Chinese expert consensus on orthopedic rehabilitation
The basic content of orthopedic rehabilitation treatment should include: physical therapy combined with surgical treatment, occupational therapy, functional training, rehabilitation nursing, psychological therapy, prosthetic and orthotic assistance, etc.
Orthopedic rehabilitation includes preoperative rehabilitation, intraoperative risk control, postoperative rehabilitation, etc. Orthopedic doctors should not only pay attention to surgical techniques, but also focus on perioperative rehabilitation, comprehensive management, and postoperative follow-up, which are prerequisites for ensuring postoperative functional recovery. Comprehensive management includes reducing trauma, bleeding, and pain; Prevent infection and venous thromboembolism, etc. 1. General assessment of orthopedic rehabilitation [11]: (1) Pain assessment: Visual Analog Scale (VAS), etc. (2) Sensory function assessment: including shallow sensation, deep sensation, and composite sensation assessment. (3) Joint range of motion (ROM) assessment: Understand the range of motion of limb joints and spine. (4) Various joint function assessment scales: commonly used include Harris Hip Score, Hospital for Special Surgery (HSS) Knee Scale, Western Ontario and McMaster University (WOMAC) Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, etc. (5) Muscle strength assessment: manual muscle strength test, isokinetic muscle strength test, etc. (6) Gait assessment: Handheld gait examination, gait analysis system. (7) Activities of Daily Living (ADL) assessment: ADL, Instrumental Activities of Daily Living (IADL), Modified Babbitt Index (MBI). (8) Quality of life assessment: Health Survey Brief (SF-36), World Health Organization Quality of Life Inventory (WHOQOL-100), etc. (9) Measurement of limb length/circumference. (10) Balance function check: Berg balance scale, balance evaluation instrument. (11) Functional testing: timed standing and walking test, five sitting up test (FTSST), etc. (12) Comprehensive ability assessment. 2. Special assessment of orthopedic rehabilitation: 1) Assessment of fracture fixation stability; (2) Assessment of fracture healing degree; (3) Spinal stability assessment; (4) Assessment of spinal cord injury severity (AIS); (5) Urodynamic assessment; (6) Evaluation of neurophysiology. 3. Preoperative rehabilitation: 1) Preoperative education: Provide relevant medical knowledge education to patients and their families to encourage them to actively cooperate in completing preoperative and postoperative rehabilitation training. (2) Preoperative evaluation: A comprehensive assessment of the patient's physiological function and psychological state is conducted to determine whether they can tolerate orthopedic surgery and cooperate with postoperative rehabilitation treatment. (3) Preoperative rehabilitation guidance: Conduct planned functional training before surgery to help patients adapt and learn rehabilitation exercises. Such as ankle pump, ROM, quadriceps, hamstring and other muscle strength training; Preparation and use of assistive walking devices (such as walking aids, crutches); Airway preparation, such as preoperative nebulization, cough and sputum evacuation training, to improve cardiovascular and pulmonary function; Bedtime urination training to prevent postoperative urinary retention, etc. (4) Preoperative management of malnutrition and anemia: For patients with malnutrition who undergo elective or limited surgery, nutritional support treatment should be performed before surgery. Firstly, treat the primary disease for anemia patients; Simultaneously undergoing anemia treatment. (5) Reduce fasting time: Patients can eat solid foods 8 hours before surgery; 2-3 hours before surgery, a clear diet can be maintained; Encourage patients to drink appropriate high carbohydrate beverages on the night before surgery and 2-3 hours later. (6) Sleep management: Improvement of insomnia symptoms can significantly alleviate postoperative pain, promote early mobilization and functional exercise, improve patient comfort and satisfaction, and accelerate rapid recovery. 4. Reduce intraoperative damage:
Minimize surgical trauma as minimally invasive surgery is an important factor for rapid recovery. Small incisions and muscle gap operations result in minimal tissue damage, less bleeding, and faster recovery of patient function. During the operation, attention should be paid to the selection of anesthesia methods, temperature control, fluid management, and infection prevention. 5. Postoperative rehabilitation:
