[스크랩] 무릎 반월상 연골파열 재활

 

 

 

* 1단계: 급성기 (7-10일) 

목표 ◆ 부종 및 염증을 가라 앉히는 시기 ◆ 운동범위 회복 ◆ 대퇴사두근(허벅지 앞쪽) 근력의 회복 

1-3일 째 ◆ 얼음찜질 ◆ 전기 자극 등의 물리치료 ◆ Quadriceps sets, SLR ◆ multi hip ◆ 무릎 신전운동 ◆ half squats ◆ 보조 능동형 운동범위 확보 운동 ◆ 목발두개를 이용하여 가능한 정도로 체중부하 ◆ 간단한 슬리브형 보조기

4-7일 째 ◆ 얼음찜질 ◆ 전기 자극 등의 물리치료 ◆ Quadriceps sets, SLR ◆ multi hip ◆ 무릎 신전운동 ◆ half squats ◆ balance/proprioceptive 운동 ◆ 운동범위 0-115도 ◆ 목발 한 개를 이용하여 가능한 정도로 체중부하 ◆ 보조기 지속

7-10일 째 ◆ 모든 운동 지속 ◆ leg press, Hamstring curls, 고정식 자전거 시작

* 2단계 : 중간단계(10일 - 4주) 

10-17일 째 ◆ 고정식 자전거(운동범위와 지구력) ◆ lateral and front lunge, half squats, leg press, lateral step ups ◆ knee extension 90-40 ◆ hamstring curls ◆ multi-hip ◆ toe raise ◆ proprioceptive and balance exercise

17일-4주 ◆ 모든 운동을 지속 ◆ 풀장에서 달리기 ◆ 보조기를 운동할 때만 사용 

* 3단계 : 복귀준비 단계(4-7주) 

3단계 진입조건 ◆ 통증 없고 완전한 운동범위 ◆ 통증 및 압통이 없음 ◆ Isokinetic 검사 상 반대편의 85% 이상 ◆ 부종 없음

운동 ◆ 모든 closed-kinetic chain exercise를 계속함 ◆ Plyometrics 시작함 ◆ 달리기와 agility program 시작함 

** 반월상 연골판 봉합술 후의 재활운동

* 1단계 : 최대보호기(1-6주) 

1일-3주 ◆ 얼음찜질, 압박, 하지거상 ◆ 전기 자극 ◆ 보조기를 이용 0도 고정 후 목발 두개를 이용하여 체중부하 ◆ 운동범위 3주 이내에 90도 까지 도달(0-30, 0-50, 0-70, 0-90으로 점진적 도달) ◆ 슬개골 스트레칭

운동 ◆ Quadriceps isometrics ◆ Hamstring isometrics(후방을 수술한 경우는 6주간 금기) ◆ Multi-hip ◆ Proprioceptive training

4-6주 ◆ 점진적으로 저항을 늘리면서 등장성 운동(0.5-2.5 kg) ◆ knee extension(90-40도) ◆ 발가락만으로 서기 ◆ mini squats ◆ 저항없이 고정식 자전거 ◆ 스트레칭 

* 2단계 : 중간보호기(6-10 주) 

2단계 진입조건 ◆ 운동범위가 최소 0-90도 이어야 한다. ◆ 동통이나 부종이 거의 없어야 한다. ◆ 대퇴사두근(허벅지 앞근육)이 조절이 잘 되어야 한다. 

운동 ◆ 근력강화- 점진적으로 저항을 늘리면서 등장성 운동 ◆ 스트레칭 ◆ lateral step ups(30초 x 5세트-> 60초 x 5세트) ◆ mini squats ◆ isokinetic exercise ◆ endurance and proprioceptive 운동 ◆ plyometrics 

* 3단계 : 운동복귀 준비단계 

3단계 진입조건 ◆ 완전하고 통증 없는 운동범위 ◆ 통증, 부종이 없어야 함 ◆ isokinetic 검사 상 반대편의 85% 이상 

운동 ◆ 이상의 모든 운동을 시행 ◆ 달리기 시작 

 

You may do the first 5 exercises right away. You may do the rest of the exercises when the pain in your knee has decreased.

