Physiotherapy is the single most important thing you can do to improve your recovery. Performing the exercises as directed by your physiotherapist routinely and persisting with your exercise protocol will help your recovery be better, and less complicated, and much faster . It will also reduce chance of complications and different forms of long-term damage.
Physiotherapy after a TPF has te main objective of helping you heal. Throughout the recovery process there are many smaller objectives for the specific exercise you will be performing. The objective and thus the exercises will be changing over time. Some of the benefits and objectives of physiotherapy are improved range of movement, gaining and improving stability of the knee and the body, , prevention of adhesions, improving motor control, gaining muscle mass and more.
Physiotherapy might start as early as a few days following your surgery or injury, and sometimes even on the same day. It is very important that you start early, and are in tough with a trained physiotherapist from the very beginning. This will have a dramatic effect later on, so if your O/S has not yet discussed this with you, consider asking him about physiotherapy.
At first the exercises will probably be performed at home, later on at a physical rehabilitation center and at some point you might be referred to your local gym to continue exercising there. In some cases several of the exercises may be performed in a pool but this is not at all mandatory. While performing the exercises a good remember that the exercises can be uncomfortable and can also be lightly painful, but should not hurt a lot. If you are in serious pain from the exercises consider slowing down and doing things more gently. Also, try not to do the exercises under heavy painkiller medications (of course, during the first several weeks this is unlikely), as these might mask the fact that you are over-straining your leg. Remember – pain is your friend, helping you know when something is wrong (but unfortunately will probably also prove to be an enemy).
The main objectives of the exercises are:
knee stability – Strengthening the smaller supporting muscles around the knee will contribute to a more stable movement as the knee bends and bears weight in the future.
Range of motion – The knee will be losing ROM due to the surgery and adhesions which form thereafter. Part of the exercise routine is aimed at constantly increasing the ROM though gentle bending, going a little further every week. It is unfortunately unlikely that you will regain 100% full range of motion, but with early and constant exercise you can get a very good result, at almost full range of motion.
Motor control – Some of the exercises will focus on regaining good motor control of the knee and leg muscles. This includes gentle movement exercises as well general stability exercises at a later stage.
Gaining muscle mass – Leg muscle mass is lost in a moment and takes forever to ragain. Many of the exercises will be focused on regaining muscle mass in the main and smaller muscle of the leg.
Below is the description of the different “periods” of physiotherapy:
First Week
During the first week or so exercise will concentrate mainly around “recovering” from the effects of the surgery. This means, for example – icing and leg elevation to reduce inflammation and pain, regaining initial knee range of motion and motor control (the ability to bend your knee), and getting used to getting around on crutches. You should not be alarmed if at the very start you can hardly bend your knee at all. This is quite a standard post-surgery symptom, and will soon improve drastically. Your ROM (range-of-motion) will continue to improve for months to come. Some exercises you can be performing during this time are:
- gentle bending of the knee in the brace, as far as you can go with no pain, many repetitions at a time (tens of repetitions)
- moving you ankle in circles in both directions.
- putting a towel under the knee of a straight leg, and trying to press down on it- straightening the leg
NWB Period
During the NWB period the goal is to gain as much ROM as possible, prevent the formation of permanent adhesions, reduce muscle wastage and build leg muscle. All of this has to be done gently, without putting too much pressure on the leg, and therefore include gentle exercises. These exercises can be done solo, with the help of another person and with the help of accessories(link). Exercises should be performed every day, multiple times daily or as directed by your physiotherapist. A few exercises that can be performed at this stage are:
- Continue with moving your foot in circles by the ankle. after a few weeks pass, use a stretch band (link) as a contradicting force to make the ankle work harder, by putting the middle of the band around your foot, and holding the ends stretched with your hands. Be very gentle as this is a form of putting some weight on the leg and you don’t want to do that too early.
- lying on your back, try to bend your leg, moving the foot towards you while touching the bed, then straighten the leg and repeat.
- lying on your back, try to bring your knee to your chest (obviously you wont be able to, but as close as your can), return and repeat. use your hands to help you go a little further.
