Leg exercises post fracture

[kimberleyone]

Hi all
I experienced a spiral fracture of Tib and Fib in Jul 07. Was manipulated under anaesthetic and had a long leg plaster and no weight bearing for 12 weeks. After this, I had a below knee cast, but as this was progressing to a non union, i experienced some external rotation from the knee. The consultant eventually agreed to insert plate and 10 screws with bone graft from iliac crest in December 07. Stayed in below knee cast for 2 weeks, when this was removed it was discovered that i had two large blistred areas on the shin. Thes are slowly healing now, although still scabby. I hope to begin some weight bearing next week when i go to see the consultant Ortho, but although i have regained most of my calf muscle, my thigh is still showing a 30% loss of muscle bulk. I also have pain in my ankle, my knee clicks and grates and I am unable to lie flat either on my front or back due to pain in hip when I try to do so. I am asssuming that these pains are due to non use of leg and will gradually go when i start walking again. I am doing straight leg raises several times during the day, however this doesnt seem to be making much difference. Can anyone out there suggest any other exercises that i can do to encourage my thigh muscles?
Also when i do stand with both feet on the floor, i feel that the injured leg is longer than the good one, I hope this is temporary due to my posture, but would be grateful for any reassurance
Thanks all

[Judith Mollet]

Insist on outpatient physio as soon as possible. You need a good assessment by a physio even if you aren't weightbearing by next week. It's not just thighs to consider. All your lower limb muscles are to be considered and if you have these pains all joints from pelvis downwards. Plus back posture as you've been walking NWB for ages. There are masses of exercises out there that could be good, supervision from a physio with advice and suggestions for what you do yourself between sessions are neccesary. If NHS waiting list is too long go private. Good luck!

[physio.smith]

Definitley insist on physio or seek some privately. There are lots of exercises / stretches that you can be doing.

Good Luck

[Canuck Physio]

Originally Posted by kimberleyone

Hi all
I experienced a spiral fracture of Tib and Fib in Jul 07.
Right leg or Left leg?
Was manipulated under anaesthetic and had a long leg plaster and no weight bearing for 12 weeks. After this, I had a below knee cast, but as this was progressing to a non union, i experienced some external rotation from the knee.
Do you mean that below the knee your lower leg is externally rotated?
The consultant eventually agreed to insert plate and 10 screws with bone graft from iliac crest in December 07. Stayed in below knee cast for 2 weeks, when this was removed it was discovered that i had two large blistred areas on the shin. Thes are slowly healing now, although still scabby. I hope to begin some weight bearing next week when i go to see the consultant Ortho, but although i have regained most of my calf muscle, my thigh is still showing a 30% loss of muscle bulk.
This is a significant loss of MM mass that will be a priority to resolve

I also have pain in my ankle, my knee clicks and grates and I am unable to lie flat either on my front or back due to pain in hip when I try to do so. I am asssuming that these pains are due to non use of leg and will gradually go when i start walking again.
Your body has gone through a lot of muscular, bone, and soft tissue changes, active rehabilitation is the only solution in my mind
I am doing straight leg raises several times during the day, however this doesnt seem to be making much difference.
The body will adapt to any exercise that it does. One study found that when study participants performed the same workout session 6 weeks apart the body responded with a decrease in Muscle protein synthesis, and decreased antioxidant quenching, as well as decreased markers of growth and repair. What this indicates is that the neuromuscular system is smart, it adapts to whatever stress is applied to it and uses the minimum amount of 'body system resources' to perform the same act. --> From this study some people, especially gym goers have come to believe that you need to 'hit' a muscle from multiple angles, switch up exercises every workout, but the fact remains this simply is not true. All that needs to be done is the key principle to inducing a physiological response in the body, and that is to 'Progress'. This can be done in a variety of ways.
Can anyone out there suggest any other exercises that i can do to encourage my thigh muscles?
Ideally, A physiotherapist who can monitor how you perform your exercise, the range of motion of exercise, the activation and recruitment of key or target mm fibres, the involved resistance, and the pain free and specific movement can be monitored and progressed to allow you to recover fully. Additionally if you are still walking the chances are you have significant muscular imbalance, and your hamstrings are probably coming into play a lot to maintain proprioceptive balance around the knee joint. It would be vitally important to improve Thigh mm proprioception, and examine the knee joint for swelling secondary to muscular imbalance and mm atrophy. This is something we simply can not do on this forum, and is a significant factor that may contraindicate any exercise that may give you.
Also when i do stand with both feet on the floor, i feel that the injured leg is longer than the good one, I hope this is temporary due to my posture, but would be grateful for any reassurance
I believe as stated above that you are simply experiencing mm imbalance and proprioceptive deficit
Thanks all

Problem List:
1. 30% loss of MM in thigh
2. External rotation of lower limb (below knee)
3. 2 blistered areas on the shin/s?
4. Pain in ankle
5. Experiencing 'clicking' & 'grating' within knee
6. Pain in hip when lying supine (on back), or prone (on front
7. ? mm imbalance
8. ? proprioceptive deficit
9. ? joint malformation

Hopefully others can add to this, and perhaps examine the above to be able to provide you some useful information!

[block]

Hi

Id start bridging and side lying abduction exercises for your glutes - if you can weight bear (my internet settings are terrible so I can read most of your post) id start slow single leg step ups on or may be wall slides (1/4range) but with feet close (6 nches) away from the wall not 3 feet away like most people

[Judith Mollet]

Without having the leg in front of me and with the information we have at the moment: "I also have pain in my ankle, my knee clicks and grates and I am unable to lie flat either on my front or back due to pain in hip ......" I would have reservations about advising single leg 1/4 step ups. The muscle imbalance stuff is likely to have to start from near zero and work gradually up to avoid producing exacerbation of pain problems.

[kimberleyone]

Hi
Thanks to all of the above for their advice. I have seen my Ortho consultant, who has advised me that there is now enough bone development to allow a little weight bearing on my right leg. I am allowed to bear 25% of my body weight on my right leg, which has been a little difficult to estimate, however I feel quite good about this. I have also had a formal physio assessment this morning and I have been given exercises tro increase ROM at ankle and knee at present. I will have more added into the programme next weeek, if these are succesfull. I have aches in my ankle and my lower leg due to weight bearing, but it feels so good to be walking again after 7 months, I can put up with it!
Thanks again for advice

[physio.smith]

Quick way to work out 25% of your body weight is (if you can safely) get on a set of scales.....weigh yourself!

If you weigh 10 stone then 2 1/2 stone is 25% for example. You can then use the scales to weight bear that amount...you will eventually get a feel for what this feels like...rechech every now and again so you don't over do it.

Good luck