What Problems Affect Ankle Ligaments?
Ankle ligament is an important structure to maintain the stability of the ankle joint. Ankle ligament injury is often an integral part of the pathology of ankle fracture and dislocation. From the aspect of trauma mechanism and pathology, ankle ligament injury and ankle fracture should not be considered. Dislocation separates analysis and understanding. The common ligament injury in clinic is the lateral malleolus ligament injury, which has its special features in diagnosis and treatment [1] .
Ankle ligament injury rehabilitation
- Chinese name
- Ankle ligament injury rehabilitation
- Foreign name
- Ankle ligament injury rehabilitation
- Location
- ankle joint
- aims
- Reduce swelling
Ankle Joint Ligament Injury Rehabilitation
- Ankle ligament is an important structure to maintain the stability of the ankle joint. Ankle ligament injury is often an integral part of the pathology of ankle fracture and dislocation. From the aspect of trauma mechanism and pathology, ankle ligament injury and ankle fracture should not be considered. Dislocation separates analysis and understanding. The common ligament injury in clinic is the lateral malleolus ligament injury, which has its special features in diagnosis and treatment [1] .
Clinical treatment of ankle ligament injury rehabilitation
- Infratal fibula ligament injury: When the ankle joint flexion is subjected to varus stress, the anterior fibula ligament injury occurs first, and a full drawer anterior drawer test will be positive. The ankle lateral X-ray image can be taken under forward stress. It shows a slight dislocation of the talus forward with subluxation. If it is a simple anterior fibula ligament injury, it is possible to perform eversion of the foot, ankle dorsiflexion, bandage 8 pressure bandaging and braking, or supplement with adhesive plaster, 2 ~ 3 weeks Remove fixation.
- Rupture of the calcaneal ligament: After the anterior fibula ligament is damaged, if the varus force continues to work, a rupture of the peroneal ligament can occur. The drawer test was significantly positive before the peroneal ligament injury, the lateral X-ray image under stress, and the talus was significantly dislocated forward. Orthotopic X-ray image under varus stress showed that the talar body was tilted in the ankle point, the lateral side was lowered, and the medial side was elevated. The acute injury of the fibular calcaneal ligament is mainly diagnosed early and should not be missed to avoid ankle instability in the future due to early and timely treatment. Acute complete rupture of the fibular calcaneal ligament can be repaired by surgery. For an avulsion fracture of the lateral malleolus, the ankle joint can be placed at 0 °, and the eversion position is fixed with short leg plaster or U-shaped plaster for 4-6 weeks. Surgery also, with absorbable suture through the proximal fractures of the proximal bore ligament suture chip fracture. If the avulsion fracture piece is large, it can be fixed with small screws, and Kirschner wire and steel nails can also be used to fix the tension band. Postoperatively, it should be supplemented with plaster external fixation for 3 to 4 weeks [2] .
- Lateral malleolus ligament reconstruction: The lateral malleolus ligament injury is not treated in a timely and appropriate manner in the early stage, and persistent ankle dysfunction may occur in the late stage. The indications for reconstruction of the external malleolus ligament are: positive front drawer test, positive varus stress test; Conservative treatments such as strength training, braces, and orthopedic shoes are ineffective; symptoms persist and patients require surgery.
- Reconstruction is divided into non-reinforced reconstruction surgery methods and reinforced reconstruction surgery methods. Non-reinforced reconstruction surgery methods include tightening the elongated ligament and fixing it through the bone hole, and suture the ligament surface with the distal fibula periosteal flap. The advantages are to restore the normal relationship of the anatomy and preserve the activity of the subtalar joint. The peroneus tendon affects the weakening of the valgus muscle. The disadvantage is that weak local soft tissue reconstruction is difficult to achieve stability. Therefore, it is not suitable for excessively loose joints, injuries with a history of more than 10 years or longer, and cases of previous ligament repair surgery.
- The aggravation reconstruction method refers to the reconstruction of the tendon displacement, and the result mainly depends on the selected displacement tendon and whether the placement of the displacement tendon is appropriate and accurate. Generally, the transposition of the peroneus brevis tendon is usually used. The methods are Evana, Watson-Jones, and Chriaman-Smook. The Anderson method uses the iliac tendon for reconstruction [3] .
Rehabilitation of ankle ligament injury
- Goals and principles
- The training plan should reflect the goals of rehabilitation and use activity exercises, strength exercises, functional exercises, and special exercises to improve neuromuscular function, and then gradually transition to more challenging exercises.
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- Rehabilitation of lateral ankle ligament sprain
- Local ice compresses to stop bleeding. After the injury, you can use the adhesive support belt to protect you. You can start jogging and other general activities. You can train in 7-10 days.
- Rehabilitation of old ankle ligament rupture combined with ankle instability Rehabilitation exercises must use an adhesive support band to protect the ankle joint. Particular attention should be paid to the strength of the heel and flexion of the ankle. In lighter cases, more training can be maintained. In cases of severe repeated sprains, the ankle joint is unstable, and it is necessary to tighten or rebuild loose ligaments.
