Body-building

Therapeutic physical culture in pelvic fractures. Chapter VI. Rehabilitation treatment for pelvic fractures

The selection of exercises for pelvic fractures is as follows.

In case of uncomplicated fractures of the pelvis with a slight displacement of fragments, when the patient is placed in a supine position on a shield with a mattress, with a roller brought under half-bent and slightly apart knees (“frog position”), the use of exercise therapy begins after 4-6 days.

AT the first period of exercise therapy for pelvic fractures various movements of the arms, partly of the body, are used, selected taking into account the nature of the fracture. The patient is trained to raise the pelvis, the technique of movement is selected in accordance with the characteristics of the fracture.

With a unilateral fracture of the pelvis, movements of the leg not on the side of the fracture are performed actively with a gradually increasing amplitude. The movements of the leg on the side of the fracture are first made without lifting the heels from the bed during movements; after 12-15 days, active flexion and extension at the knee are activated while the leg is on the roller, then the straight leg is raised (first with the help of an instructor).

Questions about the inclusion of exercise therapy exercises for pelvic fractures lying on the stomach, on the side, standing on all fours and preparing for getting up, walking, sitting position are decided individually.

Getting up is carried out from a kneeling position with the support of hands on the back of the bed. When the symphysis diverges, the prone position during exercise therapy for pelvic fractures is undesirable. When sitting, the load of exercise therapy falls on the ischial tubercles; it should be included much later.

Transition to second period of exercise therapy for pelvic fractures determined by the appointment of the patient to walk. In the methodology, special attention is paid to exercises to strengthen the pelvic muscles (especially the gluteal) on the side of the fracture, back muscles, exercises in balance and posture restoration. The need for crutches is determined by clinical data. The load on the sore leg when walking gradually increases.

AT third period of exercise therapy special attention is paid to the spring function of the pelvic muscles: the ability of the muscles of the gluteal region and the muscles that pass to the back of the thigh to perform inferior work is restored. Restoration of the skill in walking ends with the elimination of uneven steps, leading to slight lameness.

In the treatment of pelvic fractures with displacement on a hammock or with the use of traction, the technique remains fundamentally the same. When stretching, exercises are combined that are used for fractures of the spine and hip throughout.

When selecting exercises for the trunk and lower extremities, it is necessary to take into account the influence of the tension of individual muscles on the standing of bone fragments. The terms of transition to the second and third periods are significantly lengthened (with severe fractures up to 12 weeks or more).

Exercise therapy for fractures of the acetabulum of the pelvis

With uncomplicated fractures of the acetabulum and after hip dislocations reduced without complications, if plaster immobilization is not applied, classes are carried out as with isolated pelvic fractures. At the same time, in case of fractures of the acetabulum, the load along the axis of the limb (permission to proceed to the limb) is allowed much later than in other pelvic fractures, and crutches are used for a longer time.

In traction treatment, the goal of early movement and early exercise therapy for pelvic fractures is to maintain joint mobility. During immobilization with gypsum, massive scars are formed, fixing the head in the articular cavity. Therapeutic physical culture during the period of plaster immobilization should contribute to the restoration of the support function and good consolidation of the fracture. For this purpose, according to clinical data, a load is provided along the axis of the limb - first in the prone position, and then when walking with crutches in a cast. After the plaster is removed, attention is drawn to the increase in mobility in the hip joint.

