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美国的ACL重建术后康复指南

(2007-11-19 19:32:07)
标签:

健康

acl

康复

分类: ACL
 

美国的ACL重建术后康复指南

 

After your operation is over, the hard work really begins. The goals of physical therapy and rehabilitation after ACL surgery are to rebuild your strength and to get your motion back. This whole process requires a lot of work and patience on your part, but it is the most important aspect to getting you back on the playing field. In the past, rehabilitation after an ACL injury was primarily concerned with protecting the new ligament and the surgical fixation. For that reason, full extension of the knee and active quadriceps exercises were avoided. Unfortunately, it has been discovered that this type of rehabilitation can cause problems with stiffness and may result in a limited range of motion. An accelerated course for rehabilitation after ACL reconstruction was published in the American Journal of Sports Medicine. This program is divided into four phases, as follows

    在你手术之后,艰辛真正开始。 ACL 手术后的物理治疗和康复的目标,是再建你的力量、恢复运动。这个过程中,你需要耐性和大量训练,那是你回到赛场最重要的事。 过去, ACL 受伤后的康复,主要关注保护新韧带手术固定。出于这个原因,被避免做充分延长膝关节和股四头肌主动练习。不幸的是,已经被发现这类型的康复会引起坚硬的问题而且可能造成有限运动。对于 ACL 重建后的康复的加速课程被刊登在杂志美国运动医学。这一计划将分为四个阶段,如下

 

Phase I: preoperative period.
The goal for this phase of the accelerated rehabilitation program is to obtain full range of motion. This means that you should be able to flex and extend your knee as far as the uninjured side by the end of the program. This period is a good time for you to prepare for ACL surgery and to learn as much as possible about the type of surgery and rehabilitation that you are going to have.

阶段I: 手术时期

给加速康复计划的这阶段的目标,作完整的运动。这意谓你应该能够藉由计划的结束像未受伤害边一样的尽量弯曲并扩充你的膝。这时期是好时间让你准备 ACL 手术而且到处尽可能多学习你要有的手术和康复的类型。

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During this period of time, you should concentrate on maintaining as much strength as possible in your quadriceps muscle. The quadriceps muscle brings your knee into full extension. This is one of the strongest muscles in your body, but unfortunately, it can loose a significant amount of strength after any type of knee surgery.

在这个时间的期间,你应该专注于尽量绷紧你的四头肌肌肉。四头肌肌肉让你的膝进入完全的延长。 这是你的身体中最强壮的肌肉之一, 但是不幸地,它会释放任何类型的膝手术后的重要力量。

The quadriceps contracts, pulling on the patella which is connected to the tibia by the patellar tendon. The force of this contraction brings the knee into extension.

四头肌缩短, 连接胫骨髌腱拉动髌骨上拉。这收缩的力量带来膝进入延长。

Regaining the strength in your quadriceps muscles can be difficult, because your knee may hurt quite a bit in the first few weeks after your injury. Some common exercises that orthopedic surgeons and physical therapists usually recommend are knee extensions, quad sets, heel slides, and straight leg raises. These exercises are performed in the following manner:

因为你的膝在你的受伤之后在头几星期有些伤害,所以四头肌肌肉恢复力量可能有点困难。一些通常的外科医生和康复医生通常推荐膝行过伸、线组设定(翻不出啦)、脚后跟滑行和直腿上抬。这些练习方式如下:

Knee extensions and quad sets --To perform these two exercises, place the heel of your injured leg on an object that is a few inches thick (like a phone book). Gradually relax and let your leg come to full extension. This first part of the exercise helps you to maintain a normal range of motion.

