Exercising in Traumatology and ORTHOPEDICS

Musculoskeletal system performs the functions of movement and support. The bearing-locomotor apparatus function of motion are often exposed to the environment, infections, etc., which leads to various pathological conditions. So, work and sports activities often lead to significant changes in the locomotor apparatus.

Musculoskeletal (ODA) plays an important role in ensuring the life of the organism, it consists of bones, muscles, ligaments (Fig. 95). Human skeleton consists of more than 200 bones, accounting for 1/5-1/7 of body weight, and performs a supporting, protecting and locomotor function. Skeleton bones are the levers, the muscles cause them to move, holding the body in balance, move it in space, changing the relative positions of body parts. By the bones attached ligaments, muscles, tendons and fascia.

Skeleton forms a receptacle for the vital organs, protecting them from external influences. In the cranial cavity is the brain, the spinal canal - the spinal cord in the chest - heart and great vessels, lung, esophagus and others in the pelvic cavity are genito-urinary organs. Bones are involved in mineral metabolism, as a depot of calcium, phosphorus and other salts. Live bone also contains vitamins A, D, C, etc.

Fig. 95. Human skeleton: A - front view, B - back view

In humans, about 400 of striated muscles are shrinking under the influence of random pulses arriving along the nerves of the central nervous system (Fig. 96).

After the injury, disease, and especially after surgical interventions on locomotor tissues often develop functional impairment, severely limiting the possibility of patient movement, his ability to serve themselves. Restricted, and the ability to work. Therefore, early application of functional methods of treatment (LFK, gidrokinezoterapiya, etc.), massage, physiotherapy, etc. патогенетически обоснованы. pathogenetically substantiated.

Prolonged lack of exercise, associated with the immobilization of a limb, leads to secondary changes in the tissues. These include muscle atrophy, the formation of contractures, osteoporosis and other changes in the tissues of the musculoskeletal system and functional systems of the patient. Physical inactivity decreases the level of adaptation to physical stress, impairs regeneration of bone tissue and organs.

Only under the influence of systematic physical activity in the early stages can be eliminated resulting complications: muscle atrophy, contractures, improve tissue metabolism, normalize the support function of the extremities, and thereby prevent disability.

Fig. 96. Muscles (a, c) and segmental innervation (b):

a: 1 - belt muscle heads, 2 - trapezoid, 3 - deltoid, 4 - latissimus dorsi, 5 - triceps, 6 - dorsal interosseous muscle: 7 - Gluteus maximus, 8 - biceps femoris, 9 - semitendinosus, 10-11 - triceps surae, 12 - Achilles tendon;

b: 1 - cervical ganglion, 2 - middle cervical ganglion; 3 - lower cervical ganglion, 4 - Edge sympathetic trunk, 5 - Brain cone 6 - terminal (final) thread mater, 7 - lower sacral ganglion of sympathetic trunk, 8 - cervical plexus; 9 - brachial plexus; 10 - intercostal nerves, 11 - lumbosacral plexus;

c: 1 - circular muscles of the mouth, 2 - sternocleidomastoid muscle, 3 - pectoralis major, 4 - biceps, 5 - the rectus abdominis, 6 - external oblique muscle, 7 - sartorius 8 - quadriceps thigh; 9 - anterior tibial muscle

Early functional loading limb at a stable and rigid fixation of bone fragments contributes to the restoration of the active muscle function, improve blood supply to the bone, restoration of joint function, which significantly reduces the length of time that rehabilitation of the patient.

In trauma patients divided into four periods of health recovery. The duration of each of them depends on the severity of the injury, the nature of surgical intervention of complications, etc.(Scheme VII).

In the preoperative (preparatory) period used General developing exercises, relaxation exercises, breathing exercises. For the training of healthy limbs needed exercises with free weights (dumbbells, stuffed balls, expanders, rubber shock absorbers, etc.) and stretching exercises. In the immobilization (postoperative) period the main task is to strengthen the impact of physical exercise to prevent pneumonia, thrombophlebitis, for the stimulation of regenerative processes in injured tissue (bone), to improve local blood and lymph circulation, elimination of edema, prevention of contractures, osteoporosis, etc. To do this, use an LG with the inclusion of exercises for the uninjured limb, respiratory isometric, ideomotor and other exercises. Mandatory training support function, limb, training walking on crutches.

In postimmobilizatsionnom period (after removal of sutures, casts, machines, etc.) focused on the issue of full recovery of the injured extremity function (restoration of range of motion, the support function, muscle strength, etc.). In addition to LH include lessons in the pool (bath), at the gym in conjunction with cryomassage.

During the recovery (rehabilitation), the focus is aimed at restoring impaired functions, eliminating the effects of prolonged immobilization (atrophy, contractures, pain, trophic disorders, etc.). At this stage, aimed at developing a residential and new skills through the development of substitution of compensatory functions intact limbs, as well as using orthotics, orthopedic footwear. These tasks are mainly socio-psychological service in the department of occupational therapy.

MPT is mainly aimed at eliminating contracture (contracture), resulting from prolonged immobilization.

This General developing exercises, exercises in water, stretching, training on simulators (previously held cryomassage), traction, massage, physical therapy (phonophoresis with ointment mummy or artrosneksom, mobilatom, etc.). Should avoid pain when performing the exercises. The amplitude of movements built up gradually. It is also recommended squats with dumbbells (with knee injuries) and other items.