Recovery from a femur fracture

[subdivisions]

I had an oblique femur fracture in the upper part of my femur while skiing on Jan 21st 2008. I was operated on the next day and had an IM nail inserted in my bone along with one screw at the hip and two above the knee.
I have recovered well so far and I can walk without crutches. I have had no physiotherapy since I was hurt (except at the hospital after surgery for 3 days). My orthopedist has said that my bone is healing well but I don't need any physiotherapy. He has instead suggested biking or swimming. I do cardio in the gym for about 40 mins every other day.
I have been off crutches for over a month, however I still can't run/jog, and have pain in my leg after sitting in a chair for a long time or after waking up in the morning.
I have been unable to get my range of motion back and neither can I jog/run. I am worried that without proper help from a physiotherapist I will slow/impair the recovery process.
Any suggestions/thoughts are most welcome.
Thanks.

[Teje]

Firstly, I would say it's a bit early yet to be jogging or running. With your limited ROM you might set yourself up for compensatory damages elsewhere. As your Ortho suggested, biking and swimming are good exercises to regain musculature and get cardio in. As you regain ROM, strength and balance, start slowly on the treadmill and gradually work up to backward walking, sidestepping, and ultimately jogging.

For your ROM. A good stretching plan should include iliopsoas and piriformis stretches. Straight leg raises in all planes. Also, with a theraband or theratubing, "steamboats" -sets of extension, flexion, adduction and abduction. With a belt or towel, hamstring and calf stretches.

This is a link for a knee rehab, but knee and hip (femur) rehab are very similar, so you might find this useful.

Dr. David Lintner - Orthopedic Sports Medicine Surgeon - Houston TX

Good luck.

[alophysio]

Hi

With all due respect to the orthopaedic surgeon, they are experts at fixing bones but don't often have a holistic approach.

A good physio will check you bones, muscles, joints, nerves, motor control, compensations etc etc etc not only for your femur, hip and knee but for your pelvis, lumbar spine, thoracic spine, ankle, foot etc etc.

An assessment with a physio to see what the status of your body is and what options you have.

The cycling and swimming are good exercises but as a physio, i am interested in HOW you are cycling and swimming, not whether or not you are doing it...

Does that make sense?

For example, i had a patient who had a bad car accident - she needed me to plaster her arm, had fractured ribs, whiplash etc. I did the cast and offered help for her ribs because it was obvious she was in a lot of pain. However, she said she was advised not to let anyone touch her for 3 weeks. Good general advice but good treatment can help. So 3 weeks later she still had trouble breathing and moving without pain. I used some simple treatment techniques and some taping and all of a sudden, she took her first pain free deep breath. She remarked "why did you do that 3 weeks ago" and i replied "you wouldn't let me!".

The moral of the story is that maybe a physio can help you more than you or the surgeon thinks!

I hope that helps - sorry for rambling!

[laxmi64]

hi,
first i dont want to damage the ortho,s image,but as a physio i could not digest it.nowadays all surgeons are refering ortho cases to physio to minimize post operative complications.i think you may have following problems
1.knee muscle power weakness
2.stiffness in knee aswell as in hip
3.decrease patellar mobility.
4.gaitwith increased steps.
please visit near by physio and get assessment for your knee and hip functions.if the physio finds any changes than you start doing your exercises for a week and learn it. try to do yourself.
i think this will help you to find out the problem

[Canuck Physio]

I feel that your lack of Physio may have been detrimental to your acute recovery.

Just a few days bed rest, and the surgical period in itself has been shown to reduce muscle mass quite significantly, something that health professionals in general appear to overlook.

You will definitely benefit form physiotherapy within the confines of your new replacement.

[subdivisions]

Teje, alophysiom, laxmi64m Canuck - I appreciate your comments and the information. Very helpful. This has only confirmed my belief that there would be no downside to a checkup with a good physiotherapist. I will be making an appointment with a physio as soon as possible.
I called my doc who seemingly reluctantly gave me the names of a few physios around the area again reiterating that at my age (I'm 26) I don't really have to worry about physiotherapy! Maybe I'll also look for another orthopedist ......