- Ankle joint medial and lateral ligament rupture and suture recovery
- The mechanisms of injury of the medial and lateral collateral ligaments of the ankle are different, but the surgical methods are basically the same as the clinical treatment and healing process. Just because of the severity of the injury and the choice of surgical method, the timing of each exercise and the amount and intensity of the exercise are different. Start the exercise according to your specific situation under the guidance of a professional hospital.
- 1 day after operation
- Move your toes: Move your toes hard, slowly, and as widely as possible, but it is absolutely impossible to cause ankle movement. 5 minutes / group, 1 group / 1 hour.
- Quadriceps (anterior thigh muscle group) isometric contraction exercises: that is, the thigh muscles are stretched and relaxed, and do as much as possible without increasing pain, more than 500 times per day.
- 2 ~ 3 weeks after operation
- Continue the above exercise
- It can support double crutches and not touch the ground, but it is only necessary for daily life such as toilet.
- Start leg lifting exercises: 30 times / group, rest for 30 seconds between groups, practice 4 ~ 6 groups continuously, 2 ~ 3 times / day. It may not be possible to complete the exercise due to the weight of the cast.
- Gradually start leg muscle exercises: the purpose is to restore the atrophied thigh muscles during the plaster fixation period. Practise the absolute strength of the legs, using a medium load (the load of feeling fatigue after completing 20 movements), 20 times / group, and continuously practice 2 to 4 groups, rest for 60 seconds between groups until fatigue.
- 4 to 6 weeks after surgery
- Start active ankle flexion and extension exercises: slow, hard, maximal toe and hook toe (must be within the range of no pain or slight pain. Because early tissue healing is not strong enough, excessive stretching may cause adverse consequences) for 10-15 minutes / Times, 2 times / day. You can soak your feet in hot water for 20 ~ 30 minutes before the exercise to increase the tissue temperature, improve the ductility, and strengthen the exercise effect.
- The professional physician decides to start passive ankle flexion and extension exercises according to the situation: gradually increase the strength and increase the activity, 10-15 minutes / time, 2 times / day. Activity exercises should be done step by step to achieve the same ankle joint activity as the healthy side within 1 to 2 months.
- Can support a single cane, walk on the ground with feet, start weight-bearing and center-of-gravity exercises, and gradually change the weight of the legs, 5-10 minutes / times, 2 times / day. After about 2 weeks of training, try to achieve normal gait walking.
- Start static squatting exercises: strengthening the leg strength to enhance the ability to control and lower limb function, 2 minutes / time, rest 5 seconds, 10 times / group, group 2 to 3 / day.
- Impedance "hook feet" Exercise: complete resistance against rubber band "hook feet" action (toe hook up operation), 30 / group, 30 seconds rest between sets, continuous practice 4-6 groups, 2-3 times / day .
- Impedance "stretch feet" Exercise: complete resistance against rubber band "stretch foot" operation (step-down operation of the toes), 30 / group, 30 seconds rest between sets, continuous practice 4-6 groups, 2-3 times / day.
- Beginning ankle and lower limb function exercises:
- Forward stride exercise: after increasing power as the load may be heavy lifting hands or ankle as a load to reinforce the bag Gaza practice, 20 / group, 30 second intervals between groups, the continuous practice 2-4 groups, 2-3 times / day. Slow motion is required to control the upper body without shaking.
- After the stride exercise: after increasing power as the load may be heavy lifting hands or ankle as a load to reinforce the bag Gaza practice, 20 / group, 30 second intervals between groups, the continuous practice 2-4 groups, 2-3 times / day. Slow motion is required to control the upper body without shaking.
- Lateral stride exercise: after increasing power as the load may be heavy lifting hands or ankle as a load to reinforce the bag Gaza practice, 20 / group, 30 second intervals between groups, the continuous practice 2-4 groups, 2-3 times / day. Slow motion is required to control the upper body without shaking.
- 6 to 8 weeks after surgery: evaluation by a physician review considered ligament healing well, can gradually resume exercise.
- Ankle varus activity exercises: slow, hard, maximizing varus and ankle joints. Must be in the range of no pain or slight pain, and gradually increase the angle and activity (because the tissue healing is not strong enough, excessive stretching may cause adverse consequences). 10 ~ 15 minutes / time, 2 times / day. You can soak your feet in hot water for 20 to 30 minutes before and after the exercise to increase tissue temperature, improve ductility, and strengthen the effect of the exercise.
- Full recovery of ankle muscle strength and control: Lifting exercises, that is, standing on your toes, 2 minutes / time, 5 seconds rest, 10 times / group, 2 ~ 3 groups / day.
- Sitting vertical leg "hook foot" exercise: resistance to the weight of sandbags and other weights to complete the action for resistance, 30 times / group, 30 seconds rest between groups, continuous exercise 4 to 6 groups, 2 to 3 times / day.
