Method for gait training after a knee joint injury

Abstract

The invention relates to the field of sports medicine and can be used for gait training after knee joint injuries. The present method includes stretching a band of a resilient material using the knee of the injured leg, wherein one end of said band is secured in relation to a fixed support behind the injured leg. A series of exercises is then performed without removing the load on the injured knee joint, from an upright starting position on a platform with the band positioned on the knee of the injured leg and the hands on the waist. Both legs are bent. Next, sets of exercises are performed which include raising the healthy leg, placing the foot on an intermediate platform, and placing the foot on the floor. To finish, the load is removed from the injured leg and the user steps up and down from the platform. The method makes it possible to restore the coordination of the movements made when descending or climbing a flight of steps.

Description

Method of restoring walking skills after knee joint injury

[0001] The present invention relates to the field of sports medicine and can be used in restoring walking skills functions after knee joint injuries.

[0002] The prior art includes methods for rehabilitating the knee joint after injury or surgery. For example, the prior art includes invention RU No. 2 253 385 "Method for Comprehensive Rehabilitation of the Knee Joint", published on 10.06.2005 [1]. This invention relates to medicine and can be used for the rehabilitation of patients with knee joint diseases, their postoperative and post-traumatic rehabilitation. The purpose of the known invention is to develop a normal stereotype of movement, sitting, and gait. The total number of procedures coincides with the number of massage sessions. The complex is performed daily. At the same time, this method seems complicated and does not allow the patient to independently bring the coordination of movements to automatism when going up or down stairs.

[0003] The prior art also includes invention RU No. 2496462 C1 "Method for knee joint rehabilitation", published 10 / 27 / 2023 [2]. This invention relates to medicine, namely to manual therapy, arthrology. The objective of the known method is comprehensive rehabilitation of the joint with restoration of the support and movement function, strengthening of the capsular-ligamentous and muscular apparatus. The method for knee joint rehabilitation according to [2] includes manual therapy, therapeutic exercises, and a dosed increase in joint mobility. The treatment session is carried out with the elimination of functional blockades in the joints of the spinal segments using known manual therapy techniques, then periosteal massage is performed in the zones of the beginning of the attachment of the muscles involved in the implementation of movements in the joint. Periosteal massage is performed along the anterior surface of the pubic bone for the gracilis muscle, the upper anterior part of the ilium for the sartorius muscle,the lower anterior part of the ilium and the area of ​​the greater trochanter for the quadriceps muscle, in the area of ​​the ischial tuberosity for the semitendinosus and semimembranosus muscles, the popliteal surface above the medial condyle and below above the lateral condyle for the gastrocnemius muscle, the area of ​​the head and upper third of the body of the fibula for the soleus muscle, the lateral condyle of the femur for the popliteal muscle, the next step is to act on the attachment zones of the muscle tendons to the tissues of the knee joint involved in the function of the joint, by spreading the tendon tissue transversely at the sites of their attachment, namely: the tuberosity of the tibia, where the tendon of the gracilis muscle grows together with the sartorius and semitendinosus muscles and forms the goose foot, and where the patellar ligament is attached, the medial condyle of the tibia, where the internal bundle of the semimembranosus is attached muscles, head of the fibula,where the long narrow tendon of the biceps femoris is attached, above the medial condyle of the femur, where the medial head of the gastrocnemius muscle begins, above the lateral condyle, where the lateral head of the gastrocnemius muscle originates, the head and upper third of the body of the fibula, where the soleus muscle originates, the identified myofascial trigger points of the muscles involved in the function of the knee joint are eliminated by ischemic compression followed by stretching of the affected muscle in the form of passive movements without weighting. The method with the inclusion of physical exercises aimed at a dosed increase in mobility helps to strengthen the flexor-extensor apparatus, restore the range of motion, muscle strength, muscle endurance to long-term static load.

[0004] Thus, the method according to [2] describes in detail the mechanism of muscle rehabilitation, but does not disclose the achievement of the possibility of a full descent down the stairs, which is achieved through the use of the claimed method.

[0005] The technical result that the proposed technical solution is aimed at achieving is the restoration of coordination of movements when descending or ascending stairs.