膝行过伸和线组设定 –做这二种练习, 将伤腿脚后跟放在一个是数寸的厚的物体上.(如一本电话号码) 逐渐地放松,让你的腿得到完全的延伸。练习的这个第一部分可以帮助你维持一个正常范围的运动。

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After your knee has stretched out for a while, perform a set of ten quadriceps contractions with your leg in the same position. Without lifting your heel up in the air, tighten your quadriceps muscle as hard as you can for ten seconds. Then relax for ten seconds before tightening your muscle again. Repeat this ten times. This exercise helps you to maintain quadriceps strength.
在你的膝已经伸展出一阵子之后,在相同的位置做10次股四头肌收缩。向上举起你的脚后跟,绷紧你的四头肌肌肉坚持10秒。再放松10秒。 重复10次。 这练习帮助你保持四头肌力量。

 

  

Heel Slides-- For this next exercise, start with you injured leg stretched out. Then, while keeping your heel on the floor, gradually bend your knee and slide your heel towards your buttock. Bend your knee until it becomes just slightly uncomfortable and you can feel a bit of pressure inside your knee. Hold it in this position for ten seconds. Then straighten your knee out again and relax for ten seconds. Repeat this exercise ten times as well. This exercise will help you to maintain range of motion.

脚后跟滑动-- 对于这种练习,开始伸出你受伤的腿。然后, 同时保持你的脚跟在地板上, 逐渐地弯曲你的膝并足跟滑滑向PP。弯曲你的膝盖直到它变得稍为舒服, Bend your knee until it becomes just slightly uncomfortable and you can feel a bit of pressure inside your knee.你可以感到膝内有点压力。保持这个位置10秒,然后伸直膝关节放松10秒,重复这种练习10次。这练习将有助于你保持关节活动范围。

Straight leg raise --This exercise helps you maintain your quadriceps strength. Start with your leg flat on the bed. Begin by tightening your quadriceps, as in the quad sets exercise. Then lift your leg off the bed until your heel is approximately eighteen inches off of the bed. Lower your leg back down and relax for ten seconds.

直腿抬高 --这练习帮助你维持你的股四头肌力量。先把腿平放于床上,从绷紧你的四头肌开始, 象quad sets练习一样做。然后从床抬起你的腿,直到你的脚后跟大约离床十八英寸。然后放下放松十秒。

 

 

Phase II: 0 to 2 weeks after surgery
For the first two weeks after your ACL surgery, you will need to concentrate on regaining range of motion and on minimizing the amount of swelling. You should ice and elevate your knee as much as possible, and avoid spending time on your feet. Your doctor may give you a special pair of socks, called TED hose, that will help the swelling to go down. These socks may itch and drive you crazy, but they can significantly speed up the process of removing the swelling. You will require crutches for some period of time after your surgery. The amount of time that you spend on crutches depends on your doctor's rehabilitation plan and how well you are doing.

阶段II 术后02星期
在你的 ACL 手术之后最初二个星期,你要集中精神于恢复运动范围和减轻肿胀。你应该冷敷,尽可能锻炼膝关节, 避免在你的脚上花费时间。你的医生可能给你一双特别袜子, 叫 TED软管,那将会帮助减轻肿胀。这些袜子可能让你觉得痒得发疯,但是他们能快束速除去肿胀的。你在手术之后将会需要拐杖一些时间。你用拐杖的时间长短依赖医生康复计划和你做得多好。

By the end of this period of time your wound will have healed and you should be able to move your knee from full extension to ninety degrees of flexion. Each doctor and physical therapist has their own schedule and routine for ACL rehabilitation exercises to restore the motion to your knee and the strength to your quadriceps muscle. The following exercises are some of the more common ones. Many rehabilitation programs will have you performing a set of these (or similar) exercises every hour that you are awake. Each of these exercises should be done gently and gradually, and you should not push yourself to the point where you are in a significant amount of pain.

在阶段末期,你的创口将会痊愈,而且你应该能将膝关节过伸和弯曲90度。每位医生和康复师有他们自己的时间表,让 ACL 复原练习恢复你的膝关节运动以及股四头肌力量。下列的练习是一些更普通的。许多康复计划将会要求你醒着时每个小时做这一系列 (或者相似的) 练习。每一个这样的练习应该缓和地、逐渐地做,有要在痛苦中强迫自己。

Exercises练习

Knee extensions -- This exercise helps you to restore range of motion. Place your heel on object like a telephone book so that your heel and calf are not touching the bed. Remain in this position for five to ten minutes.

