Primary Surgery Vol.2 – Trauma: SOME EXERCISES

SOME EXERCISES

You will need some exercises when a patient is in bed, and others later when he is able to walk.

JAW EXERCISES

Chewing

Ask the patient to chew gum or sugar cane.

CLAVICLE EXERCISES

Shoulder bracing

Encourage the patient to keep bracing his shoulders backwards; this will help to draw the fragments of his fractured clavicle out to length. Make sure he keeps his shoulder, elbow, and hand moving.

BACK EXERCISES

Arching exercises

Ask the patient to lie on his back and arch it so as to make a tunnel that you can put your hand through. This is a good exercise for a stable fracture of his thoracic or lumbar spine.

Extension from the prone position

Ask him to lie on his front. With someone holding his legs, ask him to arch his back so as to raise his shoulders from the bed without using his arms. This is a useful extension exercise later in spinal injuries.

SHOULDER EXERCISES

Arm dangling

is useful for all arm fractures, especially those of the humerus when the patient’s arm is in a sling. Ask him to stoop forwards and let his injured shoulder swing loosely in all directions. Let it swing under the influence of gravity, like a pendulum, as in Fig. 69-11. Don’t let him tighten his shoulder with his arm to his side, because this may angulate a broken humerus. More shoulder exercises are shown in Fig. 71-7.

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Figure 69.10: PENDULUM EXERCISES FOR THE SHOULDER are useful for all arm fractures, especially those of the humerus when the patient’s arm is in a sling. Kindly contributed by John Stewart. This drawing is a good likeness of him.

ELBOW EXERCISES

Flexion and extension

Ask the patient to repeat flexion and extension movements gently many times within the limits of pain. Forceful exercises are particularly undesirable in elbow injuries (72.10).

FOREARM

Pronation and supination

Ask the patient to do this repeatedly with his elbow at 90 $\ensuremath{^\circ }$ . This is the movement of turning the knob of a door.

WRIST EXERCISES

Flexion and extension

Ask him to flex and extend his wrist as freely as he can.

FINGER EXERCISES

Squeezing a ball Ask the patient to keep squeezing a rubber ball, or a ball of cotton wool, inside a tight gauze bag.

HIP EXERCISES

Abduction

Ask him to lie on his side and abduct his hip against gravity.

Flexion

When he is lying on his back in bed, ask him to raise his leg from his hip with his knee straight.

KNEE EXERCISES

Quadriceps exercises

While the patient is lying on his back, ask him to keep his leg straight and lift his knee off the bed. When he can do these exercises satisfactorily, let him do them with sand bags of increasing weight on his ankle.

Knee swinging

If his knee is stiff, ask him to let it hang over the side of his bed, and swing until it is at least 90 $\ensuremath{^\circ }$ . As the range of movement in his knee improves, he can get the last few degrees of flexion by grasping his lower leg in his arms and flexing his knee.

Cycling

is superb knee exercise.

Knee bending with his foot raised on a step

is useful in patellar fractures and is shown in Fig. 79-7.

ANKLE EXERCISES

Cycling is also one of the best ankle exercises. Make sure the patient flexes and extends his ankle as he rides.

ALL PATIENTS WITH FRACTURES NEED SOME EXERCISES, AND THEY MUST BE SUPERVISED BY SOMEONE WHO CARES