[0006] The technical result is achieved by using a method for restoring walking skills, which consists of providing a load on the joint of the injured leg by stretching the knee of the injured leg with a band made of elastic material, the second end of which is fixed relative to a fixed support behind the injured leg, and performing a series of physical exercises without removing the load from the injured knee joint according to the following algorithm:

[0007] - take the initial standing position, in which both legs are placed on a platform located on the floor and forming a supporting surface for the legs at a distance of 10-25 cm from the floor, a band of elastic material is on the knee of the injured leg, and the hands are on the waist,

[0008] - (step 1) then bend both legs, bringing the knees forward beyond the toes and hold in this position for 2-3 seconds, after which return to the starting position, and repeat the action of this step at least 8 but not more than 15 times in one approach, and the number of approaches is set equal to no more than 3,

[0009] - (step 2) then bend your knees, bringing your knees forward past your toes and hold this position for 2-3 seconds, after which lift your healthy leg off the platform for 2-3 seconds and then return to the starting position, repeating this step at least 8 but not more than 15 times in one approach, and the number of approaches is set to no more than 3,

[0010] - (step 3) then bend the knees, bringing the knees forward beyond the toes and hold in this position for 2-3 seconds, after which straighten the knee of the healthy leg, bringing the foot forward of the step platform and return to the starting position, and repeat the action of this step at least 8 but not more than 15 times in one approach, and the number of approaches is set equal to no more than 3,

[0011] - (step 4) then bend the knees, bringing the knees forward beyond the toes and hold in this position for 2-3 seconds, after which place the foot of the healthy leg on an intermediate surface located above the floor, but below the step platform and in front of it, and return to the starting position, and repeat the action of this step at least 8 but not more than 15 times in one approach, and the number of approaches is set equal to no more than 3,

[0012] - (step 5) gradually reduce the distance between the said intermediate surface and the floor in at least 2 approaches, while at each approach the actions (Step 4) are performed, and at the last approach the foot of the healthy leg is completely placed on the floor without using the said intermediate surface,

[0013] - (step 6) then from the starting position bend your knees, bringing your knees forward past your toes and hold in this position for 2-3 seconds, after which place the foot of your healthy leg on the floor, and repeat this step at least 8 but not more than 15 times in one approach, and set the number of approaches to no more than 3,

[0014] - (step 7) after completing step (6), release the injured leg from the impact of the elastic band and perform ascents to the platform from the floor surface and descents from the platform to the floor so that before each ascent or descent both legs are on the same surface, and the action of this step is repeated at least 8 but not more than 15 times in one approach, and the number of approaches is set equal to no more than 3.

[0015] In one embodiment of the method, the intermediate surface is a set of rubber mats, each of which is 15x15 cm in size and 1 to 5 cm thick to form a support surface above the floor but below the platform.

[0016] In one embodiment of the method, a band made of elastic material is fixed relative to a fixed support and the knee of the leg with the damaged joint so that the point of fixation of the band relative to the fixed support is higher than the point of contact of the knee with the band.

[0017] In one embodiment of the method, a band made of elastic material is fixed relative to a fixed support and the patient's knee so that an angle of 45 degrees is formed between the patient's body and the band.

[0018] In one embodiment of the method, the elastic material from which the tape is made is latex or rubber.

[0019] In one embodiment of the method, the platform is a step platform, which is designed with the ability to adjust the height of the working surface relative to the floor within the range of 10 to 25 cm.

[0020] The achievement of the above-mentioned technical result is due to the presence of steps in the declared method that allow the patient to gradually practice those actions that lead to correct coordination of movements. At the same time, the proposed sequence of actions simultaneously activates the function of the brain to coordinate movements and muscle activity. By performing exercises in the proposed sequence with the specified number of repetitions, the patient undergoes the process of adaptation to training loads, as a result of which the practice of walking is honed and a training effect occurs.

[0021] The claimed method is intended primarily for patients who have knee joint injuries that make it difficult to move and go up (down) stairs. Injuries can be the result of various reasons, including postoperative consequences that require rehabilitation procedures to correct movements. The main idea of ​​using a set of sequential exercises is to develop confidence in the patient's movements, which is achieved by the required number of repetitions of each set of exercises and their repetition.

[0022] It is worth noting that the proposed method is a set of universal sequences of actions that can be suitable for patients with very different degrees of knee joint damage. Thus, the method involves a flexible scheme for selecting the number of repetitions of each exercise and the number of corresponding approaches that the patient can perform based on his physical capabilities. Between approaches, a short rest / break can be made based on the patient's physical capabilities (there can be a pause from 1 sec. to 5 min. between approaches), but the option without a break between approaches is not excluded. Due to the concentration of the load on the selected joint and special sets of movements, the training does not require significant time costs and has a long-term effect, which corresponds to the most modern trends in the field of sports medicine in medical rehabilitation.

[0023] It is worth considering each set of exercises in more detail from the point of view of achieving the technical result mentioned above.