Pelvic fractures are classified as severe injuries. The most commonly observed damage to the horizontal p descending branches of the pubic bone and the ascending branch of the ischium. Pelvic fractures are more often unilateral. The most complex treatment requires ruptures and fractures in the area of the symphysis, sacroiliac joint, and fractures of the acetabulum. In case of damage to the anterior part of the pelvic ring (pubic or ischial bones), the patient is placed on an unbending bed with legs slightly apart and half-bent (for better muscle relaxation). For this purpose, a high oilcloth roll stuffed with cotton wool is placed under the knee joints, or the lower limb of the injured side is placed on the Beler splint. Immobilization of the pelvis using a roller makes it possible for the hapre to use a functional method of treatment. The duration of the patient's stay in bed and the duration of the load on the lower limbs depend on the nature and extent of the damage. In case of fractures of the pelvic bones without breaking the continuity of the pelvic ring (for example, a fracture of the pubic bone on the left and ischial frame), the patient can be raised to his feet after 4-5 weeks. If the integrity of the pelvic ring is violated (for example, a unilateral fracture of the pubic and ischial bones), the load on the legs is allowed no earlier than 2-2 "/g months after the injury. The patient is allowed to sit later than to walk. If the symphysis is ruptured, the patient is placed on his back with the legs parallel on the roller.In case of multiple injuries with separation of fragments, the pelvis is also pulled together with a special belt (Gplferding's hammock).In case of a significant divergence of bones in the pubic joint, the patient is laid on his side with a load on the pelvis.In fractures of the anterior and posterior parts of the pelvic ring (double vertical fractures according to Malgen) for fractures of the acetabulum, skeletal traction is used for the lower metaphysis of the femur or tuberosity of the tibia with the position of the lower limb on the Beler spine. In such cases, traction lasts 2-2 "/g of the month and is closely combined with therapeutic exercises. Walking with partial load is allowed no earlier than 3 months from the moment of injury.
The technique of physical therapy is different in the treatment of patients with fractures of the pubic and sciatic bones, rupture of the symphysis, damage to the sacroiliac joint and the acetabulum (E. F. Drevnig, 1940; V. V. Berandt, 1961; V. S. Smprnptskpp, 1967; II. L. Kovalenko, 1967).
In case of damage to one or both pubic and ischial bones, a functional method of treatment is used for the most part: in conditions of unloading the pelvis, specially selected exercises are used to strengthen the muscles of the pelvic girdle. Several groups of exercises are consistently applied according to the method of Drewnig (1940). The first group of exercises is carried out from the 4-5th day after the injury for 10-14 days in the initial position of the patient lying on his back. The complex includes exercises that involve the muscles of the upper limbs and shoulder girdle, the muscles of the trunk and the muscles of the pelvic girdle. Movements of the lower limbs are performed under conditions of support on the surface of the bed, as well as with support and assistance from the methodologist.
The following exercises can serve as an example: 1) sgnbanpe, extension in the ankle joints, circular movements of the feet; 2) alternate, and then simultaneous extension of the legs in the knee joints from the plane of the bed to the level of the roller (Fig. 30, a); 3) alternating pulling up of the legs with support on the surface of the bed until the ankle comes into contact with the roller.
The second series of exercises is carried out during the second half of the first month and during the second month after the injury. The transition to this group of exercises is made gradually, by including in the complex of individual movements that have a more intense effect on the musculoskeletal system.
Exercises of the second series are characterized by a more energetic effect on the muscles of the pelvic girdle, lower limbs and torso. The movements of the lower limbs are made without the support of the hips with a roller. Exercises are performed in the initial position lying on the back, and 3-4 weeks later (depending on the nature of the fracture) after the removal of the roller - and on the stomach. In case of fractures of the ilium, divergence of the symphysis, oblique fractures with displacement, therapeutic exercises are carried out only in the supine position. In the supine position, the following exercises are performed: 1) alternating and simultaneous lifting of straight legs; 2) alternate and simultaneous retraction of the legs to the side; 3) simultaneous bending of the legs to the stomach (rps. 30, b).