(1) Early initiation of rehabilitation training: Rehabilitation physicians and therapists should intervene early in postoperative functional training. Patients undergoing elective surgery (such as joint replacement surgery) can start on the day after surgery. Emergency surgery (such as fractures) can be followed by early rehabilitation training after reduction and fixation, while ensuring patient safety, to prevent joint stiffness and muscle contraction. (2) Pain management: Its content includes pain education, reasonable pain assessment, preemptive analgesia, and postoperative anesthesia management; Multi mode analgesic use, individualized analgesia, early use of nonsteroidal anti-inflammatory drugs; Prevention of complications of nonsteroidal anti-inflammatory drugs; Ice compress, etc. (3) Edema treatment: Swelling often affects wound healing, and general treatment methods include local pressure bandaging, ice application, immobilization, and raising the affected limb. Administer anti-inflammatory medication if necessary. (4) Prevention of venous thromboembolism: basic preventive measures: surgical operation should be as gentle and delicate as possible to avoid damage to the venous intima; Standardize the use of tourniquets; Raise the affected limb after surgery to prevent deep vein reflux obstruction; Moderate fluid replacement during and after surgery, drinking plenty of water, and avoiding dehydration; Routine education, encouraging patients to frequently turn over, engage in early functional exercises, get out of bed activities, and perform deep breathing and coughing movements; Suggest patients to improve their lifestyle, such as quitting smoking, alcohol, controlling blood sugar and blood lipids, etc. Physical preventive measures: Patients actively engage in ankle pump exercises, intermittent inflation and compression devices, and gradient pressure elastic socks, using mechanical principles to accelerate lower limb venous blood flow and reduce the occurrence of postoperative deep vein thrombosis in the lower limbs. For patients who cannot or are not suitable for physical prevention measures on the affected limb, prevention can be implemented on the contralateral limb. Drug prevention measures: Commonly used clinical drugs include unfractionated heparin, low molecular weight heparin, Xa factor inhibitors, vitamin K antagonists, etc. (5) Prevent postoperative infections. (6) Postoperative fluid management and drainage tube optimization. 6. Discharge treatment:
(1) Rehabilitation medicine department, rehabilitation hospital or community hospital rehabilitation. (2) Follow up management: Follow up 2-3 weeks after surgery: examination of incision, suture removal, assessment of joint function, treatment of pain, sleep disorders, and prevention of venous thromboembolism, timely detection and treatment of complications; Follow up visits at 3, 6, 12 months and annually thereafter, including functional scale measurement, imaging evaluation, and management of complications. 7. Application of rehabilitation equipment:
Prosthetics, orthotics, walking aids, wheelchairs, etc. 3, Rehabilitation treatment suggestions for common orthopedic diseases: 1. Perioperative rehabilitation of artificial joint replacement surgery:
(1) Preoperative rehabilitation treatment: muscle strength and ROM training around the joint to be operated on; Teach patients the methods of postoperative functional training and the correct use of walking aids, axillary canes, and canes. (2) Postoperative rehabilitation treatment: ① The first stage of postoperative rehabilitation (within one week after surgery) aims to minimize pain and swelling to the greatest extent possible; Independent transfer (bed wheelchair toilet). Precautions and contraindications: Avoid hip flexion exceeding 90 °, adduction exceeding midline, and internal rotation exceeding neutral position (posterior lateral approach); Avoid lateral positioning during surgery; Place pillows between the knees when lying supine or on the healthy side; Avoid placing pillows under the knee joint when lying down to prevent hip flexion contractures; If patients undergo simultaneous osteotomy, they should reduce their weight to 20% to 30% of their body weight The rehabilitation goal for the second stage after surgery (2-6 weeks) is to walk independently without any assistive devices and have a normal gait; Independently engage in daily life activities. Caution: Avoid hip flexion exceeding 90 °, adduction exceeding midline, and internal rotation exceeding neutral position (posterior lateral approach); Avoid prolonged sitting (>1 hour); Avoid therapeutic training and functional activities under pain. Rehabilitation content: Continue early muscle strength, ROM, balance, and proprioceptive training; Hip muscle strength enhancement training; Gait