Exercise therapy for pelvic fracture: what exercises should be done?

Exercise therapy for pelvic fractures is an important part of treatment. It is necessary not only to immobilize damaged bones, but also to establish breathing, as well as maintain muscle tone. Without gymnastics, complications from various organs can occur, and the rehabilitation period after an injury is much more difficult. Therefore, therapeutic exercises begin to be carried out from the first days of therapy. Even if skeletal traction or a plaster cast is used for immobilization, the patient performs movements with his arms, upper body and healthy leg. Special exercises are also used, for example, movement of the pelvis up, which makes it possible to place the vessel and greatly facilitates the care of the patient.

How is fracture treated

The pelvis supports not only the spine, but also the entire human skeleton. With the help of these bones, the limbs are attached to the body. In addition, many internal organs are located inside the pelvic ring. Therefore, fractures of this part of the musculoskeletal system are considered serious injuries in medicine. Typically , pelvic injuries occur during car accidents, collisions with vehicles, or falling into rockfalls. Injury is accompanied by severe pain and bleeding, a shock state.

Fracture is diagnosed with x-rays. The rectum is also examined, and women are prescribed a gynecological examination. Bone fragments can damage internal organs. Then immobilization is carried out, its method depends on the type of fracture. If the bone fragments are displaced, then impose skeletal traction. In a bilateral fracture, the patient is placed in the Volkovich pose: the patient lies on a hard bed with her knees apart, special rollers are placed under the legs.

The duration of treatment takes from 1.5 to 6 months. Exercise therapy for pelvic fractures plays an important role in the process of therapy and rehabilitation. Gymnastic exercises help to avoid complications and recover faster.

When can I start therapeutic exercises

After the patient is removed from the shock state, you can begin to perform special exercises for pelvic fractures. Usually, exercise therapy is started on the second day after the patient is placed in a hospital. Gymnastics cannot accelerate the process of bone growth. But exercises help prevent congestion in the respiratory system, constipation, muscle weakness and atrophy.

The periods of the physiotherapy complex

Therapeutic exercises for pelvic fracture is divided into several periods. At each stage of therapy, physical exercises have their own tasks:

• 1 period. At an early stage of therapy, gymnastics is necessary to maintain a normal metabolism, prevent a decrease in muscle tone and quickly heal damage. Respiratory exercises, movements of the upper limbs, feet and toes are allowed.
• 2 period. At this stage, immobilization is usually already removed. Gymnastics is aimed at strengthening the muscles of the belt, limbs and trunk. Gradually begin to train joints and legs.
• 3 period. During this period of treatment, the patient learns to walk. It is important to restore support function and mobility of the joints of the lower extremities.

In more detail, each period of exercise therapy after a pelvic fracture will be considered below.

The first period of exercise therapy

This stage lasts from 10 to 14 days. Patients can do breathing exercises and active movements of the upper body and arms. The legs should remain on the rollers. Special exercises for pelvic fractures include lifting the hips (to use the vessel). At first, this movement is performed under the supervision of an instructor, but from 4-6 days of illness, the patient can do it on his own.

On the 5-7th day, the patient can bend the leg at the knee. The thigh should lie on the roller. If skeletal traction is used, the patient can make more active leg movements from a healthy side.

Exercise therapy for a pelvic fracture during this period can be combined with massage. This will help reduce swelling and prevent blood clots. Massage procedures can be started from 3-4 days, if there are no contraindications.

Before starting the exercises, the room should be well ventilated. The head should be in a slightly raised position. After 10-14 days, you can proceed to the next stage of treatment.

The second period of exercise therapy

How much do exercise therapy after a pelvic fracture in the second period? This stage of treatment lasts about 2–2.5 weeks. It is allowed to perform more complex and intense exercises. In this case, both lower limbs should be involved, and the hips do not rest on the roller. You can bend your knees, lift and hold each leg in a straightened state.

Typically, 2.5 weeks after injury, patients are allowed to roll over. From this moment, exercises for pelvic fracture can be done not only on the back, but also on the stomach.

If the patient tolerates gymnastics well and does not experience pain during exercise, then after 3–3.5 weeks he is allowed to get up and walk. After this, classes of the third period begin.

The third period of exercise therapy

At this stage, the goal of exercise therapy for a pelvic fracture is to strengthen the muscles of the lower extremities, restore walking and overcome possible lameness. Exercises are performed mainly in a standing position. It is necessary to train the strength and endurance of the muscles of the foot, lower leg, buttocks, and thighs.