In the supine position, the following exercises are performed: 1) alternate and then simultaneous extension of the legs in the hip joints; 2) breeding straight legs; 3) raising the pelvis (Fig. 30, c).
Patients rise to their feet from a prone position and do not sit down for the first time, so as not to cause displacement of fragments. With the transition to a vertical position, patients, in addition to exercises in the prone position, perform standing exercises (semi-squats, free leg movements, body movements). In parallel with performing exercises while standing, the patient learns the skill of walking. It is necessary to teach the patient to walk without limping and swaying the body. The patient can be allowed to sit (at first for a short time) provided that he walks confidently, without experiencing fatigue and discomfort in the pelvic area.
Known features differ in the method of therapeutic exercises in case of damage to the pelvis with a divergence of the symphysis. As mentioned, in this case, the patient is placed on his side or on his back using a special belt that tightens the pelvis. The position of the legs on the roller or skewers should be parallel (without dilution).
In addition to the exercises above, exercises are used to help strengthen the adductor muscles of the thigh and gluteal muscles (while the range of motion in the direction of hip abduction should be limited). Physical exercises are also used in the initial position lying on the side - alternately pulling the legs to the stomach, straightening the legs in the hip joints at a slow pace.
In case of damage to the bottom of the acetabulum with displacement of fragments, as well as in case of damage to the sacroiliac joint with displacement of half of the pelvis, the patient performs therapeutic exercises under conditions of skeletal traction and immobilization of the lower limb with a Beler splint. During the first month after the injury, general strengthening exercises, movements in the joints of the non-mobilized limb, and breathing exercises are used. During the period of immobilization of the lower limb with a splint, the patient makes movements with the foot (back and plantar flexion, circular movements), and if the needle is passed through the lower metaphysis of the femur, movements in the knee joint are supported by the shin by the methodologist or by the patient himself (using a hammock-foot pad and a cord, thrown over the block).
Given the need to create a known diastasis between the femoral head and the articular cavity during the traction process after the elimination of the central dislocation of the femoral head, we do not recommend that the patient exert tension on the muscles that move from the pelvis to the thigh (for example, the rectus femoris). as this leads to an increase in NH tone. To maintain mobility in the hip joint, it is useful for the patient to sit down with a tire and traction, leaning on his hands or pulling himself up on his hands, holding a trapezoid suspended above the bed.
After the cessation of skeletal traction (45-60 days after the fracture), the patient in the supine position carefully bends the leg at the "knee joint, sliding it along the plane of the bed; hanging the lower leg over the edge of the bed, he bends and straightens the leg at the knee joint with the support of the lower leg In connection with the possibility of pressure under the influence of the traction of the muscles of the head of the femur on the bottom of the articular cavity, extreme caution is necessary when lifting the straight leg at an early stage of treatment. This movement is initially performed by the patient with simultaneous light traction of the methodologist along the long axis of the limb. After 2-2 "/ 1 month after the fracture, free swing movements of the sore leg in the hip joint in a standing position are allowed.
Walking with crutches is allowed 2"/2-3 months after the injury. Walking with a full load on the leg is allowed both for fractures of the acetabulum and for injuries of the sacroiliac joint at a later date. A combination of rest for the area of injury and timely mobilization of the joints with the help of active physical exercises contributes to the fusion of fragments in the correct position, the preservation of the musculoskeletal function of the lower limb, and prevents the development of deforming coxarthrosis.

