Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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Rehabilitation Tips
Rehabilitation in orthopedic traumatology is the bridge between surgical stabilization and the return to everyday life. The fracture may be fixed, but the muscles are weak, the joints are stiff, and the proprioception (balance) is disrupted. Successful recovery requires active participation from the patient and a coordinated effort with physical therapists.
The rehabilitation protocol is strictly dictated by the stability of the fracture fixation. Traumatologists prescribe specific weight bearing and range of motion limits to protect the healing bone while preventing the complications of immobility.
- Progressive loading of the skeletal system
- Restoration of joint mobility and muscle strength
- Neuromuscular re-education and balance training
- Management of scar tissue and edema
Weight Bearing Status Explained
Understanding weight bearing restrictions is critical. “Non Weight Bearing” (NWB) means the foot never touches the floor. “Touch Down Weight Bearing” (TDWB) allows the foot to rest on the floor for balance only, like stepping on an eggshell without breaking it.
“Partial Weight Bearing” (PWB) allows a percentage of body weight, often 50 percent. “Weight Bearing As Tolerated” (WBAT) allows the patient to put as much weight as is comfortable. Adhering to these limits protects the hardware before the bone is fully strong.
- Strict adherence to the surgeon’s protocol
- NWB prevents hardware failure
- Graduated progression to full weight
- Use of assistive devices (crutches/walker)
Early Range of Motion
Stiffness is the enemy of trauma recovery. Fracture callus can glue moving parts together. Early range of motion exercises are often started within days of surgery, even if the patient cannot put weight on the limb.
Passive motion (therapist moving the joint) keeps the joint lubricated and prevents adhesions. Active motion (patient moving the joint) pumps fluid out of the limb and stimulates muscle firing.
- Prevention of joint contractures
- Passive vs. Active Assisted motion
- Continuous Passive Motion (CPM) machines
- Importance of moving adjacent joints
Edema (Swelling) Control
Swelling inhibits muscle function and causes pain. After trauma, the limb acts like a sponge. Gravity is the most effective tool for managing this. Elevating the limb “toes above the nose” allows fluid to drain back to the heart.
Compression stockings and retrograde massage also help. Controlling swelling is essential because a swollen knee shuts down the quadriceps muscle, delaying the ability to walk.
- Elevation above heart level
- Use of compression garments
- Lymphatic drainage techniques
- Critical for restoring muscle function
Muscle Activation and Atrophy Prevention
Muscles begin to atrophy (waste away) within days of injury. Fighting this requires isometric exercises—contracting the muscle without moving the joint. “Quad sets” and gluteal squeezes can be done in bed.
Electrical stimulation (NMES) can be used by therapists to wake up dormant muscles. Maintaining muscle tone around the fracture supports the bone and accelerates the transition to walking.
- Isometric contractions during immobilization
- Prevention of sarcopenia (muscle loss)
- Neuromuscular electrical stimulation
- Focus on core and proximal stability.
Gait Training
Learning to walk again requires retraining the brain. Trauma patients often develop a limp or “antalgic gait” to avoid pain. Physical therapists correct these mechanics to prevent secondary issues like back pain.
Gait training progresses from parallel bars to a walker, then crutches, and finally a cane. The goal is a symmetric, rhythmic stride. Rushing off assistive devices before the muscles are ready leads to poor habits.
- Normalization of walking mechanics
- Proper use of assistive devices
- Correction of compensatory limp
- Stair climbing and uneven terrain training
Proprioception and Balance
Trauma damages the microscopic sensors in ligaments that tell the brain where the limb is in space. This loss of proprioception increases the risk of falls and re-injury.
Balance training involves standing on one leg, using wobble boards, or walking on foam surfaces. This trains the nervous system to react quickly to instability, providing dynamic protection for the healed fracture.
- Retraining position sense receptors
- Balance exercises on unstable surfaces
- Prevention of falls and re-injury
- Dynamic stability drills
Scar Tissue Management
Surgical incisions and traumatic wounds leave scars. If the scar binds to the underlying tendon or bone, it restricts motion. Once the wound is fully healed, scar massage helps mobilize the tissue.
Silicone sheets and Vitamin E oils can improve the pliability of the scar. Desensitization techniques (rubbing with different textures) help reduce the hypersensitivity often found around trauma scars.
- Mobilization of adhesions
- Desensitization of hypersensitive nerves
- Use of silicone and hydration
- Prevention of skin contractures
Nutrition for Bone Healing
Bone healing is metabolically expensive. Patients require increased caloric intake, specifically protein, to build the collagen framework of the new bone. Calcium and Vitamin D are the bricks and mortar that harden that framework.
Supplements are often recommended, but a diet rich in dairy, leafy greens, and lean protein is the foundation. Hydration is also vital for tissue elasticity and the transport of nutrients to the fracture gap.
- High protein diet for collagen synthesis
- Calcium and Vitamin D optimization
- Hydration to support metabolic transport
- Avoidance of inflammatory foods
Smoking Cessation Support
Nicotine is a vasoconstrictor; it clamps down the tiny blood vessels that deliver oxygen to the healing bone. Smoking increases the risk of nonunion by 3 to 4 times.