training; Step up exercises (from 10 cm, 15 cm to 20 cm); Daily life activity training (wearing and removing pants, socks, picking up items on the ground, etc.); If conditions permit, hydrotherapy can be performed The rehabilitation goal for the third stage after surgery (7-12 weeks) is to be able to climb up and down stairs; Independently complete putting on and taking off pants and shoes and socks; The results of functional tests such as timed standing up and walking, single leg standing, etc. have reached the normal range for the corresponding age group; Restore special functional activities. Caution: Avoid engaging in daily activities and therapeutic training under pain; Monitor patient activity levels to avoid further injury. Rehabilitation content: Continue hip muscle strength exercises and gradually transition to progressive resistance training; Continue gait practice and step up practice; Practice descending steps before starting (from 10cm, 15cm to 20cm); If conditions permit, hydrotherapy can be performed. (3) Common complications and their treatment: ① Non healing/infection of the wound: During the early postoperative recovery process, it is necessary to check the condition of the wound. If there is local inflammation, relevant examinations must be carried out in a timely manner, and the surgeon must be contacted to discuss the next treatment plan. ② Deep vein thrombosis: After surgery, elevate the affected limb and start active training such as distal ankle pumps, physical therapy such as pneumatic blood circulation aids, and anticoagulant therapy if necessary Joint dislocation: Once joint dislocation occurs, it is necessary to immediately contact the surgeon for manual reduction or anesthesia reduction Ectopic ossification: Once ectopic ossification is detected, it must be immediately assessed whether it is in the progressive or quiescent phase. During the rehabilitation treatment of advanced ectopic ossification, it is necessary to ensure painlessness to avoid excessive stimulation that may lead to the expansion of the ossification range.
2. Suggestions for postoperative rehabilitation of limb trauma fractures: Rehabilitation treatment is based on fracture reduction and fixation, and takes into account factors that may cause joint dysfunction, such as swelling, adhesion, joint stiffness, muscle atrophy, etc., while fully considering the need to ensure fracture healing. Corresponding physical therapy, occupational therapy, and orthotics are adopted to restore maximum function to the injured part of the limb, in order to meet the needs of daily life and work.
The postoperative rehabilitation of fractures is divided into three stages: (1) early rehabilitation: fibrous callus formation stage (weeks 0-4): ① acute stage (within 48 hours after surgery). The rehabilitation goal is to eliminate swelling; Relieve pain; Prevent the occurrence of complications. Rehabilitation content: protecting the affected limb, local immobilization, ice application, pressure bandaging, and raising the affected limb. The main form of training is the isometric contraction of injured limb muscles. Early rehabilitation of non injured areas to prevent secondary functional impairment Subacute phase rehabilitation (48 hours to 4 weeks after surgery): The swelling and pain in the affected area have significantly improved compared to before, making it an important period for rehabilitation. The rehabilitation goal is to gradually restore joint range of motion, increase muscle strength training, rebuild neuromuscular control, and improve cardiopulmonary function. Rehabilitation content: Raise the affected limb and maintain the correct position; Equal length contraction training; Training on the range of motion of the distal and adjacent joints of the injured area; Physical therapy: Pulse electromagnetic therapy, low-intensity pulse ultrasound, and electrical stimulation therapy can be used [12,13,14]. (2) Mid term rehabilitation: The goal of rehabilitation during the callus formation period (5-12 weeks) is to eliminate residual swelling; Softening and stretching contracted fibrous tissue; Increase joint range of motion and muscle strength; Restore muscle coordination. Rehabilitation content: ① Continue to increase ROM training until full joint range of motion is restored. ② After fracture healing, if there is extension or flexion contraction of the joint, extension or flexion traction can be performed. Continuous passive terminal stretching is performed by the therapist within the patient's tolerable range Continue with muscle strength and endurance training, and gradually transition from isometric muscle exercises to resistance exercises (starting after