Exercise therapy - Therapeutic exercise for a fracture (trauma) of the pelvis The diagnosis of a pelvic fracture is specified as a result of an x-ray examination. First you need to take an overview picture in the anterior-posterior direction, then additional pictures in special projections. If necessary, then computed tomography is performed. Also, in case of a pelvic fracture, it is imperative to conduct a digital examination of the rectum, because sometimes fragments of the pelvic bones can be felt through the wall of the rectum, and it is also necessary to check for intestinal ruptures. If we are talking about a woman, then in this case she is assigned an examination by a gynecologist. Depending on the nature of the fracture, different immobilization is performed. For example, in case of injuries of the pelvis with displacement of fragments, the patient is subjected to skeletal traction, but if the fracture of the pelvis is bilateral, then the patient is placed on a hard bed, and cotton-gauze rollers are placed under his legs, while the knees should be in a divorced state (the so-called Volkovich posture) . The therapeutic course of rehabilitation treatment for a pelvic fracture includes 3 periods. In the first period of treatment, it is necessary to pay attention to maintaining the general tone of the body, improving metabolism, and also not to forget about the prevention of possible complications from the respiratory system, the cardiovascular system and the gastrointestinal tract. In this period, the tasks of exercise therapy for pelvic fractures include: improving blood circulation in the area of damage in order to activate regeneration processes, preventing endurance of the muscles of the pelvic girdle and limbs, as well as preventing joint stiffness. Some time after the injury, patients begin to teach the chest type of breathing. With fractures of the pelvic bones, there are often complications in the form of a peritoneal hematoma, and in this case, the thoracic type of breathing is gentle and prevents an increase in intra-abdominal pressure, which can increase pain and provoke bleeding. In the first period of treatment, it is advisable to use physical exercises for a pelvic fracture, which contribute to the reposition of the bones of the displaced half, for this the patient must perform the following movements: stretch the lower limb on the side of the displacement to the foot end of the bed. Also, in the complex of exercise therapy for a fracture of the pelvis of the first period of treatment, exercises should be used that are aimed at bringing the pubic bones together (beveling the legs - a healthy leg rises above the immobilized one, internal rotation, etc.), among other things, these exercises help strengthen the abdominal muscles. However, therapeutic exercises in case of a pelvic fracture should exclude from its complex exercises that are fraught with further divergence of the pubic joint (leg abduction to the side, circular movements of the leg outward, etc.). If there are no contraindications, then the exercise therapy complex for a pelvic fracture from 3-4 days after the injury can include massage, which is performed to reduce swelling of the lower extremities, improve peripheral circulation and prevent thrombosis. During the massage, both lower limbs should be massaged, however, within 7-10 days, the massage of the immobilized limb is carried out with the restriction of rubbing, kneading and vibration techniques. The course of treatment includes 15-20 procedures. The second period of treatment for a pelvic fracture lasts 1-1.5 weeks. During this period, there is an improvement in the general condition of the patient, there is an adaptation to physical activity, which gradually increases. During these periods, as a rule, immobilization is removed. The tasks of exercise therapy and LP (therapeutic gymnastics) for a pelvic fracture in the second period include: strengthening the muscles of the trunk, limbs, pelvic girdle, increasing the range of motion in the joints of the limbs, and training of the support function of the lower limbs is also of no small importance. Physical activity can be increased by performing more complex exercises with both legs, as well as by isometric muscle tension of the limbs, pelvic girdle and torso, and, of course, by increasing the number of exercises and their repetitions. During this period of treatment, early turns on the stomach are contraindicated due to the fact that this can lead to a divergence of the pubic symphysis. Now in exercise therapy (physiotherapy exercises) with a fracture of the pelvic bones, you need to use exercises in the initial position lying on your back, on your side. Before lifting the patient out of bed (several days in advance), he is taught to turn on his stomach and a number of exercises are added in this position, such as: alternating and then simultaneous extension of the legs in the hip joints, breeding straight legs, lifting the pelvis and etc. In the third period of treatment for pelvic fractures, much attention is paid to restoring the walking skill and the patient's ability to work. The tasks of exercise therapy for a pelvic fracture now include: adaptation of all body systems to increasing physical activity, training the muscles of the limbs, trunk and pelvic girdle, as well as restoring the support function of the lower extremities and increasing mobility in the hip and knee joints. In this period, patients perform the exercises of the first and second periods in the initial position lying on the back, on the side and on the stomach, with a large number of repetitions of each exercise. After the patient is transferred to a vertical position, half-squats, various leg movements, torso tilts (with obligatory support for the back of the chair) are introduced into physiotherapy exercises for fractures of the pelvic bones. In order to restore coordination of movements and increase physical activity, exercises with gymnastic objects and at the gymnastic wall are used. The patient can already move on crutches, first within the ward, and then the hospital department, and if for 1.5-2 hours of continuous walking the patient does not experience pain in the area of damage, then he is also allowed to sit (at first not for long). A set of exercises of therapeutic gymnastics for a pelvic fracture. The first period of treatment: 1. I. P. - lying on your back or sitting, while your knees are slightly bent. Perform flexion and extension of the fingers. Repeat 8-10 times. 