Physical therapy after fractures of the upper limbs. Therapeutic exercises for injuries of the lower extremities. An approximate set of post-immobilization exercises for the bones of the forearm

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Ministry of Sports and Tourism of the Republic of Belarus

Educational Institution "Belarusian State University of Physical Culture"

On the topic: Exercise therapy for injuries of the upper limbs

Completed by: Student 063 group

Romankevich D.V.

Introduction

Conclusion

Bibliography

Introduction

Therapeutic physical culture is an independent scientific discipline that uses the means of physical culture for the treatment and prevention of various diseases. It takes into itself everything that appears useful and valuable in physical education and enriches physical education with its own methods. Restrictions on the means and how to use them are determined in physiotherapy only by their safety, expediency and availability. Therapeutic physical culture in our country was formed on the basis of a variety of means and methods of physical education and centuries of experience in the practical application of physical exercises for therapeutic purposes and is part of the system of physical education.

The therapeutic effect of physical exercises is based on a systematic, strictly dosed training, which, in addition to local effects on individual organs and systems, affects the entire body as a whole, in connection with which the patient’s overall resistance to adverse factors increases, his reactive properties change. A feature of physical exercises used for therapeutic purposes is their therapeutic and pedagogical orientation. This takes into account the undoubted influence of the nervous system on the occurrence and course of pathological processes, which leads to the need to prescribe complex treatment, in which, among other measures of a general therapeutic nature, one of the important places is occupied by therapeutic physical culture.

Therapeutic physical culture contributes to a faster recovery of working capacity after diseases, protects against the occurrence of a number of pathological processes that develop with insufficient physical activity of a person, as a result of which it is a mandatory and preventive measure in all parts of health care.

The relevance of the study lies in the fact that special physical exercises mainly train and develop those functions that are impaired due to illness or injury.

Object: exercise therapy as a means of healing in case of damage to the upper limbs.

Subject: Exercise therapy for injuries of the upper limbs.

Purpose: To study the basic methods of exercise therapy for injuries of the upper limbs.

Hypothesis: Rapid and complete recovery of damaged upper limbs depends on the correct choice of means and methods of exercise therapy.

1. Analyze the literature to characterize the upper limbs.

2. Describe the injuries of the upper limbs.

3. To reveal the method of exercise therapy for injuries of the upper limbs.

4. To study exercise therapy complexes that can be used in the treatment of damaged upper limbs.

Research methods: analysis of literary sources.

1. Characteristics of damage to the upper limbs

1.1 Injury to the shoulder and shoulder joint

Shoulder dislocations: Dislocation is a violation of the integrity of the joint with a persistent displacement of the articular ends of the bones. A dislocation of the shoulder is characterized by sharp pain and a complete lack of movement in the shoulder joint, a change in its shape compared to a healthy one. The shoulder on the affected side appears to be elongated, usually abducted from the body. The patient leans towards the injured arm and supports the injured limb by the elbow or forearm. They are observed when falling on an outstretched and retracted arm. In place of the head of the shoulder, a retraction is determined, the head is palpated in the armpit or (rarely) in front under the coracoid process. Persons who do not seek medical attention in the immediate period after injury. After 6-8 days, a hematoma of the skin of the fiber appears in the area of the forearm and elbow joint, which causes anxiety in them and is a reason for seeking help. By this time, a fresh dislocation of the shoulder that has not been reduced turns into an old one. Closed reduction in such cases often fails, surgical intervention is required. Dislocation of the shoulder must be differentiated from a fracture of the neck of the shoulder, in which there is no lengthening of the shoulder, the arm is brought to the body and abduction causes severe pain. When examining the victim, it is necessary to check the pulsation on the radial artery and the function of the dorsal extension of the hand, since in some cases, when the shoulder is dislocated, damage is observed under the alar artery and the brachial plexus.

Fractures of the upper end of the humerus: A fracture is a complete violation of the integrity of the bone under the influence of various factors. In fractures, the surrounding tissues are almost always damaged: muscles, blood vessels, nerves. Most often, fractures of the surgical neck of the shoulder, detachments of the large tubercle are observed, less often - fractures of the anatomical neck. Signs of a fracture are severe local pain after injury, deformity, the so-called pathological mobility and dysfunction of the limb. Most of the victims are people involved in sports games; the mechanism of injury is a fall on the elbow, on the area of the shoulder joint. Victims note a sharp pain in the shoulder joint.

The diagnosis is established taking into account the mechanism of injury, the age of the patients and characteristic signs. It should be differentiated from dislocations of the shoulder, bruises and tears of the periosteal muscle (an increase in the volume of the shoulder joint is not pronounced, a sharp pain appears at a certain moment when the arm is moved to the side or backwards). Sometimes a similar clinical picture with a detachment of a large tubercle may have a detachment of the long head of the biceps of the shoulder. Soreness in this case will be localized below the tubercle, there is a thickening of the biceps muscle of the shoulder, especially when the arm is bent at the elbow joint.

Soft tissue injuries in the area of the shoulder joint and shoulder: Soft tissue injuries can be divided into closed - bruises, hemorrhages and open - abrasions, wounds, burns, frostbite.

They are often found in everyday life and arise as a result of a fall and a direct blow in the area of the shoulder joint, lifting heavy weights. These include bruises of the shoulder joint, sprain and rupture of the ligaments of the shoulder joint, rupture of the tendon of the long head of the biceps brachii.

