing load. By eliminating temporary compensations and by improving the regulatory processes in the body. The normalization of pathologically altered functions is based on the violation of the formed neural connections and the restoration of the conditionally unconditional regulation characteristic of a healthy organism.

The therapeutic effect of physical exercises is manifested in a complex way, by many mechanisms simultaneously and depending on the disease.

The role of exercise therapy in the rehabilitation of physical performance. The term "rehabilitation" means the restoration of health to the possible optimism in physical, spiritual and professional terms. To ensure the success of the rehabilitation process in complex treatment, exercise therapy is widely used, which contributes to the mobilization of the body's natural forces, increases the tone and fitness of the whole organism. Occupational therapy, active participation of the patient himself, dosed physical training are the basis for the rehabilitation of patients. The use of exercise therapy in the rehabilitation process occurs in stages (hospital, convalescent department, sanatoriums, clinic, home treatment). For successful recovery of patients, it is necessary to observe gradualness and adequacy in the applied physical activity. Applied forms of physical therapy in summer, autumn and spring: therapeutic exercises, walking, jogging, swimming, rowing, skating, outdoor and sports games, close tourism.

Exercises for the muscles of the legs should be selected taking into account all muscle groups that perform flexion and extension of the legs in the hip, knee and ankle joints, as well as abduction and adduction by the hips. These are various movements with straight and bent legs, lunges forward, sideways, backwards, lifting on toes, squats on two and one legs with and without support by hands, jumping in place, moving forward, etc.

Approximate set of physical exercises

G.S. Yumashev, (mid-course of treatment):

Starting position - lying on your back.

Diaphragmatic breathing.

Alternate bending of the legs in the knee joints (the foot slides along the plane of the bed).

Body tilts to the side.

Raise the straight leg, hold it for 5--7 s, return to the starting position. The same with the other leg.

Isometric tension of the muscles of the thigh and lower leg.

Bend the thoracic spine - inhale, return to and. P.

Starting position - lying on your side.

Take the straight leg to the side, hold for 5--7 s, return to the starting position.

Bend your legs at the knee joints, pull them up with your hands to your chest, return to the starting position.

Starting position - lying on the stomach.

Alternate abduction and adduction of the straight leg.

Raise the straight leg, take it to the side, return to the starting position.

Leg movements as in breaststroke swimming.

Starting position - sitting on a chair.

Adduction and abduction of the feet.

Dorsal and plantar flexion of the feet.

Feet on the ball - rolling the ball with your feet forward - backward.

Feet on the "rocking chair" - rolling feet.

Feet on a spring footrest - pressure on the footrest.

Starting position - standing, hands on the gymnastic rail.

Half squats on toes.

Walking on the outer and inner arch of the foot.

Exercises are performed at a calm pace, repeating each 10-15 times. Classes are held 2-3 times during the day.

flat foot

Flatfoot is a deformity of the foot characterized by a fixed compaction of the longitudinal arch, valgation of the posterior and abduction of its anterior sections. Longitudinal flat feet according to the severity of deformation has three degrees.

Grade 1 - fatigue of the legs and pain in the calf muscles after a long walk.

Grade 2 - pain syndrome, there are signs of foot deformity.

Grade 3 - pronounced flat feet: deformity of the foot with the expansion of its middle part and pronation of the posterior section, while the anterior section is retracted outwards and supinated in relation to the posterior one.

With bilateral flat feet, the socks are turned to the sides. The gait is clumsy, running is difficult.

There are congenital and acquired flat feet.

Acquired flat feet are divided into statistical, rachitic, traumatic and paralytic.

Statistical flatfoot develops as a result of chronic overload of the feet, leading to a weakening of muscle strength and stretching of the ligamentous apparatus of the foot joints, resulting in a flattening of the longitudinal arch of the foot. It often occurs in people who perform work associated with prolonged standing or lifting and carrying heavy loads.

Pain is felt after exercise in various parts of the foot, in the calf muscles, knee and hip joints, in the lower back. To determine the degree of flat feet, they resort to plantography, podometry, radiography.

Plantography is the process of obtaining a footprint. The resulting plantogram is divided by a straight line passing through the center of the heel and between the bases of the phalanges 3 and 4 of the fingers. With a normal foot, the shaded part in the middle section does not extend to the dissecting line.

Podometry according to Fridlan - measures the height of the foot, the length of the foot. The height of the foot is multiplied by 100 and divided by the length of the foot.

Treatment of foot deformities begins with the prevention of flat feet in children: dosed physical exercises, prevention of excessive overload, wearing rational shoes are recommended.

Surgical intervention is performed on the soft or on the osteoarticular apparatus of the foot.

With flat feet of 2-3 degrees, the deformity of the foot is eliminated by modeling correction, but soon the foot returns to its previous position, and then soft tissue surgery is performed.

A plaster bandage to the middle of the thigh is applied for 4-5 weeks. After physiotherapy exercises and massage, it is necessary to wear arch supports or orthopedic shoes.