the surgeon determines that the fracture has fully healed), increasing the intensity of muscle training After clinical diagnosis of fracture healing, progressive resistance exercises can be performed on all muscle groups. And strengthen aerobic endurance training, encourage daily life activities, work, and leisure activities. (3) Post rehabilitation: Fracture healing period (after week 12): The rehabilitation goal is to achieve full functional range of motion; Fully functional muscle strength and endurance; Participate in all functional activities, work, and leisure activities normally. Rehabilitation content: ① Joint range of motion: In addition to continuing previous exercises, joint mobilization surgery can use third - and fourth level mobilization techniques. Wearing dynamic or static progressive braces can increase joint range of motion in patients with postoperative stiffness around elbow, wrist, hand, and ankle fractures [15]. Contraction and stiffness of joints can be treated with restorative joint traction, or with continuous passive terminal stretching by a therapist within the patient's tolerance range Continue early training to avoid muscle fatigue Whole body aerobic endurance training to restore physical fitness Enhancement of proprioceptive nerves and muscles. ⑤ Function recovery: Encourage daily life activities, work, and entertainment activities. 3. Rehabilitation suggestions for sports injuries: (1) Perioperative rehabilitation for anterior cruciate ligament reconstruction surgery:
① The preoperative rehabilitation goal is to restore normal ROM; Normal gait and maximum muscle strength and function. KT2000 inspection; Constant speed testing/functional testing/balance testing; Customized postoperative braces; Support equipment installation and removal education; Cold therapy guidance; Progressive gait training; Lock the brace at 0 ° when using crutches, and practice partial weight-bearing and straight leg lifting within the tolerable range of the patellar tendon; Patellar loosening, passive extension of knee joint, active flexion, or active extension with assistance (90 °~0 ° training); Active ROM (AROM) or assisted AROM exercises; Progressive resistance exercises and functional activities; Electrical stimulation/biofeedback therapy. ② The first stage after surgery (0-2 weeks) aims to achieve complete passive extension; Control postoperative pain and swelling; ROM(0° ~90°); Early progressive weight-bearing; Prevent quadriceps suppression; Independently complete a family therapy plan. Caution: Avoid actively extending the knee by 40 °~0 °; Lock the support at 0 ° while walking; Avoid standing or walking for long periods of time. Rehabilitation content: towel roll stretching, prone position suspension training; Quadriceps relearning (quadriceps electromyography stimulation); Lock the brace in the 0 ° position and gradually increase the partial load to a tolerable range while supporting the crutch load; Patellar loosening; Active flexion/extension with assistance from 0 ° to 90 °; Straight leg elevation exercises (SLRs) in all directions; Short arm power cycling practice; Progressive hip resistance training; Proprioceptive training (bilateral weight-bearing); Kick training (bilateral/70 °~5 °); Upper limb cardiovascular system training; Cold therapy; Family practice plan based on assessment; Emphasize the patient's adherence to the training plan and the precautions/progressiveness of weight-bearing The second stage after surgery (2-6 weeks) aims to achieve a ROM of 0 °~125 °; Good patellar mobility; Mild swelling; Restore normal gait (painless); Painlessly and under good control, step up approximately 20 cm high stairs; Attention: Avoid repeatedly going downstairs until the quadriceps muscle is fully controlled and the lower limb line is restored; Avoid pain during training and functional activities. Rehabilitation content: When the quadriceps muscle is well controlled (there is no pain or delay when lifting the leg straight), adjust the angle of the brace (0 °~50 °) to gradually bear weight or bear weight within a tolerable range; When walking painlessly, remove the crutch; Follow the doctor's advice to change the brace; If ROM>115 °, routine measurement of muscle strength; Kicking (80 °~0 °); Assist ROM; Small range squatting/center of gravity shift; Proprioceptive training; Practice on the stairs before starting; Gradual resistance with straight leg lifting exercises; Hamstring/gastrocnemius flexibility training; Progressive resistance exercises for hip and hamstring muscles; Proactively extend the knee to 40 °; KT2000 joint examination at 6 weeks after surgery (do not perform maximum tension test); Carry out home rehabilitation