膝过伸 -- 这练习帮助你恢复活动的范围。像一本电话书放你的脚后跟在物体上,以便你的脚后跟和小腿没有在碰触床。保持尽量伸直 5-10 分钟。

Quad sets -- This exercise helps you to maintain your strength and your range of motion. Keep your heel elevated as in the knee extension exercise. Begin by tightening the quadriceps muscle and holding it for ten seconds. Repeat ten times.

Quad sets-- 这练习帮助你恢复力量和活动范围。抬高脚后跟象练膝过伸一样高度,绷紧四头肌保持10秒开始。 重复10次。

 

Straight leg raise --This exercise helps you maintain your quadriceps strength. Start with your leg flat on the bed. Begin by tightening your quadriceps, as in the quad sets exercise. Then lift your leg off the bed until your heel is approximately eighteen inches off of the bed. Lower your leg back down and relax for five seconds.

直腿抬高 --这练习帮助你维持你的股四头肌力量。先把腿平放于床上,从绷紧你的四头肌开始, 象quad sets练习一样做。然后从床抬起你的腿,直到你的脚后跟大约离床18英寸。然后放下放松5秒。做10组。

 

Heel slides -- This exercise is for ROM. Begin with your knee flat on the bed and slowly bend your knee until it is just slightly uncomfortable. Hold your knee in this position for ten seconds, and then relax by straightening your leg. Rest for ten seconds. Repeat ten times.

脚后跟滑动 -- 这练习是给 ROM 。开始伸出你受伤的腿。然后, 同时保持你的脚跟在床板上,弯曲你的膝盖直到只是稍不舒服, Bend your knee until it becomes just slightly uncomfortable and you can feel a bit of pressure inside your knee.保持这个位置10秒,然后伸直膝关节放松10秒,重复这种练习10次。

 

 

Phase III: 3 to 5 weeks after surgery
During this phase you will work to maintain full extension and gradually increase the amount of flexion your knee is capable of performing. If you conduct your exercises daily you will recover the motion in your knee as well as the strength in your quadriceps muscle quite quickly. You should reach a point where you have a nearly normal range of motion by the end of this time period. During this phase you can start using an exercise bicycle and a stair-stepper, as long as you are comfortable and your knee does not hurt or swell significantly after exercise.

阶段III:术后 3-5个星期
在这阶段,你要维持完全延长并逐渐地增加大量膝关节弯曲。如果你每日做练习,你将会相当快地在恢复膝关节运动和股四头肌力量。在本阶段末,你应该达到一个几乎正常的运动的点。在这阶段,你可能开始练习脚踏车和台阶步进,舒适地做尽量长时间,你的膝关节不会在练习后受伤害或肿胀。

 

Phase IV: 6 weeks after surgery.
During this phase you will work on building your strength back while allowing the ligament to heal into the bone tunnels in your femur and tibia. Most physical therapists prescribe closed-chain kinetic exercises during this phase. In this type of exercise, your foot is planted on the floor and is not free to move about. Squats are an example of a closed-chain kinetic exercise whereas quadriceps extension exercises on a weight training machine are an open-chain exercise. Most surgeons will wait until at least three months have passed before allowing their patients to return to agility training exercises. When to return to competitive or recreational sports after an ACL reconstruction is a difficult decision.

阶段IV: 在手术后 6个星期。
  
在这阶段,在你力量恢复的同时,韧带会在股骨和胫里的骨隧道内愈合,这阶段大多数康复师停止链运动的练习。这阶段的练习中,你的脚在地板上被固定而不是自由的移动。闭链运动的练习如下蹲,而在一个重量训练机上做延长股四头肌锻炼是一个开放链运动。大多数的外科医生将会等候到至少三个月,再允许他们的病人回到之前灵敏训练。ACL 重建后何时恢复到竞技或者娱乐的运动是一个困难的决定。