- Resistance varus and eversion exercises: Complete the action against the resistance of the rubber band, 30 times / group, rest 30 seconds between the groups, practice 4 ~ 6 groups continuously, 2 ~ 3 times / day.
- Strengthen the function of lower limbs: protect the whole squat, evenly distribute the weight of the legs, make the hips touch the heel as much as possible, 3 to 5 minutes / time, 1 to 2 times / day.
- Start one-leg squat exercise: Slow motion is required to control the upper body without shaking. If necessary, you can carry heavy weights to increase the difficulty of the exercise, 3 to 5 minutes / time, 1 to 2 times / day.
- Pre-step downward exercise: After strength enhancement, you can carry heavy weights as a load or add a sandbag at the ankle as a load to strengthen the exercise, 20 times / group, with a 30-second interval between the groups, and continuously practice 2 to 4 groups, 2-3 Times / day. Slow motion is required to control the upper body without shaking.
- Rehabilitation of conservative treatment of medial and lateral collateral ligaments of the ankle
- After the medial and lateral ligament injury of the ankle joint, the patient's ankle joint stability can be treated conservatively. After fixing with plaster or brace for 4-6 weeks, remove the plaster and practice ankle movement.
- 1 day after injury: rehabilitation training and ankle joint medial and lateral ligament rupture suture 1 day after surgery.
- 2 days to 4 weeks after injury: Rehabilitation training is the same as the treatment plan for 2-3 weeks after suture of the medial and lateral ligament rupture.
- 4 weeks after injury: If the plaster has been removed at this time, rehabilitation training is the same as the treatment plan for 4 weeks after suture of the ankle joint medial and lateral ligament rupture. If the plaster has not been removed, training can be postponed.
- 8 weeks after injury: The ligament has healed after examination by a professional doctor, and you can continue training. Rehabilitation training is the same as the treatment plan for 6-8 weeks after suture of the medial and lateral ligaments of the ankle joint. If the plaster has not been removed, training can be postponed.
- Prevention of ankle ligament injuries
- Since ankle injuries are a common injury in sports, the basic problem is prevention of injuries. This is especially important for athletes with previous ankle injuries, because they are 4 to 10 times more likely to be injured again than athletes without ankle injuries. Patients have not fully recovered from the injury within 6-12 months, and the risk of re-injury is particularly high. The following measures can achieve good results:
- (1) Appropriate shoes: The shoes are located between the human feet and the ground, cushioning the cushioning force between the lower limbs and the ground, and providing the lower limbs with appropriate stability and ground attachment.
- (2) Good site: The maintenance of a good site is often more important than choosing a suitable pair of shoes. The culprit of an ankle sprain is often just a stone, a small protruding mud or a pothole.
- (3) Ankle protection: For people who have suffered an ankle sprain, it is very important to prevent another sprain. The ankle joint can be protected by bandaging or ankle protection.
- (4) Restore the function of the ankle joint: No matter how much external protection is, it is not as good as you have the ability to control the prevention of recurrence of ankle sprain. To reach.
- Neuromuscular training
- Follow the rules of 10 ~ 5 ~ 10 (10 minutes for each training, 5 times a week for 10 weeks), and perform balance exercises on the shaking board. The 10-week plan looks longer, but from experience, balancing exercises are easy to complete if athletes do other activities (such as watching TV) every day. Studies on instability following ankle injury indicate:
- 10 weeks of balance training on the balance board can normalize neuromuscular function.
- Training on the balance board can greatly reduce the risk of re-injury, and its danger can be reduced to the level before injury.
- Tape and orthosis
- Athletes who have not completed rehabilitation of their neuromuscular function should use tape and orthoses when performing high-risk activities until they complete their rehabilitation training program. Tests show that tape fixation or the use of orthotics can prevent ankle sprains from being injured again, but these methods have no preventive effect on athletes who have not been injured before. This may be because tape fixation or the use of orthotics can improve the ability to respond quickly to varus stress, while their mechanical support is less effective. Recent research has shown that the use of orthotics does not degrade flexibility and speed. If athletes use tape to fix or orthotics, they must clearly tell them the importance of continuous use of external support until the ankle function is fully restored.
- Common rehabilitation training methods for ankle ligament injuries
- Cycling exercise
- Rehabilitation training methods (5 photos)
- Use small load
- Use high frequency
- Beginning with the heel on the pedal, then the load forward, so that the ankle more proactive activities
- By weight of the conversion step and
- This is the basic exercise to restore normal function
- Speed train in the rhythm control
- After a long injury, using a treadmill to train a normal gait
- Doing strength exercises with tension bands
- Endurance Training
- Conscious calf muscle work
- Standing balance training
- Pay attention to the initial movements, control the feet, knees and hips, and maintain balance;
- Close your eyes or use distracting methods (such as holding a ball or doing other actions) to increase the difficulty of practice
- Change from a soft surface to a hard surface to increase the difficulty of the exercise;
- Functional training
- Athletes do more special sports exercises
- Exercises to increase turns and distract