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..

252 thoughts on “Physiotherapy

  1. Hi terri!
    I just want to say that you I’ll be ok.
    On 2015 I did have a TPF
    3 plates 16 screws
    It is a slow recovery but you will overcome.
    I do walk again with a bit of a limp at the end of the day after work it is a depressing situation but be strong and before you know it you will be walking again.
    Keep your therapy routine but don’t over do it.
    I was going insane in the beginning but I did concentrate on positive things.
    I was walking back again 3 months later.
    Losing weight helps alot too.
    Just be patient and be strong!
    Good luck bud.

  2. Suffered TPF September 2020 was non wt bearing in Tee scope for 8 weeks after non union and several orthopedic visits later MRI , CT scan etc… had surgery in December with plate and 6 screws, started physical therapy soon after and I am struggling with foot pain, swelling, cold to touch and still lot of leg weakness and pain, will I ever walk without limping, just graduated from walker to a cane, everyday is a struggle no matter how hard I push myself. Frustrated and depressed

    • Hi terri!
      I just want to say that you I’ll be ok.
      On 2015 I did have a TPF
      3 plates 16 screws
      It is a slow recovery but you will overcome.
      I do walk again with a bit of a limp at the end of the day after work it is a depressing situation but be strong and before you know it you will be walking again.
      Keep your therapy routine but don’t over do it.
      I was going insane in the beginning but I did concentrate on positive things.
      I was walking back again 3 months later.
      Losing weight helps alot too.
      Just be patient and be strong!
      Good luck bud.

    • It’s frustrating, I know. But realize that while you were non-weight-bearing, you lost a lot of muscle tone, etc. It takes time to restore all that. Graduating to a cane is big progress! Give yourself credit for that. And keep on a steady track — don’t try to go too fast, or you could derail your progress by injuring yourself in some way.

      Progress comes gradually. If you look at where you were a month ago, haven’t you come a significant way? I had all the things you suffer, and 6 years later I still have the scar (and the plate and 6 screws) but no limp or pain. I can dance, I can run, I can ride a horse. It will all come to you eventually.

  3. The exercises listed above on this page of the site (scroll up from your comment) should get you off to a good start. But please don\’t prematurely try to put weight on your leg — it needs to heal for not just 6 weeks, but likely 6 more weeks after that. Please consult with your physician.

    Depending on where you are and your healthcare situation/insurance, you might be able to get a prescription for physical therapy — in my case, it kicked in after my non-weight-bearing period.

    Good luck!

  4. I wasn’t permitted to bend my leg for 7 weeks. I was in a leg brace and it was locked with zero ROM during this time. I’ve been working on ROM beginning with week 8. I’m now 17 weeks out with 105 ROM. I have scar tissue. I’m desperately wanting to regain full ROM because I’m a cyclist, walker and hiker.
    Any advice? Suggestions?

  5. This is the best read so far. I suffered TPF Schatzker 6 Sept 8th and surgery was Sept 19th. 5 weeks after I have 125degrees ROM. Recovery has been as expected but I am ahead of the game according to PT. Thanks for making this possible to read and learn about.

    • I shattered the top of my tibia plateau ( October 19 2018 ) and was told no weight bearing for 3 months. I learned to walk again. But still struggling with stairs and other things. I lost a lot of muscle. But I always feel that metal in my leg

      • Yeah, that plate. Keep at it, though — I let myself slack off and now I am paying the price. (Doesn’t help that my gym closed down and went bankrupt, too.) I think the most important thing to keep in mind is “use it or lose it!”

  6. Hi all! I suffered my tpf in June 2014. I had 6 months of physio, but I was rather stupid and as soon as I could walk again, I stopped doing my exercises. Can anyone recommend a gym class or some exercises I can do at home please? I do have a treadmill that I do regular walking on, but do feel that the outside muscle that runs down the outside of the thigh to the calf could do with building up. Thanks in advance

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