- Sit on a couch or the side of a bed, let the leg fall to the floor as much as possible, stretching the ROM. Do this gently, possibly with a pillow on the floor under the foot and/or your hands holding on to the end of your brace, and allow the leg to down so that you feel a stretch and possibly light pain but no more. Lift the leg with the help of your hands and/or stretch band and repeat.
- While performing the previous exercise, try to force the leg to “fall” more slowly by holding it with your hamstring muscles (the top part of your leg). Also, try to straighten the leg from a bent position by lifting the foot and straightening the leg (you probably won’t succeed at first, you can use your hands to help).When you are able to lift your foot without any help (approx 3 weeks), continue with these exercises:
- straighten it and hold it at a straight position for 5 seconds, let drop and repeat.
- Use a stretch band to add resistance to all previous exercises.
- Ankle alphabet – Sit on a chair with your foot dangling in the air or on a bed with your foot hanging off the edge, and draw the alphabet on the floor with your toe acting as a pencil, letter by letter (draw ‘A’, then draw ‘B’ etc..)
- Try to pick up marbles or towels off the floor by flexing your toes and grabbing the towel with your foot.
- stretch and flex your heels and toes against stretch bands and against your hands
- Patellar mobilization – Twice a day, use your hands to gently push your kneecap up and down, and left and right. It is best if this is done under the supervision of a trained physiotherapist
- Leg Stretches
- Lie on your back, bend the leg and hold the stretch band with both your hands so that the middle is above the foot. Try to straighten your leg in the air so that it resists the bend and stretches it (a bit logistically complicated)
- Hold the band stretched around the foot, try to bring your knee close to your chest and then push it back out, stretching the band.
- Hold the band stretched around the foot, flex and stretch your ankle as if standing on your toes.
- perform some exercises for the core body muscles as well if possible. These are the stomach and back muscles as well as all the muscles in those areas. This will not directly help the leg, but all of these muscles will also be weakening from inactivity and exercising them could prevent extra pains and strains.
- When possible, begin stationary bike training
More Coming soon..
Initial WB Period
This stage starts around 6-8 weeks During this period you will be putting partial weight on your leg, learning to walk again and slowly raising the amount of strain put on your leg. Generally speaking, at this point in time you will be in less danger of harming or reopening the fracture, but still need to take things slowly and carefully. Some exercises are:
- Continue all previous exercises, adding resistance and stationary bike exercises if possible
- Move from two crutches and tiptoeing to one crutch to a walking stick and eventually unaided walking within 4 -6 more weeks.
- possible.practice very slow, mindful walking, focusing on walking form.
- Use weight machines and ankle weights (link) to strengthen all the muscles of the leg. Practice both legs separately when possible, but don’t forget to train both legs and not only the injured one. Also, make sure train all muscles of the leg
- Stretch often and especially after weight training
- To gain stability and strengthen small muscles stand on a stability board (link) or bosu ball (link), at first with both legs. Try to stay stable while standing. When this is easy make it harded for yourself by bouncing a ball, leaning left and right or light squats. When this is also easy, try standing on just one leg.
- Leg press, heel raises, hamstring curls, Squats (one and two legs), lunges, knee extensions
- When you are able to walk, make sure you walk as much as possible
- Perform advanced Rom exercises such as trying to sit with your buttocks on your feet or using your hands
- A continuous passive motion machine may also be used if available in your physical rehabilitation center.
- Consider trying Aphostherapy (link) to help prevent the onset of osteoarthritis.
Moving Forward
You will need to continue strengthening the leg, improving ROM and stability and performing other exercises for a while. A full year of training and Physiotherapy to some extent is not unlikely, and it might be longer. take in to account that as time goes by Physiotherapy will start to feel more like a Gym session then rehabilitation and you will be able to combine your exercise schedule with cardiovascular training such as stationary or regular bike riding.
Some good exercises are:
- Elliptical trainer
- Weight training
- Leg press, heel raises, hamstring curls, Squats (one and two legs), lunges, knee extensions
- Treadmill walking
- walking in a pool
- continue ROM exercises
- Try to avoid impact exercise (running) as much as possible. Consult your Physiotherapist about when to start
Coming soon..