2. I.P. - the same. Perform dorsiflexion and plantar flexion of the foot: first healthy, then sick, then healthy and sick at the same time. Do 8-10 times in each case. 3. I.P. - the same. Put the injured leg on the knee of the healthy leg. Perform circular movements in the ankle joint: with a healthy leg, then with a sore leg, then at the same time with a healthy and sick one. Repeat in each case 8-10 times. 4. I.P. - the same. Grab small objects with your toes: balls, pencils, pens. 5. I.P. - the same. Turn the foot inward, outward (simultaneously). Repeat 8-10 times. 6. I.P. - the same. Put the toes of the feet one on top of the other. Perform dorsi and plantar flexion of the foot with resistance (at least 15-20 times). 7. I.P. - lying on your back, while the sore leg is half-bent at the knee. Supporting the thigh with your hands, perform flexion and extension of the leg at the knee joint, while tearing off the heel from the bed. Repeat 8-10 times. 8. I.P. - lying on the bed. Perform bending of the legs in the knee joints (8-10 times). 9. I.P. - lying on your back. From this position, move to a sitting position, then return to the starting position. Repeat 6-8 times. 10. I.P. - the same. Perform raising and lowering the knees. Repeat 6-8 times. 11. I.P. - the same. Grasping the edges of the bed with your hands, alternately raise your leg, straightened at the knee. Do 8-10 times. 12. I.P. - the same. Perform circular movements with the legs alternately. Repeat 6-8 times. 13. I.P. - lying on your side, while the sore leg is on top of the healthy leg. Perform leg abductions. Repeat 6-8 times. fourteen. I.P. - lying on your back. Perform leg movements imitating cycling (exercise "bike"). The second period of treatment: 1. I. P. - standing, holding hands on a chair. Rise on toes, then move to the heels and lower to the entire foot. Run 8-10 times. 2. I.P. - the same. The toes are turned slightly inward. Raise the inner arch of the foot, while transferring the entire weight of the body to the outer arch. Repeat 8-10 times. 3. I.P. - sitting on the bed. The legs are bent (the sore leg is supported by the hand). Perform flexion and extension of the leg at the knee joint, at the moment of flexion, put the leg on the bed. Do 6-8 times. 4. I.P. - sitting on the edge of the bed. Perform active alternating flexion and extension of the legs in the knee joint. Repeat 8-10 times. 5. I. P. - standing with support on the headboard. Raise the affected leg forward, bend it at the knee joint, then straighten and lower. Run 6-8 times. 6. I.P. - standing, hands on the belt. Take your healthy leg back, put on the toe. Bend the injured leg at the knee. Repeat 8-10 times. 7. I.P. - standing, legs apart. Transfer body weight alternately to the right and left legs. Then bending the leg at the knee joint. Run 8-10 times. 8. I.P. - lying on your back, arms along the body. Go to a sitting position without the help of hands: quickly, then slowly, then in the "hands on the belt" position, return to the starting position. Repeat 6-8 times. The third period of treatment: 1. I. P. - standing, the sore leg is behind on the toe (gradually increase the distance). Perform a springy movement, trying to reach the floor with the heel. Repeat 8-10 times. 2. I.P. - standing facing or sideways to the gymnastic wall, leaning on the wall at shoulder level. Put the sore leg on the 3-4 rail, then sit down on the healthy leg as deep as possible. Run 6-8 times. 3. I.P. - standing facing the gymnastic wall. Climb the wall on toes, performing additional springy squats on the toe of the sore leg (in order to increase the range of motion in the ankle joint). Do 2-3 times. 4. I.P. - the same. Climb the wall, rearranging the leg through 2-3 slats. Do 5-6 times. 5. I. P. - standing sideways to the gymnastic wall. Put a straight sore leg on the 2-3 rail, hands on the belt. Lean towards the leg, performing springy swings. Do 8-10 times. 6. I. P. - standing on the 2-3 rail of the gymnastic wall. Hands rest on the wall at chest level. Then perform the following actions (in sequence): a) sit down until the arms are fully extended b) straighten the legs at the knee joints, while not bending the arms c) pull up on the arms. Repeat all movements 16-20 times. 7. I. P. - hanging with your back to the gymnastic wall. Perform the following movements: a) alternately and simultaneously raise legs bent at the knees b) alternately raise straight legs c) simultaneously raise straight legs. Repeat each movement 6-8 times. 8. Walking with a change in stride length. 9. Walk, while pushing the medicine ball in front of you with the back of the foot of the affected leg. Perform 80-100 movements. 10. Walking on the rail of the gymnastic bench. Regular exercise included in the exercise therapy complex (physiotherapy exercises) for a pelvic fracture contributes to a beneficial effect not only on the area of damage, but also on the entire body as a whole, as well as rapid rehabilitation after a fracture. Read more about exercises, exercise therapy and therapeutic exercises in the section here.