[0024] Thus, the main condition for the beginning of the rehabilitation procedure is the creation of an effort on the damaged knee joint. Gradual loading on the joint allows to improve control of joint movement by increasing muscle work and proprioceptive control of the central nervous system (CNS). The effort can be created by various known methods, for example, by using elastic elements such as a rubber band, latex tape, etc. The tape helps to simplify the initial stage of teaching the patient to go down the stairs. The main condition for using the appropriate elastic element is that it should cover the surface of the knee completely, i.e. be wide enough. The scheme for fixing the tape from an elastic material is shown in Figure 7. This option of fastening is the most preferable, since it provides the proper load on the knee joint, and also does not slip during exercise.According to the diagram, the elastic band is fixed relative to the fixed support and the patient's knee so that an angle of 45 degrees is formed between the patient's body and the band. The location of the band at an angle of 45 degrees prevents the band from slipping during the exercise, and also at the moment of bending the knee joint in this direction, good support of the joint is created, i.e. it facilitates movement during the exercise. Of course, an angle of 45 degrees is most preferable, however, it can vary within the range of 60-45 degrees. The end of the elastic band is attached to a fixed support, which can be a Swedish wall, a pole, a simulator, etc. The main condition is to fix the tension of the band and create an effort on the knee joint of the injured leg (see Fig. 1-5).

[0025] Further, a platform that forms a support surface for the legs is a mandatory exercise equipment. The platform is placed on the floor and should provide for the formation of a support surface for the legs, which can be located at a distance of 10 to 25 cm above the floor. Placing the support surface above the floor allows the patient to use, as a result of performing the steps of the claimed method, precisely those muscles that are directly involved in the process of climbing and descending stairs. The distance from the floor to the support surface is selected based on the patient's physical fitness and can be adjusted both before and during the exercise. For example, a step platform (adjustable or non-adjustable in height relative to the floor) can be used as the said platform that forms the support surface.

[0026] After all the preparatory stages, take the initial standing position, in which both legs are placed on the platform mentioned above, the elastic band is on the knee of the injured leg, and the hands are on the waist.

[0027] Next, bend both legs (step 1, see Fig. 1), bringing the knees forward beyond the toes and hold in this position for 2-3 seconds, after which return to the starting position, and repeat the action of this step at least 2 but not more than 15 times in one approach, and the number of approaches is set equal to no more than 3.

[0028] The selection of the specified parameters (delay 2-3 sec, repetitions from 2 to 15, no more than 3 approaches) at this stage and the following ones is carried out taking into account the physical capabilities of the patient or depends on the degree of injury. At this stage, performing a group of exercises allows you to strengthen the work of the quadriceps muscle of the thigh, as well as symmetrical performance with two legs, reduces the patient's fear of movement before performing on one leg, which ensures preparation for the next stage to achieve the stated technical result.

[0029] At the next stage (step 2), the knees are bent, bringing the knees forward beyond the toes and holding in this position for 2-3 seconds, after which the healthy leg is lifted off the platform for 2-3 seconds and then returned to the starting position, and the action of this step is repeated at least 2 but not more than 15 times in one approach, and the number of approaches is set equal to no more than 3. This stage allows you to practice balance on one leg for further free descent down the stairs.

[0030] At the next stage (step 3), the knees are bent, bringing the knees forward beyond the toes and holding this position for 2-3 seconds, after which the knee of the healthy leg is straightened, bringing the foot forward of the platform and returning to the starting position, and the action of this step is repeated at least 2 but not more than 15 times in one approach, and the number of approaches is set equal to no more than 3. This stage allows you to reduce the fear of lowering the healthy leg with full support on the sore leg, improving proprioception - the feeling of your own joint.

[0031] At the next stage (step 4) the knees are bent, bringing the knees forward beyond the toes and holding in this position for 2-3 seconds, after which the foot of the healthy leg is placed on an intermediate surface located above the floor, but below the platform and in front of it, and returning to the starting position, and the action of this step is repeated at least 2 but not more than 15 times in one approach, and the number of approaches is set equal to no more than 3. This stage completely simulates descending the stairs with relief of movement due to the high step or the fact that instead of it, for example, a step and mats are used.

[0032] (Step 5) gradually decrease the distance between the said intermediate surface and the floor in at least 2 approaches, with the actions of (Step 4) being performed at each approach, and at the last approach completely ensuring that the foot of the healthy leg is placed on the floor without using the said intermediate surface. This stage includes repetition of actions, where the patient, having placed the foot on the intermediate surface, repeats the actions of (Step 4) each time the distance between the intermediate surface and the floor is decreased. When the intermediate surface is completely removed (the last approach), the patient places the foot of the healthy leg on the floor. This stage completely removes the fear of movement, and also allows the patient to develop motor control. In general, this stage gradually prepares the patient for the pattern and amplitude of movements that exactly repeat the movements of the legs when the patient descends the stairs.Usually, two approaches of several repetitions (in a particular case, it can be from 8 to 15 repetitions) achieve complete elimination of the intermediate surface between the foot and the floor. The number of approaches is regulated by a physical therapist (doctor), taking into account the individual characteristics of the patient - his strength, endurance, degree of fear, etc. For an ordinary patient of average age (25-45 years) and activity (classes 2 times a week), several approaches of 8 to 15 repetitions in each step of the exercise are required, rest is regulated individually, while the steps remain the same without changes.