Scoliosis is a lateral curvature of the spine in the frontal plane. The costal hump, which is observed at the same time, forms a deformity with a bulge to the side and posteriorly - kyphoscoliosis.

Scoliosis is much more common than people think. Petersburg Children's Orthopedic Institute. GI Turner, 40% of the examined high school students revealed a violation of statics, requiring treatment. Scoliosis gets its name from the level of curvature: cervical, thoracic or lumbar and, accordingly, the convex side of the curvature. Thus, for example, right-sided thoracic scoliosis can be found.

Scoliosis can be simple or partial, with one lateral arc of curvature, and complex - with several arcs of curvature in different directions, and finally, total, if the curvature captures the entire spine. It can be fixed and non-fixed, disappearing in a horizontal position, for example, when one limb is shortened. Simultaneously with scoliosis, its torsion is usually observed, i.e. rotation around the vertical axis, and the vertebral bodies are turned to the convex side, and the spinous processes to the concave side. Torsion contributes to the deformation of the chest and its asymmetry, while the internal organs are compressed and displaced.

The initial manifestations of scoliosis can be detected already in early childhood, but at school age (10-15 years) it manifests itself most pronouncedly.

Etiologically, congenital scoliosis is distinguished (according to V.D. Chaklin, they occur in 23.0%), which are based on various vertebral deformities:

underdevelopment;

their wedge-shaped form;

accessory vertebrae i. etc.

Acquired scoliosis includes:

rheumatic, usually occurring suddenly and caused by muscle contracture on the healthy side in the presence of myositis or spondyloarthritis;

rickets, which very early manifest themselves with various deformities of the musculoskeletal system. The softness of the bones and weakness of the muscles, carrying the child in her arms (mainly on the left), prolonged sitting, especially at school - all this favors the manifestation and progression of scoliosis;

paralytic, more often occurring after childhood paralysis, with unilateral muscle damage, but can also be observed in other nervous diseases;

habitual, on the basis of habitual bad posture (often they are called “school”, since at this age they get the most expression). The immediate cause of them may be improperly arranged desks, seating students without taking into account their height and desk numbers, carrying briefcases from the first grade, holding a child while walking by one hand, etc. etc.

This list, of course, does not cover all types of scoliosis, but only the main ones.

It is generally accepted that the cause of lower back injury is training overload. Meanwhile, pain in the lower spine is much more often caused by a person's normal daily activities. This is the explanation for the seemingly strange contradiction when people who have never known sports complain about back pain. The worst thing is to sit. Surprisingly, when sitting, the spine is loaded more than when we stand. However, the increased load is only half the battle. For many hours we have to sit in the most harmful position - leaning forward. In this position, the edges of the vertebrae come together and pinch the intervertebral disc of cartilage. In general, this fabric has a remarkable elasticity, allowing it to successfully resist compression. However, it should be borne in mind that when sitting, the pressure force on the outer edge of the disk increases 11 times. And besides, it continues not only during the working and school day, but often at home.

By the way, how then to explain the simple fact that, tired of standing for a long time, we tend to sit down? The reason is that lower back pain is not always the result of an overload of the intervertebral discs. Often the pain provokes the muscles of the lower back, which, when standing, are in a state of static tension. It is worth sitting down, as the muscles relax, and the pain subsides. By the way, disc tension is rarely the cause of pain. An injury that arose a long time ago and now makes itself felt. When a person sits down, the injured area changes position. Hence the illusion of relief.

It is interesting to understand why, after all, the sitting loads the spine more than the standing position. The explanation is that the vertical body supports both the skeleton as a whole and a large array of muscles. As a result, the load is “dispersed” throughout the body, and the spine becomes “easier”.

When a person sits down, the supporting muscle corset of the body relaxes, and the entire weight of the body rests on the spinal column. Hence the injuries that occur with prolonged sitting.

It should be emphasized that a huge potential for self-correction is hidden in the vertebral discs. Even if you injured the disc, it will recover if you manage to eliminate the traumatic effect on it.

Treatment depends on the age of the patient, the type of scoliosis, and the degree of spinal deformity.

Children's scoliosis with I and II degrees of curvature of the spine is treated conservatively. An important condition for successful treatment is a complete and vitamin-rich diet, regular exposure to fresh air, outdoor games. The bed should be hard, for which a wooden shield is placed on the bed. The chair and table in the workplace should be appropriate for height. It is necessary to ensure that the child sits straight at the table, while his legs reach the floor. The correct installation of light is also important, and in case of visual impairment, its correction is mandatory. Therapeutic exercises are systematically carried out and corsets are often prescribed.

Conservative treatment is also carried out in special boarding schools for children with scoliosis, in which, along with training according to the usual program, the necessary round-the-clock treatment regimen has been created. One of the leading means of conservative treatment of scoliosis is exercise therapy. Physical exercises have a stabilizing effect on the spine, strengthening the muscles of the body, allow you to achieve a corrective effect on deformity, improve posture, the function of external respiration, and give a general strengthening effect. Exercise therapy is indicated at all stages of the development of scoliosis, but it gives more successful results in the initial forms of scoliosis.