Fractures of the pelvic bones occur when it is compressed in the sagittal and frontal directions and are classified as severe injuries of the musculoskeletal system. Pelvic fractures are characterized by the symptom of "stuck heel".

According to the localization of damage, there are:

1) isolated fracture of one bone (wing of the ilium, one pubis or one ischium);
2) a fracture of the pelvic bones with a violation of the continuity of the pelvic ring (two pubic or two ischial; unilateral fracture of the pubic and ischial bones; bilateral fracture of the pubic and ischial bones; rupture of the symphysis - pubic joint);
3) ;
4) - one-sided, two-sided or cross.

In case of an isolated fracture of one bone or bones of the pelvic ring (in any case), the patient is placed on a bed with a wooden shield, the legs are placed on a roller with a diameter of 60-80 cm (depending on height) so that the flexion angle in the knee joints is 140 °, heels legs are connected, knees are separated - the position of the "frog" (Fig. 24).

Rice. 24. The position of the patient ("frog") with fractures of the pelvic bones

Rice. 25. Traction with the Hilferding belt for fractures of the pelvic bones with displacement of fragments

With a rupture of the pubic joint, the legs lie parallel on the roller, the pelvic region is fixed with the Hilferding belt (Fig. 25).

Therapeutic physical culture is prescribed on the 2nd day after the injury. I period lasts from the moment of injury until the permission to turn on the stomach - approximately 10-16 days. The tasks of therapeutic exercises in the I period: removing the patient from the state of depression due to trauma; relaxation of the muscles of the pelvic region for the correct comparison of fragments; removal of pain; increase in muscle tone of the lower extremities, resorption of hemorrhage, restoration of the work of the respiratory and circulatory organs, excretion and metabolism.

In the I period, breathing, general developmental exercises, as well as special exercises for the legs are performed: flexion and extension of the fingers, all kinds of movements with the feet, pulling the legs to the stomach (in the first 2-4 days without lifting the heels from the bed), “walking” lying down, raising the knees (in case of rupture of the pubic joint, it can be performed only 4-6 months after the injury), raising the legs to the roller. After restoring the muscle tone of the lower extremities, you can raise straightened legs above the roller. Breathing exercises are repeated 3 times, general developmental and special - 6-10 times. The duration of classes is 20-30 minutes, 4-5 times a day. A turn on the stomach is carried out if the patient freely raises two straightened legs above the roller. Then the roller is removed and the patient lies in the usual position.

In the II period, the tasks of therapeutic exercises are: restoring the muscle tone of the lower extremities and strengthening the muscles of the back and pelvic region.

II period begins from the moment the patient turns on his stomach and lasts until he is allowed to get up and walk. When turning on the stomach, a pillow is placed under the pelvic area, the upper edge of which is at the level of the iliac crests. Exercises are performed in the following starting positions: lying on the stomach on a pillow, standing on all fours and half-fours. Each exercise is performed 6-10 times. The duration of classes is 40-50 minutes.

The transition from a prone position to a standing position is allowed after 4-8 weeks from the moment of injury, provided that the patient, lying on his back, performs the following exercise: raises two straightened legs up, pulls bent legs to the stomach, straightens on weight, spreads in hand, reduces and puts on the bed.