It is important to establish the correct gait and prevent uneven steps. Otherwise, it may cause lameness in the future. It is useful to take high steps in one place, holding on to the back of a chair or bed. Then supporting the patient by the hands, you need to gradually teach him to walk without limping.

Exercises for the first period

All exercises are done while lying on your back and keeping your legs on the roller. Exercise therapy for pelvic fracture during this period should be performed for 20-25 minutes 4-5 times a day. The following types of exercises are shown:

1. Flexion and straightening of the fingers of the foot and hands (7-11 times).
2. Circular motion of the foot. First, the exercises are performed with a healthy foot, then the patient. Then they make movements with two limbs at the same time.
3. Toes capture small objects (balls, pencils).
4. Feet turn in and out, and also bend and unbend.
5. Bending the knees.
6. Pulling each leg to the stomach alternately.
7. Levering each lower limb to the sides and returning to the starting position. This exercise is contraindicated in trauma of the pubic joint.
8. Raise each leg upright. This exercise for a pelvic fracture should be done holding on to the edges of the bed.

When doing gymnastics after each exercise, you need to take a deep breath and exhale several times.

Exercises for the second period

During this period, you can perform exercises in the initial position on the abdomen. A pillow should be placed under the body. You can increase the load on the lower limbs. At the same time, you need to continue to do gymnastics to strengthen the shoulder girdle, arms and back. You can perform the following sample set of exercises:

1. Straight legs lift back alternately. Both limbs lift, holding on to the headboard.
2. Raise and bring straight legs (contraindicated in case of damage to the pubic joint).
3. Lift the pelvis, resting on your hands and socks.
4. Lifting legs bent at the knees.
5. Deflection of the body in the lower back, in a position on the abdomen. The same exercise can be done and standing on all fours.

With some types of pelvic fractures, the patient is carefully transferred to the position on the abdomen. This applies to damage to the symphysis. The attending physician should prescribe gymnastics, taking into account the patient's condition and the rate of healing of the injury. With good health and rapid healing of the fracture in the second period, the patient should learn to roll on his stomach himself, without using his hands. This will be a good muscle training.

To perform gymnastics for the arms and shoulder girdle, you need to lie on your back. The following movements must be done:

1. Lower your arms along the torso. Then part the upper limbs in front of you and reduce in front of the chest. Then again lower along the body. Repeat movements 4–5 times, alternating inhale (when bringing the hands together) and exhale (when lowering).
2. Arms outstretched to the sides and make circular movements, caving in the lower back. In this case, you need to use the muscles of the shoulders and forearms.
3. Leaning on your elbows and shoulders, arch your chest.
4. Bend the upper limbs at the elbows and make them circular movement forward and backward.

Exercises for the third period

What exercises should be done with a pelvic fracture in the third period? This is the movement of the legs and arms in a standing position. At the stage of recovery, it is important to establish the correct gait of the patient. Elderly patients at first perform gymnastics, holding on to the headboard. The following exercises can be recommended:

1. Hands on the belt. The patient steps in place, raising his legs high.
2. Walking on toes and on heels, with simultaneous movements of the hands (forward, backward, upward and sideways).
3. Swing legs in all directions.
4. Exercises on the gymnastic wall (climbing, push-ups).

You can do squats, but with caution. This exercise can only be performed if the patient can be on his feet for about 2 hours without feeling discomfort or pain in the area of ​​injury. If the patient suffered severe damage to the pelvic bones, then you can not squat for another 6-8 months.

Complete recovery of disability occurs approximately 1.5–3 months after the fracture.

Features of exercise therapy for acetabular injuries

In case of damage to the recess in the iliac region (acetabulum), the third period of treatment takes a long time. Patients are allowed to step on their sore legs later, and they have to use crutches longer.

If gypsum immobilization is used, then physiotherapy exercises are aimed at maintaining movement in the joint. A moderate load on the axis of the limb is needed when the patient is lying, and during the start of walking with crutches in a cast.

Pelvic fracture walking

To form the correct gait, you need to avoid dragging the leg and overloading from one limb to another. A useful exercise in the third period is walking in the water.

Walking without crutches is allowed approximately 3 months after the injury. To develop legs, you need to take daily walks. Their duration needs to be increased gradually. Restore the correct gait will also help special simulators - steppers.

The process of rehabilitation after a pelvic fracture is different. Many patients manage to fully restore motor function. With damage to the pubic joint, most people remain disabled. Often, patients suffer from periodic pain within 1–2 years after the injury. As for professional athletes, usually they no longer return to training and competition after the damage.