Strength Training

In these two pictures, open-chain kinetic exercises are being performed. On the knee extension and hamstring curl machines, the foot is not firmly planted on the floor. A factor that may affect the way in which the knee moves through its range of motion. These types of exercise may put more strain on a reconstructed ACL and are often avoided during the rehabilitation period.
力量训练
在这些二张图片中, 示意了开链动力训练。在膝延长和腿筋卷曲机器上,脚不固定在地板上。一个因素可能会影响到以何种方式膝动运动通过一系列运动。这些类型的运动会更多倾向于重建ACL,而且往往回避恢复时期。

 

 

  

 

In contrast, during the squat type of exercise, the foot is firmly planted on the floor and does not move. This allows the body to control the motion of the knee more precisely, a factor that may also decrease the amount of strain placed on the new ACL graft.
  对比,在下蹲练习期间,脚固定在地板上而且不移动。这让身体更精确控制膝的运动,是一个也可能减少将大部分紧张因素放在新 ACL上的因素。

 

 

Many people find squatting exercises difficult, especially if they do not have a physical therapist or a partner to train with. Fortunately, there are several different strength training machines that will allow you to perform these types of exercises. The squat deck permits you to vary the amount of weight that you press with your legs. It is a very good exercise machine for keeping your quadriceps strong after surgery. It is important to note that in both of these quadriceps exercises, the goal is not to put your knee through a full range of motion. Instead, you should perform "short-arc" exercises where you only bend your knees to the degree shown in these pictures.
许多人发现下蹲练习困难, 尤其如果他们没有一位康复师或者训练伙伴。幸运地,有一些不同的力量机器可以让你做这类练习。蹲着的甲板允许你改变腿压的重量。它是一部在术后保持股四头肌强壮的非常好的练习机器。值得注意的是,在这两股四头肌练习,其目的是不要把你的膝盖通过全套的运动。反之,你应该做"短弧"练习,你只能如图示程度弯曲你的膝盖。

 

 

 

The timing of your return to normal athletic activities will depend upon how well you have done with your rehabilitation, how solid your knee feels to you, and what you and your surgeon decide is reasonable. Even after you return to your activities, it is important that you pay special attention to keeping your quadriceps and hamstrings in good shape, as this is considered an essential part of protecting the ACL.

你何时回到正常竞技活动,将取决于你康复训练做得多好,, 你膝关节的感觉如何及你和你的外科医生决定是否合理。甚至在你回到你的活动之后,特别注意保持优良的股四头肌和腿筋形状很重要, 因为这被视为保护 ACL 的必要部份

 

Staying healthy and strong
During this phase you will work on building your strength back while allowing the ligament to heal into the bone tunnels in your femur and tibia. Most physical therapists prescribe closed chain kinetic exercises during this phase. In this type of exercise your foot is planted on the floor and it is not free to move about. Squats are an example of a closed chain kinetic exercise whereas quadriceps extension exercises on a weight training machine are an open chain exercise.

保持健康和强壮
在这阶段,在你力量恢复的同时,韧带会在股骨和胫里的骨隧道内愈合,这阶段大多数康复师停止链运动的练习。这阶段的练习中,你的脚在地板上被固定而不是自由的移动。闭链运动的练习如下蹲,而在一个重量训练机上做延长股四头肌锻炼是一个开放链练习。

Keeping your quads strong.

Two very good exercises for maintaining quadriceps strength are short arc squats and lunges. In the short arc squat, which is illustrated below, the feet are kept shoulder-width apart, the back is held straight, and the knees are bent to the point where this is still a comfortable exercise. The goal of this exercise is to strengthen your quadriceps muscle, and not to force your knee through a complete range of motion. Therefore, it is not wise to try to squat down as far as you can possibly go, but rather to perform the exercise to the point where you just start to feel pressure inside your knee. When first starting with a strength training program, it is a good idea to have a physical therapist give you instructions on how to perform each exercise.
保持quads强壮
短弧下蹲和弓步是练股四头肌力量的二种非常好的方式。 在短弧蹲中, 如下图示, 脚保持与肩同宽,背挺直,膝关节弯曲到一种舒服的点练习。目标是加强股四头肌肌肉, 而不要再经过一个完全范围的运动强迫你的膝关节。因此, 试着尽量下蹲是不明智的, 练习的程度宁可是在你刚觉得内膝有压力的点处。当首先以一个力量训练计划开始的时候,让一位康复师给你关于该如何作每种练习的指令是一个好主意。