With bruises of the shoulder joint, the injury occurs due to a direct blow. There are bruises and abrasions; abduction of the shoulder to the side is painful. Sprain and rupture of the ligaments most often occurs from an indirect injury (falling on the elbow, on an outstretched and retracted arm). There are no external manifestations of the injury, there is pain on palpation of the head of the shoulder and when the arm is moved to the side. Often for the first time days after the injury, the pain is slight or moderate, but it sharply increases after a repeated minor injury to the joint, with an awkward turn of the arm, putting on clothes, etc. The abduction of the arm to the side is significantly limited and accompanied by pain. Often, a ligament injury takes a chronic course and goes into the shoulder - scapular periarthritis.

Rupture of the tendon of the long head of the biceps muscle occurs when lifting large weights. Patients feel a "crack" in the area of the shoulder joint, the flexion force in the elbow joint is significantly reduced, the shape of the biceps muscle changes. After 3-4 days, a small hematoma appears in the upper third of the shoulder along the external - front surface.

Shaft fractures of the shoulder: Shaft fractures of the shoulder occur as a result of indirect trauma (falling on the elbow, sharp twisting of the shoulder), and with a direct blow to the shoulder. With fractures in the middle third, the radial nerve can be damaged.

There are all the classic signs of a fracture: shortening and deformity of the shoulder, abnormal mobility at the fracture site, crepitation of fragments. If the radial nerve is damaged, the hand hangs down to the palmar side, active dorsiextension of the hand and thumb abduction are impossible.

1.2 Injuries of the elbow joint and bones of the forearm

Dislocations of the forearm: Most often, posterior dislocations are observed, less often - anterior and lateral. Dislocations can be combined with fractures of the bones that make up the elbow joint. Mechanism of injury: fall on the hand, hitting the machine, car injuries.

With a posterior dislocation, the forearm is shortened and there is a characteristic bayonet-like deformity of the elbow joint due to the protrusion of the olecranon. Victims complain of severe pain, movements in the joint are sharply limited and painful. When trying to extend the joint, springy resistance is determined.

With an anterior dislocation, the forearm is elongated compared to a healthy limb, retraction is determined in the region of the olecranon, and the function is less limited than with a posterior dislocation. With lateral dislocations, the forearm is displaced to the inside or to the outside. With anterior and lateral, there is often damage to the ulnar or median nerve with loss of sensitivity to the hand.

Fractures of the bones that make up the elbow joint: Of all the bones that make up the elbow joint, according to clinical signs, only a fracture of the olecranon can be diagnosed with sufficient certainty. Fractures of other extremities (condyles of the shoulder, head of the radius, coronoid process) are presumably diagnosed. The final diagnosis is confirmed by radiography. Elbow injury is one of the most common injuries. The tissues surrounding the elbow joint are very well vascularized. Therefore, a joint injury is always accompanied by a hematoma, a rapidly developing traumatic edema. In case of a fracture of the olecranon with displacement of the fragments, a gap between the fragments can be determined by palpation. With fractures of the condyles of the shoulder, an attempt to passive movements in the elbow joint causes crepitus of the fragments.

Fracture of the diaphysis of the bones of the forearm: Both bones can be fractured, as well as one (ulnar or radius). The fracture occurs as a result of a direct blow to the forearm, forearm and hand being pulled into the moving parts of the machines, during a car accident. A fracture of one bone of the forearm may be accompanied by a dislocation of another. With fractures of both bones, deformation of the forearm, pathological mobility, pain, crepitus of fragments are noted. With fractures of one bone, the deformation is less pronounced, palpation can determine the place of greatest pain, displacement of fragments.

1.3 Damage to the carpal (wrist) joint and hand

The wrist joint is a movable connection of the carpal bones of the hand (1) with the radius (2) and ulna (3) bones. The articular ends of the bones that form the joint are covered with strong and elastic cartilage (4), and the joint cavity is filled with slippery synovial fluid (5), which reduces friction and transfers some nutrients. The joint is very strong and mobile. On all sides it is reinforced with strong ligaments. Nerves and tendons that control the fingers pass through the wrist joint.

The wrist joint usually responds well to treatment, except in cases of significant destruction of the tissues of the joint. It is important not only to relieve inflammation and pain, but also to pay attention to the blood circulation in the joint, and ensuring its nutrition, and the proper functioning of the muscles. Often, suffering of the wrist joint is found during some professional and sports loads (musicians, tennis players, athletes).

Fractures of the distal metaepiphysis of the radius. This injury occurs more frequently in women than in men. In children, fractures along the line of the growth zone (epiphysiolysis) are often observed. The distal fragment is displaced to the rear, resulting in a bayonet-like deformation. The mechanism of injury is a fall on the hand.

Severe pain at the fracture site, with displacement of fragments - deformity of the wrist joint. The volume of the joint is increased due to the outpouring of blood. Movement is sharply limited and painful.

Wounds of the hand with damage to large vessels, tendons and nerves. Wounds of the hand with damage to large vessels, tendons and nerves occur as a result of domestic and industrial injuries. Often the cause of heavy bleeding is a clumsily applied makeshift tourniquet that compresses the veins, so it is necessary to understand the causes of bleeding. Improvised tourniquets are removed, the radial artery is pressed against the lower third of the radius to reduce the blood supply to the hand. Carefully inspect the wound, finding out the presence in it of the ends of the tendons, blood vessels, nerves.

Fractures of the metacarpal bones and phalanges of the fingers: occurs more often as a result of a direct blow. Deformation is observed (in case of fractures with displacement), swelling, acute pain, crepitation of fragments, subungual hematoma in case of fractures of the nail phalanges.