Period III begins from the moment of transition to a standing position and continues until discharge to work and permission to sit. The tasks of therapeutic gymnastics are the restoration of normal gait and the general training of the whole organism. Particular attention during classes should be paid to proper walking, as a pathological "duck" gait can form when the body rolls from side to side, or "attractive" gait, when the patient drags one leg behind him. Exercises are performed in a standing position, walking (on toes, on heels, on the entire foot, in a semi-squat, with a cross step, forward with your back, side, etc.), at the gymnastic wall (in case of a rupture of the pubic joint, you can squat only with joined legs ). It is allowed to sit down, provided that after a two-hour walk the patient does not experience pain in the area of the fracture and a feeling of heaviness in the legs. Classes are held 3-4 times a day, last 40-60 minutes. Dosed walking is prescribed 3-4 times a day. Ability to work is restored in 1.5-3 months.

A thoughtful rehabilitation is needed. Such an injury is more often received by people of retirement years, in whom the process of bone fusion is difficult. If elderly people are not prescribed exercise therapy, they face disability, even loss of life.

The tasks of exercise therapy depend on the degree of injury and the phase of treatment. Immediately after the fracture, it is required to bring the patient to a normal state of emotions, resume blood circulation in the injured leg, renew muscle tone, and facilitate the body's activity. Actions are taken to prevent the development of muscle atrophy.

A well-known exercise therapy program, including special exercises after.

After a hip fracture, the victim is shown to undergo a course of renewal. At this stage, remain patient with the sick, the chances of the injury remaining for life are high.

Young people cope with what happened more easily, therapeutic exercises will help them start walking faster than older people whose bones grow together heavily.

Exercise therapy provides a special complex aimed at restoring movement, at renewing the body. If a hip fracture occurs, the process of rehabilitation of the patient begins. A person will have to lie without getting out of bed for three or more months. Age patients do not get out of bed for six months or more!

The consequences of this type of fracture

Elderly people find it difficult to overcome constant lying in bed. Age-related changes in the bone do not contribute to rapid healing. As a result, other body systems suffer. A recumbent lifestyle provokes the appearance of bedsores, pneumonia, often leading to the death of age-related patients. Prolonged immobilization disrupts the functioning of the heart, lungs and other organs.

Exercise after an injury

To resume motor functions above the bed, it is desirable to fix the crossbar. So that the patient can independently rise or sit down, they stretch out a belt for grasping with their hands.

In order for the treatment to be successful, exercise therapy exercises begin to be performed the next day. First of all, do breathing exercises. You will need to buy balloons and inflate daily. Active movements are performed three days after the hip fracture has occurred. You can already start moving your body.

Of course, exercise therapy exercises have the right to appoint only a doctor, and individually for the patient. Therapeutic gymnastics is developed on the basis of the patient's well-being during treatment. In addition to exercise therapy, rehabilitation includes massage, physiotherapy, which promote bone renewal.

There are types of general and special physiotherapy exercises:

General physical education is aimed at improving the body as a whole with the help of general strengthening exercises;
Special training includes exercises that directly affect the diseased organ and promote bone fusion.

Exercise therapy is prescribed before surgery and after the intervention. Physical exercise has a positive effect on the psychophysical state of the victim.

Why do you need therapeutic exercises:

To restore blood circulation and prevent complications in the thigh area.
To strengthen the pelvic muscles.
To strengthen the muscles of the body, to prevent the occurrence of atrophy.
To restore the functioning of the leg.
For a person to walk.

On the third day after traction is applied to the thigh, physiotherapy exercises are prescribed. With the aforementioned diagnosis, skeletal traction is mandatory, gypsum will not help the proper fusion of the bone.

The rehabilitation associated with a hip fracture is divided into three periods. For a certain period, developed their own methods of physical therapy.

Methods of physiotherapy after the imposition of skeletal traction consist in stretching the leg with the help of a needle passed through the bone. In order for the bone to grow together, a splint is applied to it. During the specified period, gymnastics is performed:

Therapeutic gymnastics involves working with the muscles of a broken hip, with other muscles.