 

 

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Lunges are also an excellent exercise for maintaining quadriceps and hamstring strength. In this exercise, start with both feet shoulder-width apart, and then step forward with one foot. Allow yourself to dip down to the point where you just start to feel pressure inside your knee, and then come smoothly back up to the starting position. As your quadriceps get stronger, you can increase the amount of weight and repetitions that you perform.
  弓步也是维持股四头肌和腿筋力量的一种好练习。训练中,先两肩同宽,然后伤腿向前一步。 允许在膝内开始感觉压力的点浸下来, 然后平滑地向后回复到起点位置。若你的股四头肌变得比较强壮,可以增大压重和重复次数。

  


Agility Exercises

Agility exercises are designed to improve the power and strength in the muscles that move your knee after the ACL graft has healed. These exercises are often called plyometrics, and they are an important part of agility exercises and retraining. In this first box jump exercise, stand to the side of the box and hop up onto the box, landing with both feet. Then hop off the box down to the ground, again landing with both feet.
敏捷练习

在 ACL 痊愈后,敏捷练习用来改善肌肉力量和力量运动。这些练习时常叫做 plyometrics ,而且它是敏捷练习和再训练的一个重要部份。在第一个盒子跳跃起练习中,站在盒子的一侧跳上盒子(本人建议按自己的肌肉力量选择高度),双脚着地(盒)。然后跳下盒子(另一侧),仍是双脚着地。

 

   

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As your strength and agility increases, you can progress to jumping completely over the box, landing with both feet together on the far side.

当你的力量和灵敏度增加时,你从盒子的一侧跳向另一侧,双脚着地。

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To brace or not to brace?

Most people who have ACL surgery are given a brace to wear as they return to normal and resume their sporting activities. The issue whether or not you should wear a brace after an ACL reconstruction is complicated. In general, all braces are designed both to resist abnormal motions and to increase the stability of the knee. The degree to which braces actually accomplish these goals is the subject of a lot of debate. While there have been many articles written in the sports medicine literature about how braces do and do not work, the fact is that some patients feel more comfortable and secure when using a brace, whereas others do not.

For the most part, brace-wear is a decision that will be made jointly by you and your surgeon, and there is not an overwhelming amount of support for either course of action.

支撑支撑?
当他们回到常态而且重新开始他们的喜好运动活动的时候,大多数的有 ACL 手术的人有一个支柱穿着。 议题是否你在应该穿着一个支柱之后, ACL 重建是复杂的。大体上,所有的支柱被设计两者抵抗不正常的运动而且增加膝的安定。程度到实际上支撑完成这些目标是许多辩论的主题。已经有在支柱如何做附近的运动药文学中被写的许多文章而且不工作, 事实是当使用一个支柱的时候,一些病人觉得更舒服和更安心,然而其他不是。
大致上 , 支柱-穿着是将会共同地被你和你的外科医生所作出的决定,而且没有对行动的任一课程的压倒性量的支持。

 

为了支持或者不支持?

有ACL外科的大多数人当他们返回,被给穿带子对于正常并且恢复他们的运动活动。 发布是否在ACL重建被复杂化之后,你应该穿带子。 在中将军,所有带子对于两个都被设计以便抵抗反常的运动和增加膝盖的稳定性。 的程度实际上支持 完成这些目的是许多辩论的题目。当时在那里 是许多文章在关于的运动药文学中书面带子如何做和不工作,事实是一些患者感到更多舒适和安全当使用带子,而其他不。

对于大多数部分,曲柄穿是将被你共同做出的决定和你的医生,并且在那里不是任一个行动方针步骤的支持的一个压倒优势的量。

 

 

 

 

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