Flexor tendon injuries. In the vast majority of cases, their causes are wounds with sharp objects. If both tendons were damaged, then the middle and nail phalanges of the finger do not bend; if only deep, then the nail phalanx does not bend. To check this, the finger is straightened, the middle phalanx is fixed and the victim is asked to bend the nail phalanx.

Injury to the extensor tendons. Lack of active extension of the injured finger is characteristic. The ends of the tendon are often visible in the wound, since, unlike the flexors, the extensor does not diverge far.

Annular avulsion of the skin of the finger: An annular avulsion of the skin of the finger occurs if the victim falls, catching on something with a ring worn on the finger. A circular skin defect is formed from the base to the end of the finger with exposure of the tendons.

Compression of the finger with a ring: With various injuries of the fingers, edema develops. If the ring is not removed in time, then it cuts into the soft tissues of the finger. It should be remembered that in case of any injuries of the upper limbs, all rings and bracelets must be removed.

2. Method of exercise therapy for injuries of the upper limbs

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.

1st period (immobilization): In this period, the fusion of fragments occurs (formation of primary bone callus). 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 are used for a symmetrical limb, for joints free from immobilization, ideomotor exercises and static muscle tension, exercises for an immobilized limb. The process of movement includes all undamaged 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 fragments and their complete fixation. The danger of displacement is less when fragments are connected with metal structures, bone pins, and plates. In the treatment of fractures using the devices of Elizarov, Volkov, Oganesyan and others, it is possible to include active muscle contractions and movements in adjacent joints at an earlier time.

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 starting positions are used at the beginning. 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 begins from the 2nd week. They start with a healthy limb, and then act on the segments of the damaged limb, free from immobilization, starting above the injury site.

Contraindications: purulent processes, thrombophlebitis.

2 period (post-immobilization): 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 starting positions are used, which are alternated with relaxation exercises for muscles with increased tone. To restore muscle strength, exercises with resistance are used, with objects, at the gymnastic ladder.

Massage is prescribed for muscle weakness, their hypertonicity. Massage begins above the site of injury. Massage techniques alternate with elementary gymnastic exercises.

3rd period (recovery): In this period, exercise therapy is aimed at restoring the full range of motion in the joints, further strengthening the muscles. General developmental exercises are used with a greater load, they are supplemented with swimming, physical exercises in water, mechanotherapy.

Tasks of exercise therapy: to increase the vitality of the patient, improve the functions of the cardiovascular, respiratory systems, gastrointestinal tract, metabolic processes, trophism of the immobilized limb, blood circulation in the area of damage (operation) in order to stimulate regenerative processes, prevent muscle hypotrophy and stiffness of the joints.

In therapeutic exercises, it is necessary to exclude the possibility of the appearance or intensification of pain, since pain, leading to reflex muscle tension, makes it difficult to perform physical exercises. The classes include static and dynamic, breathing exercises, general developmental exercises covering all muscle groups. As the patient adapts to physical activity, the exercises are supplemented with coordination exercises, exercises with resistance and weights, with objects. Improvement of the trophism of the immobilized limb is facilitated by exercises for a symmetrical limb. From the first days of the immobilization period, patients should perform ideomotor movements in the joint. Sequential excitation of the flexor muscles during ideomotor flexion and the extensor muscles during ideomotor extension contributes to the preservation of the motor dynamic stereotype of the processes of excitation and inhibition in the central nervous system that take place during the actual reproduction of this movement. Isometric muscle tension contributes to the prevention of muscle atrophy, the restoration of muscle sensation and other indicators of the function of the neuromuscular apparatus. Isometric muscle tensions are used in the form of rhythmic and prolonged tensions.

In case of fractures of the lower extremities, the exercises include static holding of the limb, grasping various small objects with the fingers, and dosed resistance with the help of an instructor. After each general developmental or special exercise (special exercises include movements for the muscles of the affected or injured area), any breathing exercise follows. The pace is slow or medium. A set of physical exercises consists of 3 parts: introductory or preparatory (the body is gradually preparing for complex exercises), main (the most difficult and stressful exercises that are allowed in this period) and final (relaxation and breathing exercises that relieve stress and tension that have arisen during class). The introductory and final parts make up 2/3 of the total class time. The classes include 25% of special exercises and 75% of general developmental and respiratory exercises.

You can determine the optimal physical activity by the pulse, counting it before the lesson, after the introductory, main, final parts and 3 minutes after the lesson. The pulse should increase as much as possible in the middle of the main part - after performing the most difficult physical exercises. 3 minutes after the lesson, the pulse should return to normal, i.e., to the initial value.

3. Complexes of therapeutic exercises for injuries of the upper limbs

therapeutic gymnastics trauma upper limb

COMPLEX OF BASIC EXERCISES AFTER REDUCTION OF A TRAUMATIC SHOULDER DISCOSION.

1.I. n. - a healthy arm is brought under a large arm half-bent at the elbow joint, the body is slightly tilted. Slow bending of the arm in the shoulder joint and return to the starting position (4-5 times).

2. I. p. - about. With. Simultaneous bending of the arms in the elbow joints and return to and. n. (6-8 times).

3. I. p. - hands on the belt, slightly bending the spine in the thoracic region, take the elbows back - inhale, and. p. - exhale (3-4 times at a slow pace).

4. I. p. - standing with a gymnastic stick in his hands down. Raise the stick forward in outstretched hands and return to the sp. (4-6 times).

5. I. p. - a stick in hands down. Leading the stick to the side of the sore hand and returning to and. n. (4-6 times).

6. I. p. - about. With. The body is slightly tilted forward. Slow abduction of the straight arm to the side and return to and. n. (3-4 times).