Rehabilitation includes support for quitting. Even using nicotine patches is less harmful than smoking, but total cessation is the goal. The fracture is a “teachable moment” where patients are motivated to quit to save their limb.
- Absolute contraindication for bone healing
- Vasoconstriction limits oxygen delivery.
- Significantly increases nonunion risk.
- Counseling and support resources
Managing Post-Traumatic PTSD
Trauma is not just physical; it is psychological. Many patients have PTSD, anxiety, or depression following a significant accident. Fear of movement (kinesiophobia) can halt rehabilitation progress.
Acknowledging the mental toll is part of recovery. Therapists use graded exposure to help patients trust their bodies again. Referral to counseling is standard for patients struggling with the emotional aftermath of the event.
- Recognition of psychological impact
- Addressing kinesiophobia (fear of movement)
- Referral for counseling and support
- Building confidence through milestones
Return to Driving
Driving requires reaction time and the ability to perform an emergency stop. Patients cannot drive while on narcotics or while wearing a cast on the right leg.
The timeline for returning to driving depends on the fracture location. For right leg fractures, it is typically 6 to 9 weeks until brake reaction time returns to normal. Patients should test their ability in a parking lot before entering traffic.
- Assessment of brake reaction time
- Restriction while on opioids
- Modification for right vs. left leg injuries
- Safety first clearance protocols
Joint Stiffness vs. Hardware Block
If a joint refuses to bend despite therapy, the surgeon must differentiate between soft tissue stiffness and a hardware block. Sometimes, a screw is too long or a plate impinges on the joint motion.
Dynamic X rays or CT scans can diagnose this. If hardware is blocking motion, removal is indicated. If it is scar tissue, a “manipulation under anesthesia” may be performed to break the adhesions.
- Differentiation of mechanical block vs. scarring
- Diagnostic imaging for hardware position
- Surgical removal of impingement
- Manipulation under anesthesia options
Return to Sport and Work
Returning to high impact activities requires the bone to be fully remodeled, which takes months longer than initial healing. The radiologist and surgeon look for “cortical bridging” on 3 or 4 sides of the bone.
Work conditioning programs mimic the physical demands of the patient’s job (lifting, climbing) to ensure they are safe to return. It is a graded reintegration rather than an abrupt restart.
- Requirement for complete cortical remodeling
- Work hardening and conditioning programs
- Sport specific functional testing
- Graded return to activity
Cold Therapy vs. Heat
In the acute phase, ice is the best analgesic. It numbs the area and reduces the inflammatory inflow. However, for stiffness in the later stages of rehab, heat is often better.
Heat increases blood flow and makes collagen tissues more extensible, allowing for a better stretch. Alternating contrast baths (hot/cold) can help pump swelling out of the distal extremities, like the hand or foot.
- Ice for acute pain and inflammation
- Heat for stiffness and pre stretch warm up.
- Contrast baths for vascular pumping
- Avoidance of heat on swollen, hot joints
Long-Term Hardware Maintenance
While most hardware stays in, patients should monitor the area. If they develop new pain over a plate years later, it could indicate loosening or a late infection.
Patients should inform security personnel at airports, though cards are rarely needed. Protecting the skin over prominent hardware (like the ankle or elbow) from rubbing prevents skin breakdown and infection.
- Monitoring for late pain or swelling
- Skin protection over subcutaneous plates
- Awareness of airport security interactions
- Reporting of any new drainage immediately
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FREQUENTLY ASKED QUESTIONS
Why does my therapy hurt?
Rehabilitation involves stretching tight tissues and waking up weak muscles. This causes “good pain” or soreness. However, sharp, stabbing pain is a warning sign. Communicate with your therapist to distinguish between the discomfort of progress and the pain of injury.
Can I take ibuprofen for the pain?
Some studies suggest NSAIDs (like ibuprofen) might slow down bone healing in the very early stages. Many surgeons prefer that you use acetaminophen (Tylenol) for the first few weeks. Ask your specific surgeon for their protocol regarding anti inflammatories.
How do I know if I have a blood clot?
Signs of a DVT (clot) in the leg include new, throbbing pain in the calf, redness, increased swelling that doesn’t go down with elevation, and warmth. If you have sudden shortness of breath or chest pain, go to the ER immediately, as the clot may have moved to the lungs.
When can I sleep on my side?
If you have a pelvic or hip fracture, you may need to sleep on your back with a pillow between your legs to prevent the leg from crossing the midline (adduction), which stresses the repair. Your surgeon will clear you for side sleeping once the hip stability is confirmed, usually after 6 weeks.
Why is my foot purple when I stand up?
This is called “dependent rubor.” When you lower your leg, gravity pulls blood down. Because your muscles aren’t pumping efficiently and the nerves are recovering, the blood pools, turning the foot purple/red. It is normal and resolves when you elevate the leg again. It improves as you heal and walk more.
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