Thank you for your advice. Friends and neighbours have been great – they offer to do shopping and errands etc. I hope to be able to go out soon for a run in a friend’s car, maybe just to a cafe. I have also decided to do an on line course which starts after Christmas, so that will keep me occupied. Usually I have a positive attitude to life, so hope that will come back.
Thank you. It really does make me feel so much better listening to other people who have been through, or are going through the same thing. I hate feeling sorry for myself, but sometimes do. I try to be patient and have been reading all the recommendations on the blog re exercises etc. I haven’t got a physiotherapist yet, which is probably why I’m feeling so frustrated. It must be wonderful to have your independence back after so long. I hope you continue to get stronger.
Thank you! That has made me feel better. I’m still not weight bearing after only 10 weeks so I guess it’s a game of patience. You’re right about it making you reflect on life. I will never take my health and physical well being for granted again. I hope you continue to make a good recovery.
My experience almost totally parallels Steve’s and so I have the same recommendation. Try to be patient (I know it’s tough) and do your homework, and it will (mostly) all come back to you. When people ask me how I am doing, even though I can’t yet run and stairs are still hard, I say I have no complaints — being in a wheelchair for nearly 4 months really gives one perspective. I have my independence back, and that is a wonderful thing. Soon you will have yours, too.
If your experience with NWB is typical, you only have a few more weeks of it — then you get a whole new set of challenges (and frustrations — I was told I could bear weight but the leg simply didn’t work! My lovely PT folks did wonders). Good luck!
hi
stick with it ! it will get better but just takes time. I broke mine skiing on 29th December last year. had surgery on new years eve and spent 4 months unable to weight bare at all. Ive had weekly physio until today and only now is it feeling more like my on leg again. it just takes time. I still have problems with stairs and cannot run but that will all come in time. It made me reflect a lot on whats important in life. hope it goes well for you
Hi there. Was knocked down by a car on 16th October 2015 and had leg brace removed 8 days ago. Am now awaiting physio. Can move leg 90 degrees but slowly. Doing exercises often and leg definitely getting stronger. Haven’t left house for over none weeks. Getting very tearful and bit depressed waiting for my physio to start. Any advice?
You have probably heard this from others, but patience is the key ingredient. You are making progress already and you will make lots more; try to focus on progress you’re making toward your goals. Can you arrange to leave the house? If you have cabin fever maybe getting out would help. I had to go up and down my front steps on my rear, and then have someone help me into the wheelchair, but it was necessary to get to my surgical checkups. And when I got back home, it sure felt like an outing :-).
I work from home so I had enough to occupy me, but I had an idea in reserve, if I had needed it — I was going to learn origami. Is there something you’ve kind of wanted to do but didn’t have time for previously? Now could be the opportunity.
I would also recommend getting people to come around to see you — my friends and neighbors were happy to help in small ways, and it was nice just to have the visitors. No one will expect an immaculate dwelling or even refreshments — they’ll want to bring them to you. Good luck!
Just remember it could have been worse! As Job’s comforter there is always worse so count your blessing and save your tears and remember that you will not be beaten by this little upset to your plans. Physio and determination will get you on your feet again. I did all of that so have the T-shirt – the pain, the plates the screws etc.; anniversary date 30th Nov 2014! Perhaps I will make a pilgrimage to Santiago when my leg is stronger.
I had my accident on 11/6/15. I have pins and plates and am getting stitches out on Tuesday. I suppose I will start some sort of PT after that. How do you keep your spirit up? I’ve been crying everyday – not because of any pain, but because I feel so helpless. I know patience is the key. Thanks for anyone’s response.
I know, it is awful to feel so helpless and dependent on others. When you get the stitches out, will you be able to be weight-bearing? Even though it is very hard at first — when I got off NWB status after 14 weeks, I still did not relinquish my wheelchair for another week or so, because using the leg was so difficult — it will feel gradually like more and more progress, and that does wonders for one’s attitude. Don’t beat yourself up — being in pain, with reduced function, and not being able to do things for yourself are good reasons to cry! Are there sedentary exercises you could start doing, so that your muscle tone will be more ready for normal activity? Any sort of program you can put yourself on, so that you can feel that you are doing something and making progress, will help your head. At least, it did mine. Best wishes and keep us informed!
