After a rupture of the cruciate ligament, immobilisation of the knee in order not to impede the wound healing of the acute phase is the first important measure. The doctor then determines the further course of treatment. Once the movement is released, the patient can start with careful mobilization exercises.
1. exercise At the beginning a careful mobilization in supine position should be done. With the help of the therapist, the heel is pulled over the pad in a dragging motion towards the buttocks. The movement limitation of the doctor should be followed and practiced with the patient.
If the patient is able to do the exercise muscularly alone, the exercise can be done at home. 2nd Exercise Besides the flexion, the extension is extremely important to train. The final extension of the knee joint is necessary for a physiological gait pattern.
Even if the patient is dependent on supports, he should try to unroll the foot completely and stretch the knee joint in the process. To practice this extension, the patient pushes the back of the knee through the hollow of the knee so that there is no gap between the knee and the support. This exercise should also be done at home.
More information can be found in the article Gait Training. 3rd exercise In the further course of wound healing other exercises can be added. In the sitting position the patient places his foot on a towel on the floor and pulls it back as far as it is allowed.
(Alternative: ball) In addition, cycling in the supine position can be included. 4th exercise For stretching, the 3rd exercise for stretching is supplemented by lifting the leg. Exercises in the water and cycling on an ergometer are additional ways to improve mobility.
As the exercise progresses, it becomes clear to what extent mobility has been restored. If movement is still restricted after a rupture of the cruciate ligament, manual therapy can help. In this case, the therapist pushes the tibia in prone position with the knee joint bent towards the buttocks.
For the stretching, the therapist pushes the femur condyles in the supine position with the lower leg underneath towards the support or alternatively in the prone position the tibia also towards the support. If the movement is finally possible again after a cruciate ligament rupture, stretching exercises are performed to make the affected muscles more supple. The affected muscles are mainly the ischiocrucial muscles (posterior thigh) and the anterior muscles, the quadriceps femoris and the iliopsoas.
However, the adductors, abductors and calf muscles should not be forgotten. 1st exercise To stretch the ischiocrucial muscles, the patient lies on his back, stretches his leg and tries to pull it as far as possible towards the upper body. Alternatively, the patient can stand and place the leg on an elevation and tilt the upper body towards the leg or touch the floor with the hands while standing.
2nd Exercise As a stretch for the quadriceps femoris muscle, the patient stands on one leg and tries to pull the foot towards the buttocks. 3rd Exercise For the Iliopsoas muscle (hip flexor) the patient lies on the floor, pulls one leg towards the upper body and stretches the other leg completely through and also tries to press the back of the knee to the floor. 4th exercise To stretch the adductors, the patient stands in a lateral step position and tries to shift the weight to one side.
The leg, which is thereby stretched, is stretched. Alternatively, the patient can place the leg on an elevation at the side and reach to the floor with his hands. 5th Exercise The calf muscles can be stretched by bending the torso forward with stretched legs or in a lunge step by keeping one heel on the floor and shifting the weight to the front leg.
For further exercises, please refer to the article Stretching exercises or cruciate ligament rupture AftercareWhen a cruciate ligament rupture occurs, it is crucial to strengthen the entire surrounding musculature so that the knee becomes stable. It is especially important during conservative treatment, because the muscles have to take over the task of the cruciate ligaments. Involved are: M. Quadriceps femoris, ischiocrucial muscles, M. Sartorius, M. tensor fascie latae, adductors, calf muscles M. Quadriceps femoris As in general strength training, all exercises must be performed properly, i.e. never push the knees out over the tips of the feet, push the buttocks backwards, keep the upper body straight, abdomen and back tension is maintained.Ischiocrucial Musculature Exercises on the machines in the gym Adductors Abductors (M. Sartorius, M. Tensor, Fascia latea) For the muscles of the adductors and abductors, the exercises of the ischios and M. quadriceps are just as good, but can be intensified even more by the above-mentioned exercises.
Calf Musculature Further exercises can be found on the pages
- Supine position or seat: push through the hollow of the knee of the stretched leg so that the M. Quadriceps is tensed (raise stretched leg in pushed through position)
- Knee bend (variations: stay in the bent position or just the wall seats, or the lateral knee bend)
- Failure steps
- See above knee bend and lunge
- Bridging (supine position, feet with the heels in place, lift pelvis) Variation: alternately lift legs; push pelvis up and down; write numbers with stretched leg
- Prone position or 4-footed stand, stretch leg bent or stretched upwards
- Leg press
- Leg Extensions
- Bridging with a ball between the knees and actively squeeze
- Side position; place the upper leg to the front and press it into the floor
- Bridging (see above) with Theraband around the knees ? Pressure to the outside
- Side position; lift leg up (several Wdh and passes)
- Wide knee bend
- Calf press (toe stand) one-legged or on both sides
- Physiotherapy after cruciate ligament rupture
- Exercises for knee arthrosis
For the coordination exercises it is important to get confirmation from the doctor that full capacity has been reached. Coordination training for a rupture of the cruciate ligament is essential.
The training is more specific than strength training via proprioception, and the stabilizing muscles are controlled more specifically. The exercises should be built up from simple to more difficult and should be carried out depending on the patient’s ability to cope with stress. Exercises: 1- Legstand practice (important: keep knees slightly bent): Running on an Airex mat, trampoline, wobble board: 1-legstand practice: Increase the exercises after a few weeks: Jumps on the mat or one-leg stand
- Move with the other leg in all directions (8th letter)
- Therapist gives resistance to pelvis, knee or foot
- Throw the ball so that the concentration is no longer on the knee
- Normal walking to get used to the underground
- From walking stop on command and hold position
- Faster walking (increase with also stop out of motion)
- Increase see above
- Pendulum movements with the other leg
- Lunges on the uneven surface
- Knee bends on the uneven ground
- Jumps from right to left while keeping the leg axis
- Jump on one leg on uneven ground
- Sprinting on a large mat with sudden stops
Due to the injury, a reactive tensing of the muscles can occur.
This tension remains for a longer period of time and should be released to restore the flexibility of the movement. For this purpose, a massage can be performed by a therapist who will release the trigger points and detonate the muscles. A massage can also be difficult to perform, because it is not possible to relax completely.
One possibility is to loosen the affected areas with a trigger stick, cupping glass or fascial roller. More information can be found in the article connective tissue massage and trigger point therapy. If stability and resilience have been restored after a cruciate ligament rupture, jogging can be started carefully.
As soon as pain occurs, however, the load should be reduced again. Pain can occur due to a short-term overload, which can be reduced by cold and a break after a training session. It is important to wear proper footwear to avoid false statics while running.
A running analysis by an expert is recommended for this purpose. If the pain remains longer and gets worse, you should stop running for the time being. This is followed by increased coordination training to further improve stability and to get closer to running step by step.With supporting taping around the knee, the patient can be given the feeling that it is stable again.
This is often enough, since the patient may have a pain memory and therefore react more sensitively to changes around the knee. Cycling can be started at an earlier stage. However, it should be started with a low wattage and riding should be used as mobilisation.
If pain occurs, this is probably due to the lack of movement in the knee joint and can be reduced by reducing the radius. If the pain does not improve, driving should be avoided, as it may have been too early. In the further course of wound healing, however, it can be restarted, as it is a gentle way of training the muscles and improving mobility in the knee joint.
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