[0033] At the next stage (step 6), from the initial position, bend the knees, bringing the knees forward beyond the toes and hold in this position for 2-3 seconds, after which place the foot of the healthy leg on the floor, and the action of this step is repeated at least 2 but not more than 15 times in one approach, and the number of approaches is set equal to no more than 3. This stage allows you to fully adapt to the upcoming walking up and down the stairs, with maximum control of movement, optimal strength, and correctness of sequential actions.

[0034] At the next stage (Step 7) after completing Step (6), the injured leg is released from the effect of the elastic band and the steps are raised to the step platform from the floor surface and lowered from the step platform to the floor so that before each rise or descent both legs are on the same surface, and the action of this step is repeated at least 2 but not more than 15 times in one approach, and the number of approaches is set equal to no more than 3. This stage allows for 100% load on the joint, since the band that was there before is not used, this is the final stage of learning to descend stairs with the maximum usual load.

[0035] A set of rubber mats measuring 15x15 cm and 1 to 5 cm thick can be used as an intermediate surface. The mats can be used to form an intermediate support surface of any height. To form the desired height, the required number of mats are removed.

[0036] As confirmation of the achievement of the technical effect and, accordingly, the technical result from the application of the stages of the method, examples of patients performing the corresponding exercises are given below.

[0037] Example 1.

[0038] A 47-year-old woman sought rehabilitation after surgery on her right knee to restore normal function of descending stairs. Before the training stages, her motor control was reduced. We selected the optimal level of repetitions in the amount of 15 times with 3 approaches in each step according to the stated method. In particular, we loaded the damaged joint by stretching the elastic band with the knee of the damaged leg. Then we flexed both legs, bringing the knees forward with a delay in this position for 2 seconds, after which we took the initial position (the patient did 15 times in 3 approaches). Then the patient repeated the flexion with a delay of 2 seconds, after which he raised the healthy leg from the platform for 2 seconds and then returned to the initial position (he repeated the action 15 times in 3 approaches).The patient then repeated knee flexion with a 2-second delay, after which he extended the knee of the healthy leg, moving the foot forward of the platform, and returned to the starting position (repeated the action 15 times in 3 sets). The patient then repeated knee flexion with a 2-second delay, after which he ensured that the foot of the healthy leg was placed on the intermediate surface located above the floor but below the platform, and returned to the starting position (repeated the action 15 times in 3 sets). Then, the distance between the said intermediate surface and the floor was reduced by half of the previously established height, and the previous actions were repeated (knee flexion with a 2-second delay and ensuring that the foot of the healthy leg was placed on the intermediate surface, repeating this exercise 15 times in 3 sets).Next, another part of the mats were removed (two mats) and the previous actions were repeated (bending the knees with a 2-second delay and ensuring that the foot of the healthy leg was placed on the intermediate surface, repeating this exercise 15 times in 3 sets). Next, the intermediate surface was completely removed and from the initial position, the knees were bent, bringing the knees forward by the toes with a 2-second delay in this position, after which the patient placed the foot of the healthy leg on the floor (repeated the action 15 times in 3 sets).

[0039] After completing the exercises with a load on the injured leg, we switched to exercises without a load. We performed ascents to the platform from the floor surface and descents from the platform to the floor so that before each ascent or descent both legs were on the same surface (repeated the action 15 times in 3 sets).

[0040] The training lasted about 50 minutes. As a result of the training, the patient brought the movements to automatism, which had a positive effect on the control of movements when descending the stairs. The gait became more precise and confident.

[0041] Example 2.

[0042] A girl after a fracture of the shin bones and subsequent surgery sought rehabilitation. At 8-10 weeks, the patient still had difficulty descending the stairs due to fear and pain, and also noted a decrease in movement control. In one training session, performing successive actions of the stated method, they achieved free descent of the stairs. The patient performed 8 repetitions of 2 approaches in each step. The result is further consolidated independently during normal descent of the stairs.

[0043] Actual training time is 45 minutes. The number of required trainings is one.