Resuming walking with a cane or crutch. After skeletal traction or removal of gypsum, exercises are performed:

Lying on your back, hug your sore bent leg with your hands. Then the arms fall, try to bend and unbend the leg in limbo.
Sitting on a high stool, move your foot back and forth.
Stand up straight, resting on a healthy leg, lean your hands against the wall. We make swings with a sick leg.
Stand in the same position, trying to bend and straighten the sore leg at the joint.
Get back to your original position, try to squat six or eight times.

Resuming walking without canes and crutches. The exercises of the rehabilitation period are associated with the development of the joints. Useful stepping over the barrier, maintaining balance.

Gymnastics lasts for two hours daily. Exercise is difficult even for a healthy person. Patients need to understand that the only way to a full life with a hip fracture is movement. After six months of systematic training, it is possible to complete the treatment.

Walking exercises

Examples of exercises that renew walking skills:

Lying on the bed, tighten the thigh muscles, then relax ten times.
In a supine position, hands are taken over the edge of the bed. The assistant puts a hand on the foot of the patient's sore leg. Now the patient is trying to put pressure on the hand of the assistant with the injured leg. It is more convenient to use a plank as a support.
Roll over from back to side, on the stomach and on the back.
Bend a healthy leg, fix the foot on the bed. Raise the affected leg slightly for a count of three. On the third count, lower the leg.
Flexing the knee for a hip fracture is allowed after two weeks in the presence of a healthcare professional. A little later, the patient will be able to do a warm-up without assistance.
With both hands, lean on the bed, lowering the injured leg to the edge. Try to sit down. The load during the exercise increases gradually.
Standing, holding on to a wall or handrails, tilt the body forward. Bend the healthy leg, the patient lightly stand on the toe. Do three or four times.
Stand on a healthy leg, shake a sick one. It is advisable to do 13-14 movements.
Stand on a healthy leg, the patient draw the number 8 in the air.

After three months of rehabilitation, they switch to crutches. When walking, you do not need to lean on a sore leg. Let's just step a little.

In addition to the above exercises for a fracture, an additional complex is used to help restore gait much faster. For example, grasping and holding a small object with the toes of the injured foot. Or take a gymnastic stick or a tennis ball, try to roll objects with the foot of a sore leg.

For rehabilitation to be successful, it is possible to stand on your toes, stand on your heels, walk on the back and outside of the foot, walk in single file, back and sideways.

Strengthening exercises for the whole body

At the third stage of rehabilitation, therapeutic gymnastics restores and heals the body. In the classroom, various turns of the torso are made. The number of exercises is 15-20, the approach is performed 10 times.

When patients begin to walk without crutches or canes, a complicated complex of therapeutic exercises is prescribed, including exercises on simulators, water gymnastics.

The third stage of treatment for a fracture is aimed at resuming walking. The tasks of the stage are solved with the help of strength exercises. Actual exercises aimed at coordination and speed of movement: jumping, walking, training on simulators.

To relieve swelling of the thigh, it is useful, while lying on the bed, to raise your legs, hold them for a short time in a suspended state of tension, then lower them. Later, the holding time of the legs is increased. With severe swelling, we put a pillow under the hips.

General strengthening exercises

When a hip fracture occurs, other organs suffer. For rehabilitation to be successful, during the formation of the gait, try to perform a set of exercises:

Contract the thigh muscles twenty to thirty times. Breathe and contract muscles slowly.
Bend and unbend your fingers 20 times on both legs separately. Breathing is maintained even and calm, the pace is slow.
With the feet, make circular movements in different directions 10 times per leg. Breathing and pace are selected average.
Legs alternately bend to the stomach. Exercise to perform at an average pace.

It is always advisable to remember that a hip fracture is a serious disorder that requires competent treatment and rehabilitation. An increase in exercise therapy loads is carried out under the supervision of a doctor. It is allowed to fully rely on the sore leg after six months have passed since the hip fracture.

The restoration of the functions of a leg that has suffered after a fracture is a long process. Therapeutic gymnastics will return motor activity to the leg, will enable the patient to cope with the defect. Remember, the injured leg should not be overstretched. Excessive stress will cause a re-fracture. It is necessary to increase the load gradually, exclusively under the supervision of physicians.