I know is frustrating.specially when u are an active person. This injury definitely sucks. Im in the 5th. Week after surgery.
Sleeping is very uncomfortable. but i can bent my leg to 90 very slow.
The glass of your life (or mine too) is always half full: 1) The leg was not so serious as to be amputated; 2) All the other things from here to 100 that make you better off for not having/ being should make you feel more positive about your situation that will improve with time. Cheer up and make it better by thinking it so. Is there not more to you and your life?
I’m also tearful and frustrated in equal measures. Am doing my exercises and waiting for physiotherapy. Can’t wait for the day I can walk properly again! I try to keep my mind occupied with reading etc but difficult to concentrate sometimes.
I am 5 weeks post op, I had comminuted fracture on my left tibia and fibula almost near my ankle area, had 2 plates and 20 screws total. Still NWB, my doctor ordered/ advised ROM, no PT yet.My fracture is healing very, very slowly, I started taking Vit D, Calcium and Antioxidant after my surgery. Need any advise to hasten bone healing pls. By the way I am a healthy, active 46 year old female.
Did your actually doctor prohibit PT? I ask because when I went to the rehab center for 20 days after my surgery, they did PT and OT with me every day. I was NWB but they still wanted me to exercise my muscles — both legs and my arms, too. I think exercise — not strenuous but mild or moderate — might help with blood flow, and that could help with your healing. Of course with a healing incision and a plate and screws, my options for exercising that leg were limited, but I remember doing leg lifts up and to the side. I’m sure that helped retain a little bit of fitness. As I recall, I didn’t get the actual prescription for PT till I went off NWB status, but I suggest you check with your doctor about what you might be able to do. Good luck!
Thank you both for your suggestions and knowledge. Presently I have not been able to access a PT but this week I hope to start on the journey of recovery. I have been doing the exercises you both suggested and my ROM is improving already.
Many thanks.
Polly, I am so pleased to hear that! Best wishes for continued improvements.
I am glad I found this website. I am in to week 13 and now doing pt outside of my home. Also was given the ok to drive. This has been very difficult and very expensive! I am a very active 60 plus woman, ride a horse, and in the midst of getting a graduate degree in mental health counseling. Will I ever be able to resume a normal life again? I know this takes time but I am worried. My pt therapist tells me that I will get back 90 to 95% of original mobility. I thought it would be a lot easier as my fracture was a tibia plateau stage 1. However, the break was a little funky and healed a bit flat. I didn’t have surgery as the docs felt that this kind of injury may require a knee transplant down the road. In 3 weeks it will be 4 months! Trying to keep a stiff upper lip and pushing myself to walk as much as I can. Any input would be much appreciated. My break was 7/2/2015.
I think you are doing very well! I was told the recovery period is 6 months to a year (or more) — in my case I think it will definitely be at least a year. Even so, at my last checkup my surgeon said that I was doing better than some people at this point. I had my injury on Dec. 30 and 4 months later I was barely out of the wheelchair. (But I was so thrilled after spending the winter incapacitated.) I can ride my horse now, though getting on and off is still an issue, and I can walk pretty much anywhere. My knee is still quite stiff and painful when starting to move, but it is gradually getting better. My PT is running out but I hope to start jogging on an underwater treadmill and heading back to the gym soon. I hope your PT has given you exercises to do on your own? As the essay at the top of this section says, doing those is the most important thing. Persevere and you will get there. Just do it, as they say! Good luck.
Hello Seabiscute,
Thank you so much for your encouragement – yes I believe it will be about a year for those of us to fully recover..but we will recover. So great you are back riding! My pt has not given me exercises to do on my own – he says just walk. However, I am doing leg lifts with 1lb weights – 60 reps each and pt at the hospital 3x a week. I take it you had surgery – what kind?