7. I. p. - hands to shoulders. Abduction of the shoulders to the sides - inhale, return to and. p. - exhale (3-4 times).

Lying position

8. I. p. - lying on your back, a healthy arm is brought under the patient, bending the arms in the shoulder joints (4-5 times).

9. I. p. - lying on your back, arms bent at the elbow joints, resting on the elbows, slight bending in the thoracic spine with the shoulders apart - inhale, return to and. p. - exhale (3-4 times).

10. I.p. - lying on his back, the sore arm rests on a plastic panel. Abduction of a straight arm along a polished surface in a horizontal position and an inclined position of the panel (4-6 times).

11. I. p. - lying on your back, gymnastic stick in lowered hands. Raising the stick forward - up at a slow pace, return to and. n. (4-5 times).

SPECIAL EXERCISES OF THERAPEUTIC GYMNASTICS USED IN FRACTURES OF THE ELBOW JOINT BONES.

Sitting exercises

1. I. p. - hand on the plane of the table. Actively bend and unbend the arm in the elbow joint, sliding on the surface of the table (4-6 times).

2. Hand on the plane of the table. Active movements in the elbow joint with rolling on the smooth surface of a light gymnastic stick, roller cart.

3. Hands rest on the table, fingers interlaced. Flexion and extension in the elbow joint with the help of a healthy arm.

4. Supporting the shoulder on the back of the chair, the forearm is lowered, swing the arm in the elbow joint (6-8 times).

5. With the support of the shoulders on the plane of the table: a gymnastic stick in the hands. Extension of the arms in the elbow joints, trying to stretch them. Hand on the plastic surface, rubbing the plastic surface with circular movements of the hand, 4-6 movements in each direction.

I. p. - standing.

6. Free, relaxed swaying of the arms while tilting the torso.

7. A healthy hand is brought under the patient. Raise the diseased arm, bent at the elbow joint, above the horizontal level and lower it with the help of a healthy arm (3-4 times).

8. Clenching fingers into a fist.

9. Raise your shoulders up and down.

10. Flexion in the elbow joints, sliding the palms along the body, reach the armpits.

11. Hands "in the lock", behind the back, get the shoulder blades, sliding movements.

12. Hands to the shoulders, circular movements in the shoulder joints.

13. Free arm swing to the sides.

Club exercises

14. Free swinging in front of you to the sides and crosswise in a forward bend.

15. Mahi in one direction and the other with both hands.

16. Mahi forward and backward, simultaneously and alternately (towards).

17. Hands back, crosswise, get the shoulder blades.

SPECIAL PHYSICAL EXERCISES APPLIED WHEN THE TENDONS OF THE FINGERS ARE DAMAGED.

I. p. - sitting at the table.

1. Hands on the surface of the table. Active flexion in the joints of the injured finger with fixation of the proximal phalanx with the fingers of a healthy hand (6-8 times).

2. Hands on the surface of the table, palm down. Fingering, fold the handkerchief lying on the table into folds.

3. Hands on the surface of the table, palm down. Bending fingers with sliding on the surface of the table (5-7 times).

4. Hands on the surface of the table, palm down. Squeezing a cotton ball or sponge with your fingers.

5. Hands on the surface of the table, forearm in the middle position between pronation and supination. Finger flexion with slight resistance to movement.

6. Hands on, the surface of the table. Moving projectiles of various shapes and sizes.

7. Rotation of the ball towards the thumb and little finger, assembly and disassembly of parts that are simple in design. 8. I. p. - standing. Throwing and catching in various ways a small rubber ball.

SPECIAL EXERCISES USED IN DAMAGE TO THE EXTENDER TENDON OF THE FINGERS.

1. I. p. - sitting at the table. Active extension of the fingers with fixation of the proximal phalanx.

2. Rotate the wooden cylinder with your fingers clockwise and counterclockwise.

3. An attempt to grasp, spreading the fingers as wide as possible, a cylinder of large diameter.

4. Alternate and simultaneous raising of the fingers from the surface of the table (forearm and hand in the pronation position).

5. Promotion by extensor movement of a finger of a wooden projectile weighing 100-250 g along the surface of the table.

6. Finger extension with slight resistance (resistance of the instructor's hand).

7. Rolling back along the plane of the table with straightened fingers of a gymnastic stick.

8. Capturing and moving large wooden objects (cylinders, cubes) over the surface of the table.

9. I. p. - standing. Throwing a medium-sized soft rubber ball with the good hand, catching it with the fingers of the bad hand.

EXERCISES DIRECTED TO RESTORE THE MUSCLE STRENGTH OF THE FLEXORS AND EXTENDERS OF THE HAND AND FINGERS.

1. Flexion and extension of the fingers with maximum muscle tension.

2. Forearm on the table, squeezing a rubber ball, sponge or carpal expander with your fingers.

stick exercise

3. Standing, arms bent at the elbows at a right angle, a stick with a load tied to a rope horizontally, slowly twisting the stick with winding a rope with a load on it and slow reverse untwisting.

Medicine ball exercise

4. Standing, arms down with medicine ball, passing the medicine ball around the torso from the affected arm to the good one.