exercises based on the assessment The third stage after surgery (6-14 weeks) aims to restore normal ROM; The lower limbs are painless and well controlled when stepping down from a height of about 20 cm; Improve ADL endurance; Improve lower limb flexibility; Protect the patellofemoral joint; Caution: Avoid pain during training and functional activities; Avoid running and exercise training until sufficient muscle strength and surgeon's permission are obtained. Rehabilitation content: progressive squatting exercises; Start practicing stepping down the stairs; Kick your legs; Step forward; 90 °~40 ° equal knee extension (open chain); Advanced (interference) proprioceptive training; Flexibility training (exercise belt); Practice running backwards or backwards on the treadmill; Quadriceps stretch; Front down step test; Check KT2000 at 3 months after surgery; Carry out home rehabilitation exercises based on the assessment The fourth stage after surgery (14-22 weeks after surgery) aims to achieve painless running; Can meet the maximum strength and flexibility of ADL; During the jumping test, the affected knee reaches over 75% of the healthy side. Precautions: Avoid pain during treatment training and functional activities; Avoid exercise until sufficient muscle strength is restored and the surgeon allows it. Rehabilitation content: After successfully descending a step about 20 cm high, start practicing forward running on the treadmill; Continue practicing lower limb strength and flexibility; Enhance the flexibility/specificity of exercise; When the strength is sufficient, start practicing functional reciprocating movements; Wait for knee extension (painless full arc) (closed chain preferred); Constant speed training (from fast to medium speed) (closed chain priority); KT2000 joint measurement at 3 months postoperatively; Carry out home rehabilitation training based on assessment In the fifth postoperative stage (after 22 weeks), the goal is to have no fear of specific motor movements; Obtain maximum strength and flexibility to meet the requirements of specialized sports; During the jumping test, the affected knee reaches over 85% of the healthy side.
Caution: Avoid pain during training movements and functional activities; Avoid exercise until sufficient muscle strength is restored and the surgeon allows it.
Rehabilitation content: Continue to strengthen lower limb strength, flexibility, and agility; Enhanced functional reciprocating motion; Specialized sports wearing braces; Monitor the patient's activity level during the rehabilitation process; Re evaluate the patient's chief complaint (i.e. pain/swelling - corresponding adjustment plan); Encourage them to follow the family therapy plan; At 6 months postoperatively, KT2000 was used to measure joint stability; Adjust the family treatment plan based on the assessment. (2) Perioperative rehabilitation of lateral collateral ligament reconstruction of ankle joint:
① Preoperative rehabilitation treatment: emphasizing knowledge education; Targeted preoperative muscle strength and ROM training; Teach patients the methods of postoperative functional training and educate them on how to use axillary and elbow canes correctly; Explain to the patient the possible problems, treatment methods, and precautions that may arise during the rehabilitation treatment process Postoperative rehabilitation treatment: Start postoperative rehabilitation as early as possible, including gait training. Early postoperative weight-bearing is prohibited, and the ankle joint is fixed in a neutral position with plaster. In the earliest stages of the healing process, once AROM practice begins, special attention should be paid to preventing inversion of the ankle joint, as excessive pulling on the repaired tissue may cause
Organizational rupture. Formal physical therapy begins 6 weeks after surgery. Patients undergo tolerable weight-bearing training with the assistance of crutches or walkers. In the initial stage, the focus is on observing the effectiveness of the family training program, providing further education to patients, and striving for progress in ROM on various planes. Evaluating outpatient patients can reveal intrinsic organic factors, including varus of the hind foot and laxity of systemic ligaments, which can affect postoperative repair of Achilles tendon stress and even the implementation of the entire treatment plan. The process of rehabilitation is determined by function. It is worth mentioning that most of the research and theories supporting relevant rehabilitation guidelines are related to functional ankle instability (FAI). The reconstruction of lateral ankle ligaments and FAI are similar in principle, and for such patients, proprioceptive training and exercises of eversion and inversion muscle strength are also important. It takes about 3 months after surgery to resume normal exercise or start sports. Compared to the prescribed rehabilitation period, more emphasis should be placed on patients' subjective feelings and objective measurement results. It is also crucial to clarify the patient's own abilities and rehabilitation goals. For athletes, it is best to use ankle braces with straps to protect their ankles during the first 4-6 months of their recovery from exercise. (3) Perioperative rehabilitation for rotator cuff injury repair:
① The first stage after surgery: maximum protection period (0-3 weeks after surgery), with the goal of protecting and repairing tissues, reducing pain and inflammatory reactions, gradually increasing shoulder ROM (under the guidance of the surgeon) by 45 ° external rotation, 45 ° internal rotation, and 120 ° forward flexion, improving proximal and distal muscle strength and range of motion, and allowing for independent home training. Attention: After training, wear a brace to brake. Do not actively move the affected shoulder joint. Gently move the elbow, wrist, and hand on your own to avoid exceeding the range of motion set by the surgeon. Avoid pain during range of motion exercises and isometric contractions. Rehabilitation content: wearing suspension braces; Correction of daily life movements; Ice compress; Pendulum practice; Assistance and passive activity exercises; Passive joint activities performed by therapists; Assistance in joint flexion with supine position and contralateral limb support; Use a gymnastics stick to perform internal and external rotations of the scapular plane in a supine position; Active range of motion exercises for elbows, forearms, wrists, and hands; Shoulder stability exercise - lateral position; Neutral elbow flexion with submaximal deltoid muscle isometric contraction improves activity The second stage after surgery: moderate protection period (3-7 weeks after surgery) aims to protect and repair tissues, reduce pain and inflammatory reactions, improve 80% to 100% of flexion and external rotation range of motion, enhance muscle strength and stability around the scapula, improve shoulder humeral rhythm and neuromuscular control. Precautions: Avoid pain during daily activities, avoid actively raising the arm, do not engage in active movement of the rotator cuff to the maximum extent, avoid pain during range of motion training and therapy training, and avoid movements beyond the limits of range of motion. Rehabilitation content: Continue the first stage of practice and increase the range of activities within tolerable limits; Release the suspension; Active assistance in exercise range: practicing forward bending and internal/external rotation with a supine gymnastics stick; Joint loosening techniques and tension training; Practice for scapular stability of therapeutic balls; Isometric contraction exercise: Improve neutral position internal and external rotation (submaximal), neutral position deltoid muscle isometric contraction; Waiting for tension and contraction exercises. ③ The third stage after surgery (7-13 weeks after surgery): The goal is to eliminate or reduce pain and inflammatory reactions, regain passive full joint range of motion, improve strength and flexibility, restore normal shoulder brachial rhythm below 90 ° of arm lift, and gradually return to low-intensity daily activities below 90 ° of shoulder lift. Attention: Limit the upward movement of the head, avoid shrugging during activities and exercises, and patients should avoid vigorous activities and lifting heavy objects. Rehabilitation content: Improvement of activities, continued cold therapy if necessary; Continue practicing with the gymnastics stick: internal and external rotation, flexion; Continue joint loosening technique - changed to grade III and IV; Flexibility exercises, horizontal adduction; Perform functional activity exercises; Shoulder strap muscle strength exercises: scapular flexion, scapular retraction exercises, shoulder joint extension exercises with elastic bands, dumbbell exercises, rotator cuff stretching exercises, etc; Active activity training: lateral rotation; Improve the neutral position elastic band to practice internal and external rotation; Functional strength exercises: active forward flexion range of motion exercises in supine position (scapular plane), forward flexion exercises in standing position; Developing rhythmic stability exercises; Upper limb closed chain exercise. ④ The fourth stage after surgery (4-19 weeks): The goal is to enhance the strength of the shoulder strap muscles and shoulder joint muscles to level 5, improve neuromuscular control, and normalize the shoulder humeral rhythm within the range of motion of the entire joint. Attention: Increased stability of the proximal shoulder joint