Noel
Noel, thanks for asking. I had rather a lot to repair — besides breaking a couple of chunks off the top of my tibia (at the platform) and displacing them, I fractured the tibia vertically. So they went in and fixed it all with a stainless steel plate and six screws, topped off with 38 staples. I was in a brace and not allowed to be weight-bearing for at least three months. Recovery was fortunately uneventful — the incision was a total non-issue.
Right now I am trying to strengthen the structures that brace the knee on the side (not sure how to describe it) so that it bends straight when weight is put on it, and I can go up and down stairs like a normal person. My PT makes me do a variety of difficult and/or painful side- and back-stepping exercises — if it’s that bad, it must be working, right 🙂 ?!
I meant plateau, not platform, sorry!
Hi Seabiscute,
Holy Moley, you had some fracture. It is amazing you got back on your horse so soon. With that kind of determination you will be as good as ever. Tomorrow, I am riding my Rocky Mountain for the first time, so we will see how the leg holds up. I was not given any PT exercises and have been doing my own routine at home. Today, I went to the gym and did the circuit and light weights. I let my leg tell me what to do. My fracture was a funky stage 1. It healed very nicely, however it pancaked in a bit which has made my leg shorter. The doctors felt that I would need a knee replacement and to put some pins in now would compromise the surgery later on. I had minimal displacement. My fear is, will this be a game changer? I have a really good surgeon here and I do hope that when I have the surgery it will not be too bad of a recovery. How did you break your leg? and Where do you get your optimism from? Noel
Noel, thank you for your comment! My injury was one of those extremely stupid unlikely accidents — I was at my mother’s house, running around the corner in the very crowded guestroom, to catch my brother before he left for the post office. I caught my left foot in the angled-out support for the sofabed — kind of a pipe thing — and fell. My foot stayed caught and the force of my momentum was taken up by my left leg. If I hadn’t been running I could have possibly just stopped and corrected my step. My optimism may come from my treatment team — my terrific surgeon and the wonderful physical therapists I have been seeing. It was so incredibly devastating that I may not have taken it all in to start with, and then the winter here was so dreadful it minimalized other things by comparison. I did think every now and then that I was taking it all very well LOL. Good luck with your ride!
I shattered my knee BAD and broke my leg…love to all of you going through this!you are in my thoughts!xoxo!
It’s been one full week for me to be full weght bearing, ok to walk. However, aftr I walk, the area around my ankle & top of my foot of my injured leg starts to hurt, often some minor swelling on the top of my foot & ankle area. I put ice on it, massage it, but it is still sore & stiff and sometimes afyr a nght’s rest still stiff & sore. Is this typical as I return to walking? Also what are some good exercises for this? I have no health ins. (Im lucky I could afford the surgery & dr. said my recovery was a “miracle) so PT is not a consideration. Im in more pain now FWB; returning to walking, than I was NWB days. Any suggestions would be much appreciaed.
F. Venable, I think what you are experiencing is reasonable and to be expected. Don’t know how long you were NWB but remember that your muscles and ligaments, etc. all lost strength and ability during the time they were not working. So, now it is a big strain on your tissues to get back into service — swelling is one result and stiffness the next day is another. (You didn’t mention elevation, but that is probably as important as ice — get the swollen part higher than your heart. This was a good excuse for me to lounge on the sofa with my foot on the back of it and watch TV for a while!)
You can do ankle-circles (forgotten the PT name for these) and write the alphabet with your pointed toes. Those exercises loosen up the ankle and get circulation going and I think they also build up your strength there. The other exercises described in the Initial Weight Bearing and Moving Forward sections above are also good. Your leg is a system and you have to strengthen all the parts for it to work right again.
You note that you have no health insurance. There is no state program where you are for people who can’t afford insurance or whose employers don’t offer it? That is too bad (we really need single-payer healthcare in this country). But I suggest that if you can spring for just one session with a reputable physical therapist, you can get evaluated and come away with recommendations for exercises specifically chosen for your particular needs (say, your quadriceps is weak compared to your adductors, or vice versa) so that you build back capability in a harmonious way.