[0044] Example 3

[0045] A young man, 45 years old, left knee replacement. At 6 weeks there was pain in the knee joint and fear of movement when walking up the stairs, while climbing the stairs was correct and without any problems, but going down was difficult.

[0046] In one training session, performing the sequential actions of the stated method, we achieved free descent down the stairs without pain in the knee joint. The patient performed 12 repetitions of 2 approaches in each step. The result is further consolidated independently during normal descent down the stairs.

[0047] Actual training time is 35 minutes. The number of required trainings is one.

[0048] Fig. 1. Starting position and fixing the elastic band in order to create a load on the knee of the injured leg in preparation for the first step of the exercise (starting position, squat and frontal view).

[0049] Fig. 2. Visualization of the position of the legs when performing the second step of the exercise.

[0050] Fig. 3. Visualization of the position of the legs when performing the third step of the exercise.

[0051] Fig. 4. Visualization of the position of the legs when performing the fourth step of the exercise.

[0052] Fig. 5. Visualization of the position of the legs when performing the fifth and sixth steps of the exercises.

[0053] Fig. 6. Visualization of the position of the legs when performing the seventh step of the exercises with the removal of the load.

[0054] Fig. 7. Scheme of fixing a tape made of elastic material.

Claims

A method for restoring walking skills after a knee joint injury, which consists in providing a load on the joint of the injured leg by stretching a band made of elastic material with the knee of the injured leg, the other end of which is fixed relative to a fixed support behind the injured leg, and performing a series of physical exercises without removing the load from the injured knee joint according to the following algorithm: - take the initial standing position, in which both legs are placed on a platform located on the floor and forming a supporting surface for the legs at a distance of 10-25 cm from the floor, the band made of elastic material is on the knee of the injured leg, and the hands are on the waist, - then, in step 1, bend both legs, bringing the knees forward beyond the toes and hold in this position for 2-3 seconds, after which return to the initial position, and the action of this step is repeated at least 8 but not more than 15 times in one approach,and the number of approaches is set equal to no more than 3, - then in step 2, bend the knees, bringing the knees forward beyond the toes and hold in this position for 2-3 seconds, after which the healthy leg is lifted off the platform for 2-3 seconds and then returned to the starting position, and the action of this step is repeated at least 8 but not more than 15 times per approach, and the number of approaches is set equal to no more than 3, - then in step 3, bend the knees, bringing the knees forward beyond the toes and hold in this position for 2-3 seconds, after which straighten the knee of the healthy leg with the foot forward of the platform and return to the starting position, and the action of this step is repeated at least 8 but not more than 15 times per approach, and the number of approaches is set equal to no more than 3, - then in step 4, bend the knees, bringing the knees forward beyond the toes and hold in this position for 2-3 seconds,after which the foot of the healthy leg is placed on an intermediate surface located above the floor but below and in front of the platform, and returned to the initial position, wherein the action of this step is repeated at least 8 but not more than 15 times per approach, and the number of approaches is set equal to no more than 3, - then in step 5 the distance between the said intermediate surface and the floor is gradually reduced in at least 2 approaches, while in each approach the actions of step 4 are performed, and in the last approach the foot of the healthy leg is completely placed on the floor without using the said intermediate surface, - then in step 6 from the initial position the knees are bent, bringing the knees forward beyond the toes and holding in this state for 2-3 seconds, after which the foot of the healthy leg is placed on the floor, wherein the action of this step is repeated at least 8 but not more than 15 times per approach,and the number of approaches is set equal to no more than 3, - then at step 7 after completing step 6, the injured leg is released from the effect of the elastic band and lifted up onto the platform from the floor surface and lowered from the platform onto the floor so that before each lift or descent both legs are on the same surface, and the action of this step is repeated at least 8 but no more than 15 times per approach, and the number of approaches is set equal to no more than 3., The method according to paragraph 1, characterized in that the intermediate surface is a set of rubber mats, each of which has a size of 15x15 cm and a thickness of 1 to 5 cm to form a supporting surface above the floor, but below the platform. The method according to paragraph 1, characterized in that the tape made of elastic material is fixed relative to the fixed support and the knee of the leg with the damaged joint so that the point of fixation of the tape relative to the fixed support is higher than the point of contact of the knee with the tape. The method according to paragraph 3, characterized in that the band made of elastic material is fixed relative to the fixed support and the patient's knee so that an angle of 45 degrees is formed between the patient's body and the band. The method according to paragraph 3, characterized in that the elastic material from which the tape is made is latex or rubber. The method according to paragraph 1, characterized in that the platform is a step platform, which is designed with the possibility of adjusting the height of the working surface relative to the floor within the range of 10 to 25 cm.

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