Add it and then try lifting the head again. Rehabilitation content: Continue to perform isometric strength exercises on the shoulder strap muscles and rotator cuff muscles, and lower back latissimus muscle training (rowing machine, chest pushing machine); Continuing flexibility exercises - stretching the posterior joint capsule in a lateral position; Perform scapular stability exercises; Start practicing isokinetic exercises (internal and external rotation) on the scapular plane. ⑤ The fifth stage after surgery (20-24 weeks after surgery): The goal is to maximize flexibility, strength, and neuromuscular control to meet the requirements of sports and returning to work, entertainment, and daily activities. Isokinetic testing: 85% of the healthy side can independently engage in therapeutic exercise exercises to maintain and improve functional levels. Caution: Avoid pain during therapeutic exercises and activities, avoid physical activity until sufficient strength, flexibility, and neuromuscular control are obtained, and return to physical activity with the permission of the surgeon. Rehabilitation content: Continue to perform isometric strength exercises on the shoulder strap muscles and rotator cuff muscle tissues; Constant speed training and internal and external rotation testing; Continue practicing flexibility and stability; Individualized practice plan; Functional reciprocating motion (above the horizontal plane). 4. Rehabilitation treatment for ankle injuries:
Common ankle injuries include ankle fractures, ankle osteoarthritis, Achilles tendon rupture, eversion, and flat feet. This article focuses on the postoperative rehabilitation treatment of ankle fractures and Achilles tendon fractures. (1) Rehabilitation treatment after ankle fracture surgery:
According to time, rehabilitation can be divided into early, middle, and late stages: ① Early rehabilitation: fibrous callus formation stage (weeks 0-4). The goal of acute phase rehabilitation (within 48 hours after surgery) is to eliminate swelling, relieve pain, and prevent the occurrence of complications. Rehabilitation content: toe pump exercise, beneficial for foot blood circulation, promotes the elimination of swelling; After the pressure bandage is opened, physical therapy can begin, which can include cold therapy or semiconductor laser therapy to promote swelling elimination and wound healing. Subacute phase rehabilitation (48 hours to 4 weeks after surgery), with the goal of restoring the corresponding range of activities; Muscle strength training; Reconstruct neuromuscular control. Rehabilitation content: raising the affected limb, correct posture, cold therapy, light pressure bandage (or elastic bandage); Physical therapy (pulse)
Pulse electromagnetic therapy, low-intensity pulsed ultrasound therapy); Equal length contraction training; Range of motion training for joints adjacent to the injured area (active range of motion training for knee joint muscles, metatarsophalangeal joints). Attention: If there is significant swelling in the tissue after practice, continue to raise the affected limb and apply ice compress to the joint area. Continuous severe pain, first evaluate the blood supply of the toes, whether there is numbness or sensory dysfunction in the lower legs and feet, and if so, rule out compartment syndrome of the lower leg Mid term rehabilitation: callus formation period (5-8 weeks), with the goal of eliminating residual swelling; Softening and stretching contracted fibrous tissue; Increase joint range of motion and muscle strength; Restore muscle coordination. Rehabilitation content: application of physical therapy; Joint range of motion training; Increase distal muscle strength and proximal stable muscle strength, restore the affected limb to complete mild functional activities; Weight bearing training, during this period, patients can gradually undergo weight bearing training with the assistance of crutches, standing or walking Post rehabilitation: callus shaping period (9-12 weeks), with the goal of enhancing motor function and rebuilding neuromuscular control; Conduct ADL training to meet the needs of professional activities. Rehabilitation therapy: Physical therapy (low-energy laser, lymphatic massage, pressure therapy device, etc.); Joint range of motion training; Muscle strength training (complete weight-bearing, resistance strength training); Balance training; Gait and stair training. (2) Postoperative rehabilitation of Achilles tendon rupture:
① The first stage after surgery: protection and healing period (1-6 weeks after surgery), with the goal of protecting the repaired Achilles tendon, controlling edema and pain, reducing scar formation, improving dorsiflexion range of motion to neutral position (0 °), achieving a muscle strength level of 5 in each group of the proximal lower limbs, and completing the training program independently at home under the guidance of a doctor. Precautions: Avoid passive stretching of the Achilles tendon, limit active neutral position (0 °) ankle dorsiflexion at 90 ° knee flexion, avoid hot compress, and avoid prolonged ankle joint sagging. Rehabilitation content: Under the guidance of a doctor, use an axillary cane or walking stick, and wear Achilles tendon boots with discs for gradual weight-bearing; Active ankle dorsiflexion, plantarflexion, inversion, and eversion; Massage scars; Proximal muscle strength exercises; Ice compress. ② Postoperative second stage: Early joint activity (6-12 weeks postoperatively), with the goal of restoring normal gait, restoring functional ROM to meet the requirements of normal gait (15 ° ankle dorsiflexion) and stair climbing (25 ° ankle dorsiflexion), and restoring ankle dorsiflexion, inversion, and eversion muscle strength to normal level 5. Caution: Avoid pain during therapeutic exercises and functional activities, and avoid passive stretching of the Achilles tendon. Rehabilitation content: Exercise gait from tolerable weight-bearing to complete weight-bearing under protection, and can remove crutches when painless; Active ankle dorsiflexion, plantarflexion, inversion, and eversion exercises; Proprioceptive training; Equal length and isometric muscle strength exercises; Ankle inversion and eversion; 6 weeks after surgery: 90 ° ankle plantar flexion and dorsiflexion exercises for knee flexion; 8 weeks after surgery: Practice ankle plantar flexion and dorsiflexion in knee extension position; Bicycle practice; Reverse the treadmill; Physical factor therapy; Scar massage; Practice on the stairs Post operative third stage: Early muscle strength training (12-20 weeks post surgery), with the goal of restoring full range AROM, ankle and plantar flexion muscle strength to normal level 5, normal balance ability, recovery of painless functional activities, and ability to descend stairs. Attention: In addition to the above, it is also necessary to avoid high load on the Achilles tendon (i.e. excessive dorsiflexion of the ankle joint during whole weight or jumping). Rehabilitation content: isometric and isokinetic inversion and eversion exercises; Fixed bicycles, training stairs; Proprioceptive training; Strengthen ankle and plantar flexion exercises; Development of specialized skills in sub extreme sports; Developing proprioceptive projects; Lower limb proximal muscle strength exercise; Constant speed project practice; Flexibility exercises during activities; Practice down the stairs. ④ Postoperative Stage Four: Late Muscle Strength Exercise (Weeks 20-28), with the goal of being able to freely complete forward running activities on the treadmill, achieving an average torque of 75% of the healthy side through isokinetic testing, meeting the maximum muscle strength and flexibility required for daily life activities, restoring unrestricted functional activities, and completing higher-level physical activities without fear. Caution: Avoid pain and fear during activities, and avoid running and physical activity before reaching sufficient strength and flexibility. Rehabilitation content: Start practicing running forward on the treadmill; Isokinetic assessment and training; Continue practicing lower limb muscle strength and flexibility; Swing training improves proprioception; Mild functional reciprocating movements (jumping exercises with both feet); Continue to strengthen plantar flexion muscle strength exercises (emphasizing eccentric movements); Extreme sports skill practice; Continue cycling and training on the ladder; Continue to strengthen proximal muscle strength exercises. ⑤ Postoperative Stage 5: Comprehensive recovery of physical skills (28 weeks to 1 year after surgery), with the goal of engaging in sports without fear, meeting the maximum muscle strength and flexibility required for individual physical activities, and achieving 85% of the healthy side (plantarflexion/dorsiflexion/inversion/eversion) in isokinetic muscle strength measurement of the affected limb. Caution: Avoid comprehensive physical activity until you have sufficient muscle strength and flexibility. Rehabilitation content: more advanced functional training and flexibility exercises; Functional reciprocating motion; Constant speed training.