Also, this being summer in the Northern Hemisphere, is there a pool you can go to? Walking — and other exercising, such as leg lifts — in a pool is a great way to ease into weight bearing activity. The resistance of the water helps but the biggest benefit is the lesser gravity: your body doesn’t have to hold itself up as much while you reaccustom your muscles, etc. to their jobs. Start with just five minutes then build up to more. You should be in waist-deep or chest-deep water. This is easiest in a pool with a treadmill but i think it’s feasible in a regular pool as well. (You may need to figure out when the traffic is lowest, to allow you room to walk back and forth.) Note that when you leave the pool you will feel very heavy again!
Im 6 week post op, still NWB, on crutches, my dr. said no to using stretch bands, ok to do range of motion exercises only w/o putting any weight on my injured right leg. Ive found yoga-stretching exercises you can do on the floor to be most beneficial – do these first & at the end of your exercise session. I dont have a stationary bike or pool, so I do leg lifts while on my back & sides and bending the leg while laying on my stomach was v.hard at first, but became a little easier as I continued. I do the exercises in the morning and at night, but I stretch as much as I can throughout the day. I can bend my knee all the way in, tho it can be stiff if I dont stretch or deeply massage the muscles all around the injury. At least 3 x’s a day I rub my injured leg v.deeply w lavendar essential oil mixed w a little olive oil. This has helped w the pain, swelling and healed my incision wounds quickly. Plus deep tissue & muscle massage helps keep the stiffness down. Everyday I am focused on my bad leg and trying to get better – my dr has not been one w advice, suggestions etc. Ive researched a lot online on my own.
Thank you for your comments Frances. I a at 4 weeks post op and can only bend my knee to 45 degrees. It just seems to stop at that everytime I try. It’s good to know you researched and tried doing the exercises without a physiotherapist. I too have had no extra care and feel like I need to be doing more to break through this barrier of 45 degrees. You mentioned the yoga stretches, which ones would you recommend? Also laying on your front and bending the leg, how did you research this? Using olive oil and lavender to help heal is very appealing.
I notice it has been some months since you posted on here, how are you recovering?
Polly stretching both my legs helped a lot & I still continue the stretches. While I was NWB, I would lay on the floor w my legs outstretchd in front & bend over slowly trying to touch my toes, hold for 30 sec. Do not bounce. Do this w toes pointed & flexed. Do same w your legs spread to sides too. I rubbed my TPF knee minimum 3 x’s a day w lavender oil mixd w some olive oil – I cut my nails real short so I could give my knee area deep tissue massages.
It is hard at first but persevere! In addition to the stretching that Frances mentioned, I would suggest another exercise my PT gave me: “heel slides” — sitting in bed (or on the floor) with your leg out straight, slide your heel toward you so that your knee bends, as far as you can make it go. The object would be to touch your buttocks with it, though obviously with a 45 degree ROM you won’t be able to do that yet. These were pretty painful to begin with. You can get a bigger flexion by putting something on your foot to pull it toward you (I used a long belt of my son’s). There are a lot of exercises that will help with this — do you have access to PT? Though my knee is still very stiff after a period of inactivity, I got full range of motion back. I am still working on strengthening, but at 10 months post-injury, I really feel almost normal.
I’m wondering if anyone has a recommendation for a physical therapy outfit in the Brookline-Brighton-Allston area of Massachusetts? I was just cleared by my surgeon for WB and they handed me a four-page list of places in the state — would help to have someone’s experience, if possible! thanks.
If anyone is interested, I ended up going with Boston Sports Medicine, at their Allston location (right across from Regina’s Pizzeria and next to the railroad tracks — love it when trains go by). I am very pleased with the therapists (Michelle and Michelle, if you go) and their treatment of me. The facility has two therapy pools with treadmills in addition to the usual equipment. I strongly recommend them!
I found this very helpful. Wish I had read it a lot earlier (broke my TP in early Dec 2014). Patience is key. I was never a patient person, but I’ve had to learn to be!
I think it is not always productive to compare your timeline to others as we all go at our own speed but Physio and exercises are part of my day’s programme including the CPM, while on the machine I am learning another language, it makes it more interesting!