Conclusion

One of the characteristic features of therapeutic physical culture in case of damage to the upper limbs is the training of patients with the help of physical exercises. In the process of training patients, depending on the medical tasks, such qualities as: speed of reaction, strength, dexterity and endurance are brought up. In contrast to sports training, which involves loads with maximum mental and physical stress, the training of patients in therapeutic physical culture is limited by the dosage. In this regard, the process of treatment and restoration of the patient's strength when using therapeutic physical culture should be in full accordance with the functional capabilities of the patient. To obtain the best therapeutic results, the following methodological rules must be observed:

1. Systematic impact with the provision of a certain selection of exercises and the sequence of their application, depending on the general condition of the patient, age, state of fitness and taking into account the characteristics of the injury of the upper extremities.

2. The regularity of the use of physical exercises, i.e. their daily use. In case of damage to the neuromuscular apparatus and a disorder in the function of movement, it is necessary to apply physical exercises several times a day, with fractional loads.

3. The duration of the use of physical exercises in case of damage to the upper limbs is a necessary condition for obtaining therapeutic success.

4. The increase in physical activity during training is determined by the nature of the exercises used and the methods of their application. Physical training of patients will lead to success only when this process will gradually increase and become more complicated, i.e. will increase the requirements for the patient when performing physical exercises.

5. Individualization in the method and dosage of the use of physical exercises, depending on the characteristics of the injury of the upper limbs, as well as the age and general condition of the patient. Movement will only be a therapeutic and prophylactic factor when it is organized in the form of physical exercise and is used purposefully in accordance with therapeutic tasks, in a dosed form, taking into account the general condition of the patient, the characteristics of the disease and the dysfunction of the affected system or organ.

Bibliography

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2. Bandurashvili A.G., Solovieva K.S. "Injury and actual problems of its prevention" St. Petersburg 1989

3. Dubrovsky V.I. "Therapeutic exercise" Vlados - Moscow 2001.

4. Egorov G.E., T.N. Zaitseva, L.K. Burchik, G.I. Avsievich "Special exercises of therapeutic gymnastics for injuries and diseases of the upper limbs" Novokuznetsk 2001.

5. Epifanov V.A. "Therapeutic physical culture" Moscow: GEOTAR-Media 2006.

6. Epifanov V.A. "Therapeutic physical culture and sports medicine" Moscow, 1999.

7. Ingerleib M.B. "Anatomy of exercise" Moscow 2009.

8. Mironov S.P., Burmakova G.M. "Injuries of the elbow joint during sports" Moscow: "Lesar-Art", 2000.

9. Makarova G.A. "Therapeutic exercise" Moscow 2003.

10. Parhotik I.I. "Physical rehabilitation for injuries of the upper limbs" St. Petersburg, 2001.

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13. Synopsis on Therapeutic Physical Culture.

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The benefits of exercise therapy for injuries

Immobilization with gypsum, while ensuring the retention of fragments, maintaining immobility in the joints, faster wound healing, at the same time does not exclude the possibility of straining the muscles under the gypsum, performing various movements with the immobilized limb, early initiation of axial load when walking in a plaster cast and thus contributing to the improvement of regeneration processes and restoration of function .

The tonic effect of exercise therapy in injuries is of great importance. It is especially important in bed rest, as it ensures the activation of all autonomic functions and processes of cortical dynamics, prevents the development of various complications (congestive pneumonia, atonic constipation) and mobilizes the body's defense reactions. It should be borne in mind that during manifestations of protective inhibition, for example, after a shock, even small muscle loads can be excessive and cause its deepening. The tonic effect of exercise in these cases should be used with caution.

In the presence of gypsum (traction), systematic movements under the gypsum reduce the degree of inhibition in the nerve centers of the muscles and balance the inhibitory-excitatory processes in them. Under the influence of muscle contractions in the area of damage, metabolic processes in tissues are gradually normalized. It should be noted that if exercises are used too early after injury, they can worsen tissue trophism. The contraction of symmetrical muscles of a healthy limb can to some extent affect the improvement of trophic processes in tissues that have undergone injury.

The stimulating effect of exercise therapy exercises in injuries on regeneration processes is reduced to improving metabolism in the regeneration zone and ensures the formation of a full-fledged structure of regenerating tissue. By selecting exercises in accordance with the characteristics of clinical manifestations, it seems possible to interfere with the course of regeneration processes, for example, by turning off or changing the nature of the load on the callus, depending on the location of the fracture, standing fragments. Excessively early and powerful functional irritation can slow down or pervert the process of regeneration.

When using the influence on trophic processes after reconstructive processes, functional irritation is very important, commensurate with the course of adaptation of the morphological structures of tissues to new conditions of function. Excessively early and heavy loading, for example, during arthroplasty, may lead not to the transformation of the tissue interposed between the articular surfaces into articular cartilage, but to its partial death and the development of arthrosis.

Restoration of impaired functions with the help of exercise therapy for injuries

Gradually increasing impulses to the tension of damaged muscles contribute to the restoration of their full-fledged active contraction. A full plaster cast, traction, and sutures placed on the damaged muscle or tendon provide a faster recovery of this ability. With a poorly immobilized fracture or with a violation of the fixation of one of the ends of the muscle, for example, with. tendon rupture or, it is sharply difficult or impossible to restore tension.
Physiological regularities of "transfer" of the strength, speed of movements and endurance of the muscles of a healthy limb to the damaged one, which increase as a result of exercises, begin to appear somewhat later.
To normalize muscle function, it is very important to restore the ability to relax them. The special exercises used for this purpose simultaneously contribute to an increase in the range of motion.

With contractures caused or accompanied by pain, it is advisable to preliminarily relieve pain by blockades, after which the range of motion can significantly increase with the usual methods of training. In addition to relieving pain, this action is also due to the infiltration of altered tissues with an anesthetic solution, leading to an increase in their ability to stretch.