• Passive knee extension: Do this exercise if you are unable to fully extend your knee. While lying on your back, place a rolled-up towel underneath the heel of your injured leg so the heel is about 6 inches off the ground. Relax your leg muscles and let gravity slowly straighten your knee. You may feel some discomfort while doing this exercise. Try to hold this position for 2 minutes. Repeat 3 times. Do this exercise several times per day. This exercise can also be done while sitting in a chair with your heel on another chair or stool.
• Heel slide: Sit on a firm surface with your legs straight in front of you. Slowly slide the heel of your injured leg leg toward your buttock by pulling your knee to your chest as you slide. Return to the starting position. Do 3 sets of 10.
• Standing calf stretch: Facing a wall, put your hands against the wall at about eye level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times and then switch the position of your legs and repeat the exercise 3 times. Do this exercise several times each day.
• Hamstring stretch on wall: Lie on your back with your buttocks close to a doorway, and extend your legs straight out in front of you along the floor. Raise one leg and rest it against the wall next to the door frame. Your other leg should extend through the doorway. You should feel a stretch in the back of your thigh. Hold this position for 15 to 30 seconds. Repeat 3 times and then switch legs and do the exercise again.
• Straight leg raise: Lie on your back with your legs straight out in front of you. Bend the knee on your uninjured side and place the foot flat on the floor. Tighten the thigh muscle of the other leg and lift it about 8 inches off the floor, keeping the thigh muscle tight throughout. Slowly lower your leg back down to the floor. Do 3 sets of 10.
• Wall squat with a ball: Stand with your back, shoulders, and head against a wall and look straight ahead. Keep your shoulders relaxed and your feet 2 feet away from the wall and a shoulder's width apart. Place a soccer or basketball-sized ball behind your back. Keeping your back upright, slowly squat down to a 45-degree angle. Your thighs will not yet be parallel to the floor. Hold this position for 10 seconds and then slowly slide back up the wall. Repeat 10 times. Build up to 3 sets of 10.
• Step-up: Stand with the foot of your injured leg on a support (like a small step or block of wood) 3 to 5 inches high. Keep your other foot flat on the floor. Shift your weight onto your injured leg on the support straighten your knee as the other leg comes off the floor. Lower your leg back to the floor slowly. Do 3 sets of 10.
• Knee stabilization: Wrap a piece of elastic tubing around the ankle of the uninjured leg. Tie a knot in the other end of the tubing and close it in a door.
  1. Stand facing the door on the leg without tubing and bend your knee slightly, keeping your thigh muscles tight. While maintaining this position, move the leg with the tubing straight back behind you. Do 3 sets of 10.
  2. Turn 90 degrees so the leg without tubing is closest to the door. Move the leg with tubing away from your body. Do 3 sets of 10.
  3. Turn 90 degrees again so your back is to the door. Move the leg with tubing straight out in front of you. Do 3 sets of 10.
  4. Turn your body 90 degrees again so the leg with tubing is closest to the door. Move the leg with tubing across your body. Do 3 sets of 10.

  Hold onto a chair if you need help balancing. This exercise can be made even more challenging by standing on a pillow while you move the leg with tubing.

• Resisted terminal knee extension: Make a loop from a piece of elastic tubing by tying a knot in both ends. Close both knots in a door. Step into the loop so the tubing is around the back of your injured leg. Lift the other foot off the ground. Hold onto a chair for balance, if needed. Bend the knee on the leg with tubing about 45 degrees. Slowly straighten your leg, keeping your thigh muscle tight as you do this. Do this 10 times. Do 3 sets. An easier way to do this is to stand on both legs for better support while you do the exercise.
• Wobble board exercises:
  1. Stand on a wobble board with your feet shoulder width apart. Rock the board forwards and backwards 30 times, then side to side 30 times. Hold on to a chair if you need support.
  2. Rotate the wobble board around so that the edge of the board is in contact with the floor at all times. Do this 30 times in a clockwise and then a counterclockwise direction.
  3. Balance on the wobble board for as long as you can without letting the edges touch the floor. Try to do this for 2 minutes without touching the floor.
  4. Rotate the wobble board in clockwise and counterclockwise circles, but do not allow the edge of the board to touch the floor.
  5. When you have mastered exercises A through D, try repeating them while standing on only one leg (your injured leg).
  6. Once you can do these exercises on one leg, try to do them with your eyes closed. Make sure you have something nearby to support you in case you lose your balance.

 

출처 : 메드짐(MedGym)

글쓴이 : 바람개비 원글보기

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