[alophysio]

HI Subdivions,

I hope you go well with physio.

I can't help but wondering...why would professional sports athletes be getting physio after such an injury? Is there some benefit??

If all you needed to do was go swimming or riding, why do they do other exercises?

If it is your money, why not? it is your choice.

If it is not your money (insurance), who is the doctor looking out for - you or the insurance company?

Having said that, i think you would have an adequate recovery without physio. However, if you notice where the rest of the posts come from (commonwealth countries), we don't have a medical system like yours and we aim for BEST practice rather than acceptable practice.

I am sure i can speak for many that an insurance dictated recovery is not what we are after - good for insurance companies, ??not so good for patients?? A very left wing film is "Sicko" by Michael Moore. A bit extreme - i am sure it is not all that bad all the time and the free care systems in the UK and France are suffering i think.

Sorry to get political!

Good luck with your recovery! I am sure it will help!

[Canuck Physio]

If not a physio, perhaps a sports physio, or a personal trainer with rehab specialty

Why? Because Sarcopenia prevention is now being iterated as vitally important in prime years when we can gain more strength and subsequently muscle to prevent deterioration as we age. The fact that you have had surgery predisposes you to greater changes of diminished function.

Additionally, we don't know what you have lost along the way, were you relatively high functioning previously? Do you want to optimize your current function?

Best to do what you can to maintain strength/function

[alophysio]

Thanks Canuckphysio - do you have a reference re sarcopaenia prevention?

Thanks again

[Canuck Physio]

Yes indeed, here are a few, hopefully they will attach:

Janssen (2004) - The healthcare costs of sarcopena in the US.pdf

Deschenes (2004) - Effects of aging on muscle fibre type and size.pdf

Hasselgren & Attaix (2005) - Muscle wasting Current progress and future aims.pdf

Regards

[alophysio]

Thank you muchly.

I heard a talk by Fiatrone-Singh some years ago about something similar but can't find their research (may not be on medline). They found a number of things but interestingly, strength training (not matter the weight but must be 80% of 10RM or something like it) x5/week has an effect equal to antidepressants.

Thanks again...

[subdivisions]

Hello everyone. You all had been quite helpful in responding to my query. I appreciate that. Just to fill you in, I did start going to the physiotherapist and that has helped me quite a bit.
I am hoping to get some input on a more recent development:
I have developed severe pain a little above my knee for the past 1 week.
I got an x-ray done and everything related to the fracture/rod seems fine.

The pain is very severe when I'm climbing stairs (in fact I can't climb them - I go up one step at a time) and getting up or sitting down. While walking/standing I don't have any. It is only when my knee bends to the point of going in front of the toes that this sharp pain occurs.
I was wondering if any one has any thoughts about why this may occur. There doesn't seem to be any trigger to this. I've been dong light gym/physio work quite regularly for a couple of months.
Also, the pain seems like it is muscular/nerve related than bone related directly.
Doc says - 'take it easy it'll go away', but I'm quite concerned.

Thanks.

[alophysio]

Hi subdivisions,

Sorry to be cynical, but what has your experience so far been with doctors (that you have told us)?? "don't need physio" and you ahve physio and it helps..."it will go away" tends to be "i am hoping it will go away if you don't do anything to make it worse".

It could be many things. Perhaps it is patellofemoral pain which is common after fractures because muscular imbalances tend to occur.

Tell your physio and ask for a proper assessment and diagnosis with treatment plan.

Good luck!

[subdivisions]

The two docs that I've interacted with were both under advising AGAINST physio. Anyway, i'm certainly glad I did some physical therapy. It has definitely helped.
Though I must say that the physios that are covered with my insurance plan didn't seem to have any holistic approach to things. They never checked how my gait has changed, or how my ROM has changed etc. Basically just had a bunch of drills/stretches they had me do - and simultaneously were managing 2-3 patients. Even so, things have been better because of my visits.

Thanks for the advice regarding the pain. My physio had said that I might be developing tendinitis but he seemed unsure. I'll consult with others as well.