Immediately after the removal of plaster immobilization or traction, the ability of the muscles to tension is significantly reduced. This is caused by a change in the nature of muscle-articular and skin-tactile impulses from a limb freed from fixation and the appearance of pain when moving it.

It should be noted that when using exercise therapy for injuries, the increase in muscle strength occurs much faster than atrophy is eliminated. This is explained by the fact that physical exercises, improving the cortical regulation of movements, provide in a short time the restoration of the maximum functional mobilization of all tissue elements of the muscles during its tension.

For the preservation of everyday and industrial motor skills, their early use, at least in a modified and simplified form, during the period of immobilization is of exceptional importance. This applies to walking, movements when eating, when writing.

Normalization of autonomic functions (especially the vascular system, respiratory organs, digestion) should be ensured in cases where they are permanently changed under the influence of trauma, bed rest, forced positions, and plaster immobilization.

Formation of compensation with the help of exercise therapy for injuries

The formation of temporary compensations in the treatment of traumatic disease concerns unusual motor skills (standing up in the presence of a cast). If a new movement, such as walking with crutches in a plaster cast, temporarily replaces the usual motor act, the main structure of the latter should be preserved (for example, avoid walking with a sharply rotated outward leg, walking with an added step). After the need to use temporary compensations has passed, one should strive to restore the full-fledged technique of the motor skill that was compensated. In some cases (for example, during muscle transplantation), a movement that is old in external form can essentially be a permanent compensation that requires the formation of a new complex structure for controlling it.

The combination of exercise therapy with other methods

The use of exercise therapy for injuries should be completed with all other methods of treatment. When combined with therapeutic regimens, careful dosage of stimulating functional stimulation on regeneration processes with the help of exercises and movements performed in the process of household self-service, for example, when using therapeutic walking and walking associated with self-service, is of particular importance.

The use of exercise therapy for injuries before surgery can prepare tissues for it in the area of the proposed intervention, mobilizing their mobility, improving elasticity, and blood supply. Therapeutic physical culture can contribute to the psychological preparation of the patient for the upcoming operation.

In the postoperative period, therapeutic physical culture should favor the fastest elimination of acute manifestations of a traumatic disease that developed after surgery, and then a faster and more complete implementation of the morphological and functional results of the operation.

The use of exercise therapy for injuries with non-blood methods of orthopedic treatment in the form of one-stage and staged redressations, traction, fixing devices is widely integrated.

Complexing exercise therapy for injuries with physiotherapy is carried out taking into account their joint stimulating effect on regeneration processes, on the elimination of contractures and restoration of joint mobility.

The combined use of exercise therapy for injuries and natural or preformed natural factors is carried out in the form of air baths during classes at room temperature and at low air temperature, by conducting classes with solar insolation (it is also possible to use artificial sources of ultraviolet radiation) and by conducting exercises in water (in the bath, in the form of bathing and swimming).

Indications and contraindications for exercise therapy for injuries

Indications for the use of physical exercises for injuries are as follows:

damage to the skin, ligamentous-articular apparatus and muscles caused by mechanical (bruises, tears and tears, wounds and crush injuries), thermal (burns and frostbite) and chemical (burns) agents; bone fractures;
surgical interventions on soft tissues (skin and tendon plasty, skin grafts); on bones (osteotomies, osteosynthesis and bone grafting, resections, amputations and reamputations) and on joints (arthrotomies, plastics of the ligamentous apparatus, surgical reduction of dislocations, removal of menisci and intraarticular bodies, resections, arthrodesis, arthroplasty).

Temporary contraindications to exercise therapy for injuries are as follows:

condition after shock, large blood loss, the presence of pronounced reactions to an infection in the area of damage or to a generalized infection;
danger of bleeding due to movements;
foreign bodies in tissues and bone fragments located close to large vessels, nerves, important organs;
the presence of severe pain.

Accounting for the influence of physical exercises should reflect the change in both general manifestations and the course of local processes in traumatic disease.

The results of exercise therapy for injuries

With pronounced general manifestations of traumatic disease, the beneficial effect of exercise therapy for injuries is manifested in a change in indifferent attitude to classes to a positive one, in a decrease in motor and speech inhibition, in the appearance of more mobile facial expressions and greater sonority of the voice, in improving the course of vegetative reactions (improving filling and slowing the pulse with tachycardia, deepening and slowing of breathing, decrease in pallor or cyanosis).

With moderate general manifestations of traumatic disease, the general tonic effect of fully performed exercise therapy complexes for injuries affects the improvement of well-being and mood, a slight pleasant fatigue, a positive verbal assessment of the impact of classes, establishing good contact with those conducting the lesson, increasing pulse pressure, slight shifts in the increase in heart rate and breathing . The favorable tonic effect of the exercises continues to affect for several hours (improved well-being, reduction of irritability and complaints about the interfering bandage and the inconvenience of the forced position, even, not rapid breathing, good filling and moderate pulse rate).

When assessing the impact of physical therapy exercises in case of injuries on locally occurring processes and the state of the function of the damaged musculoskeletal system, muscle tension under the bandage (determined by palpation or tonometer), the degree of displacement of the patella with tension of the quadriceps extensor of the lower leg, the ability to raise the injured limb in a plaster bandage are taken into account , the amount of pressure (in kilograms) that causes pain during loading along the axis of the limb, pain and their intensification during exercise, the time during which the pain persists after exercise, the range of motion in individual joints in degrees, the strength of individual muscles, the ability to perform individual integral movements (putting on clothes, combing hair) and the nature of adaptive compensations (walking with a side step, raising the shoulder when moving the arm). Clinical data are taken into account (according to the characteristics of the damage): the intensity of development and quality of granulations, the course of epithelialization, the nature of the wound discharge, the course of formation of callus (clinical and radiological data), the severity of secondary changes (atrophy, mobility restrictions, vicious positions).