Physical exercises that increase the flexibility of the spine and lead to its overstretching are contraindicated. The complex of exercise therapy tools used in the conservative treatment of scoliosis includes:

medical gymnastics;

water exercises;

position correction;

sports elements.

Exercise therapy is combined with a regimen of reduced static load on the spine. Exercise therapy is carried out in the form of group classes, individual procedures (mainly shown to patients with an unfavorable course of the disease), as well as individual tasks performed by patients on their own. The exercise therapy technique is also determined by the degree of scoliosis: with scoliosis I, III, IV, it is aimed at increasing the stability of the spine (stabilization of the pathological process), while with scoliosis II, it is also aimed at correcting the deformity.

Correction of scoliosis during exercise is achieved by changing the position of the shoulder, pelvic girdle and torso of the patient. Exercises should be aimed at correcting the curvature of the spine in the frontal plane. With great care, for the purpose of correction, exercises are used that stretch the spine, for example, at the gymnastic wall.

Exercises of therapeutic gymnastics should serve to strengthen the main muscle groups that support the spine - the muscles that straighten the spine, oblique abdominal muscles, square muscles of the lower back, iliopsoas muscles, etc. Of the exercises that contribute to the development of correct posture, exercises for balance, balancing, with increased visual control, etc.

One of the means of exercise therapy is the use of elements of sports:

swimming style "BRASS" after a preliminary course of study. Volleyball elements are shown to children with compensated scoliosis.

Prevention of scoliosis involves maintaining the correct posture. When sitting for a long time, the following rules must be observed:

sit still for no longer than 20 minutes;

try to get up as often as possible. The minimum duration of such a “break” is 10 seconds.

sitting, change the position of the legs as often as possible: feet forward, backward, put them side by side, then, on the contrary, spread them and. etc.

try to sit “correctly”: sit on the edge of the chair so that your knees are bent exactly at a right angle, perfectly straighten your back and, if possible, take some of the load off your spine by resting your straight elbows on the armrests;

periodically do special compensatory exercises:

Hang and pull your knees to your chest. Do the exercise the maximum number of times;

Get into a kneeling position on the floor with outstretched arms. Try to arch your back up as much as possible, and then bend it down as much as possible.

Morning gymnastics, health training, outdoor activities - the minimum motor level necessary for every person and it consists of walking, running, gymnastics and swimming. In addition to exercises of a general strengthening, health-improving nature, there are also many special ones, for example, to strengthen the abdominal muscles, chest, improve posture ... These exercises allow you to correct figure flaws to some extent, allow you to better control your body. You can perform them at any convenient time:

together with a complex of morning exercises and during a wellness workout;

during lunch break;

during a Sunday walk out of town.

Success will depend on the duration and regularity of classes.

Correct posture makes us not only more attractive, but also largely contributes to the normal functioning of all organs and systems of the body, is the prevention of scoliosis.

The following exercises will significantly strengthen the back muscles and keep the body in the correct position:

I.p. - standing, hands behind the head. With force, take your hands to the sides, raising your hands up, bend. Freeze for 2-4 seconds and return to I.p. Repeat 6-10 times. Breathing is arbitrary.

I.p. - standing and holding a gymnastic stick behind your back (the upper end is pressed to the head, the lower end to the pelvis). Sit down, return to I.P. Lean forward, return to SP. and finally lean to the right, then to the left. Perform each movement 8-12 times.

I.p. - lying on the stomach. Leaning on your hands and, without lifting your hips from the floor, bend. Freeze in this position for 3-5 seconds, then return to the i.p.

I.p. - standing one step away from the wall. Touching the wall with your hands, bend back, raising your hands up, and return to the sp. Repeat 5-8 times. Standing against the wall, press the back of your head, shoulder blades, buttocks and heels against it. Then move away from the wall and try to hold this body position as long as possible. If you work while sitting, periodically “press your back and lower back into the back of the chair, and if there is a high headrest, push your head against it with effort.

Conclusion

Classes of therapeutic physical culture should be systematic and regular. Only in this case, you can count on the maximum positive effect. In this case, it is necessary to take into account your capabilities, state of health, level of fitness and the recommendations of the attending physician. The healing effect of classes is primarily associated with an increase in the aerobic capacity of the body, the level of general endurance and physical performance.

Bibliography

1. Popov. Healing Fitness. Moscow, 2004.

2. Matveeva L.P., Novikova A.D. Theory and methods of physical education: Proc. for institutes of physics. culture / Under the general. ed. Matveeva L.P. - T.1. General foundations of the theory and methods of physical education. - M.: Physical culture and sport, 1993.

3. Edited by Kovalenko V.A., Physical culture: Textbook - DIA Publishing House, 2000.

4. Ed. IN AND. Ilyinich, Physical culture of the student - M.: Gardariki, 1999.

5. G.S. Yumashev. Operative traumatology and rehabilitation of patients with damage to the musculoskeletal system. M.: Medicine 1990.

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