In accordance with the data obtained and their dynamics, the selection of exercise therapy exercises for injuries and the training methodology change, the intensity of the load decreases or increases, sometimes classes are temporarily canceled.

The article was prepared and edited by: surgeon As a rule, the entire course of exercise therapy (physiotherapy exercises) for limb injuries is divided into three periods: immobilization, post-immobilization and recovery.
The first period of LH (therapeutic gymnastics) for limb injuries - immobilization - corresponds to the process of bone fragment fusion, which occurs 30-90 days after the injury. The termination of immobilization occurs when the end of this stage of consolidation occurs.

The tasks of exercise therapy in this period are: increasing the patient's vitality, improving function, normalizing metabolic processes, the gastrointestinal tract, improving trophism (nutrition) of the immobilized limb, lymph and blood circulation in the area of damage (operation) in order to stimulate regenerative processes. Also, the task of physical therapy for injuries of the limbs includes the prevention of muscle hypotrophy and stiffness of the joints.

There are also contraindications to therapeutic exercises for injuries of the limbs. They are: the general serious condition of the patient, which is due to large blood loss, shock, infection, etc., as well as increased - over 37.5 degrees Celsius.

Classes in exercise therapy and LP (therapeutic gymnastics) consist of static and dynamic exercises, as well as general developmental exercises that cover all muscle groups. As soon as the patient adapts to this physical activity, exercises on physical therapy and LP are included in the exercises (in order to prevent vestibular disorders). These exercises are carried out with various objects, as well as weights and resistance.

In therapeutic gymnastics and physiotherapy exercises for limb injuries, it is also necessary to use exercises that help improve the trophism of the immobilized limb, namely, exercises for a symmetrical limb. Equally important are the exercises that improve blood circulation, as well as the activation of reparative processes in the area of damage (operation). Such exercises are exercises for joints free from immobilization.

If the lower limbs are damaged, for example -, then, as a rule, the following exercises are included in exercise therapy and exercise therapy classes:

Static retention of a limb (intact, damaged,).
Exercises that are aimed at restoring the supporting function of an intact limb (this includes grabbing various small objects with the fingers of the foot, imitation of walking, axial pressure on the footrest, etc.).
Exercises that contribute to the training of peripheral circulation, namely: lowering the injured limb and then giving it.
Dosed resistance (with the support of an exercise therapy instructor) in an attempt to abduct and adduct the injured limb, which is in traction.
Isometric tensions, as well as ideomotor exercises.

All these exercises must be performed in a complex in the form of therapeutic exercises, morning hygienic exercises, and also as independent exercises.

Starting from the second week of classes, it is prescribed once a day.

Patients should perform therapeutic exercises at least 2-3 times a day.

This period of exercise therapy for limb injuries is characterized by the fact that patients can already master the simplest self-care skills.

The second period of physical therapy for injuries of the extremities - post-immobilization - begins immediately after the removal of the plaster cast or skeletal traction. In this period, the general tasks of exercise therapy and exercise therapy include: preparing the patient for getting up (if he has bed rest), training the vestibular apparatus, teaching movement skills on, and also, if the lower limb is damaged, then with the help of exercise therapy, the support ability of a healthy limb is prepared.

This material will describe the process of rehabilitation for injuries of the upper limbs. In this process, exercise therapy for children and adults is a mandatory component of treatment, as it helps to restore the functioning of the musculoskeletal system. Exercises can be prescribed from the first days of the injury, if there is no severe pain. Physiotherapy should not be used if the patient has severe blood loss, shock, risk of bleeding, or persistent pain.

Let's analyze a set of exercises in physiotherapy exercises for injuries of the upper limbs for bedridden patients:

1. Raise your arm up in two counts while inhaling. Also lower by two counts. Exhale. At a slow pace, repeat the exercise at least three times.

2. Put your hand to your shoulder. Slowly rotate your shoulder in a circular motion. Without increasing speed, do 4 times. At the same time, inhale on the first semicircle and exhale on the second.

3. Slowly, in two counts, tilt your head up. Take a breath. Exhaling, tilt your head down for two counts.

4. For two counts, bend your arm at the elbow joint. Breathe freely and do the exercise 6 to 8 times.

5. Slowly bend your knees one at a time. Breathe freely.

6. Perform a breathing exercise: in two counts, while inhaling, take your hand to the side. Slowly return to the starting position while exhaling.

7. Turn your head to the right for two counts. Slowly return to starting position. Do the same on the other side. Repeat first.

8. Raise your leg up in two counts - inhale. At the same pace, lower - exhale. Repeat five times. Do the same on the other leg.

9. While exhaling, lean on a healthy arm and legs bent at the knees. Raise your pelvis for two counts. For the next two - lower it, accompanying with an exhalation.

10. Rotate your legs alternately, each for four counts.

11. Repeat the breathing exercise: in two counts, while inhaling, move your hand to the side. Slowly return to the starting position while exhaling.

12. Bend and unbend your feet in four counts.

13. Finish with a breathing exercise.

Therapeutic exercise for osteochondrosis, hernias, fractures, scoliosis, arthrosis, flat feet is extremely effective. At the same time, it is important to know contraindications to its use and use other methods of treatment in combination.

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Traumatic damage to the median nerve leads to atrophic paresis or paralysis of the flexors of the hand, I and II fingers, pronators of the hand, muscles that oppose the first finger to the rest, severe thenar atrophy. This gives the brush a characteristic "monkey brush" look - the brush is flat, the first finger is on the same plane as the others. Violated or impossible movements: pronation of the forearm, flexion of the hand, especially the I and II fingers, grasping function of the hand. Pronounced vegetotrophic disorders and burning pain are characteristic (Fig. 4.3, 4.4).

Rice. 4.3. Patient P., 35 years old. Damage to the median nerve at the level of the hand

Rice. 4.4. Patient O., 25 years old. Damage to the median nerve at the level of the forearm

Physical rehabilitation begins with treatment with a position aimed at creating a half-bent position of the hand in the metacarpophalangeal and interphalangeal joints based on a splint or splint, which is removed periodically during the day. Exercises are also used in sending impulses to flexion of the hand, fingers, pronation of the forearm, combined with active movements of a healthy hand. The number of repetitions of the exercise gradually increases to 8-12.

Passive therapeutic exercises are also performed in the patient's sitting position and are combined with active therapeutic exercises for healthy muscles of the injured limb and in an uninjured arm. The goal of passive gymnastics is to develop flexion movements of the hand and fingers, pronation of the forearm, opposition of the first finger to the rest. The load gradually increases to 10-14 exercises 4-5 times a day.

Passive-active and active therapeutic exercises are aimed at strengthening the affected muscles. Assign exercises for bending the hand, I and II fingers, opposing the I finger to the rest, pronation of the forearm. The number of repetitions of exercises gradually increases from 4-6 to 10-14. They are combined with physical exercises for healthy muscles of damaged and healthy limbs, as well as with general strengthening physical activity and breathing exercises. Then exercises with resistance, weights, exercises on gymnastic apparatus, the Swedish ladder are performed.

Elements of occupational therapy are used to develop practical skills. Thus, in the preoperative and early postoperative period of treatment, gymnastics is aimed at preventing post-immobilization complications, manifested in the form of muscle atrophy and contractures, and vasospasm. Active physical exercises are used for muscles and blood vessels outside the plaster cast, as well as for a healthy limb with weights. Gymnastics complements the complex of exercises with ideomotor acts and isometric tension of the muscles under the cast. After the cessation of fixation against the background of general strengthening exercises, passive, passive-active and active movements in the joints, ideomotor and isometric exercises are used. A special set of physical exercises is selected for each damaged nerve of the upper extremities.

So, in case of damage to the radial nerve, the target setting is the development of flexion of the hand and fingers, abduction of the first finger, and for the ulnar and median nerve - flexion of the fingers, opposition of the I and V fingers. As the nerves regenerate and muscle innervation is restored, special exercises with objects, strengthening and counteraction, and position correction are used.

Therefore, special therapeutic exercises in case of damage to peripheral nerves should help improve blood and lymph circulation, trophism of the affected segment and contribute to a faster recovery of impaired functions or the development of adequate compensation mechanisms that can most effectively replace impaired or lost functions. Kinesitherapy makes it possible to develop rational ways of using compensations that have arisen in a patient in the process of rehabilitation treatment.

In the acute period, all means and methods of movement therapy should be aimed at preventing the consequences of traumatic disease and post-immobilization complications, manifested as circulatory disorders, muscle dystonia and atrophy, contractures in the joints.

Active gymnastic exercises are used for joints outside the plaster cast, as well as for a healthy limb with weights, resistance and opposition (proprioceptive effect on the injured limb). For the muscles under the cast, physical activity with isometric tension is assigned. After the cessation of fixation against the background of general strengthening physical exercises for the trunk and intact arm, passive, active-passive and active movements for the injured limb are used in combination with ideomotor and isometric exercises.

A special complex of therapeutic exercises is selected for each group of denervated muscles. So, in case of traumatic damage to the radial nerve, the main task of therapeutic exercises is the development of extension of the hand and fingers and abduction of the first finger, and in case of damage to the median and ulnar nerves, flexion of the fingers and opposition of the I and V fingers. This is facilitated, along with therapeutic exercises, by the use of special objects, devices and devices with weights, resistance and opposition, position correction, mechanical and occupational therapy.

At the final stage of physical rehabilitation, along with the use of mechanotherapy, exercises with objects, weights and resistance, great importance is attached to functional occupational therapy - the therapeutic use of various labor processes and labor operations. When selecting labor operations, it is important to focus on the patient's functional defect, take into account the profession and age of the victim. The final result of physical rehabilitation should be the social and labor orientation of the victim, the performance of household and production functions. To solve all these issues, in addition to therapeutic gymnastics, a complex scientifically based application of complementary methods of physical therapy is necessary (Table 4.1).

TABLE 4.1. The scheme of active therapeutic exercises with a combination of damage to the nerves of the hand

Physical and reflexotherapy, balneotherapy and mud therapy are widely used, which, in combination with passive and active therapeutic exercises, improve metabolic processes, trophism of denervated muscles, and prevent the development of contractures in the joints. In this case, passive therapeutic exercises should be carried out with a maximum range of motion in the joints, especially in small ones. Active therapeutic exercises should also be carried out with the maximum possible range of motion, but the motor load should be strictly individual and dosed due to the rapid fatigue of damaged muscles. It is important to combine active therapeutic exercises with relaxation of damaged muscles, active general strengthening and breathing exercises, as well as massage and balneotherapy.