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Author Topic: Aggressive physical therapist Post tibia plateau fracture range of motion  (Read 9140 times)

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Offline patoregon

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Due to a bike accident, I had surgery 3.5 months ago to repair 2 tibia plateau fractures and a depression. The surgeon (not a knee specialist) kept me immobilized for 6 weeks. Now I have about 105 degrees of flexion and 0 (or better) extension.  Last week my physical therapist told me that either I should have manipulation under anesthesia, or let him bend my knee to the point of maximum pain. He did the maximum pain treatment twice, and I hope to see a knee specialist ASAP to discuss these issues. Iím not convinced I should have allowed the PT to be so aggressive, but wonder if others have found this approach successful.
On a related topic, the accident also caused nerve damage, so my foot, ankle and lower leg were numb and/or tingling for months Ė the bottom of the foot is still numb. My ankle was very stiff, but it is recovering. Now that I am cleared for full weight bearing, the physical therapist is very anxious for me to give up my walker and put full weight on the foot. Since that hurts my foot, my leg and my knee, Iím resisting. He is convinced I am just scared. I realize Iím not moving along as fast as he wants me to, but I donít actually see the harm in taking a few extra weeks.  (I have gone from 25 pounds partial weight bearing to 68, and I weigh 104, so there is progress)
I would like to hear from others who have resisted their physical therapistsí advice to push harder and have been successful, or from people who have increased range of motion significantly even after 3 or four months post-surgery. 

Offline stavebomb

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Hi there!  First off, gaining your range of motion throughout the recovery process is paramount with tibial plateau fractures.  The longer you wait to start moving your knee, the harder it will be to reach your maximum amount of recovery.  That is probably why your therapist is so eager to get your moving.

I also had a tibial plateau fracture about 1.5 years ago, and I am still working on my range of motion.  It seemed to be very good up until I had my hardware removed in April of 2012.  Everything seems fine, except for when I  need to squat down as far as I can go.  I have been trying to "sit on it" and shift all of my weight over to the affected side while in a squatting position.  I am not sure if this is doing me any good!

I am a very active young male, so I am really trying to get back to "normal" asap!

I would recommend sticking with the therapy.  It was very helpful for me, and I am now considering returning for a couple more sessions.

Offline patoregon

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I thought I'd update my report. The surgeon who operated on me advised me to wait two more months before considering manipulation under anesthesia, and not allowing the PT to continue trying to force my knee and break up the scar tissue. The PT is convinced I have to have the MUA done, but I'm going with the surgeon's opinion. We all agree I might benefit from pool therapy on my own, so I'll begin that tomorrow. I also plan to begin acupuncture on Friday to reduce pain and swelling in my foot, and maybe in my knee. Opinions on that?

By the way, thanks to stavebomb for your response. It sounds like you're in pretty good shape, which is great! Unlike you, I'm female and older (60), so my goal is just steady progress with minimal pain and ultimate range of motion that is good enough to ride a bike.

Offline maryc

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Hi Patoregon - sorry you're having issues.  I hope the acupuncture works for you.  You will love the pool therapy, just be careful around the side of the pool.  If you have pool shoes wear them, the extra traction helps.  I was lucky with my ROM, but I can't stress doing your exercises multiple times a day.  In my opinion, that made all the difference for me.
If you have access to a stationary bike, just sit and rock the pedals back and forth, slowly trying for a little more bend each day.
Sending healing rays your way

P.S. - I was 56 when I got my tpf 5 years ago.  Recovery may take awhile, but keep at it.
8/4/07 fell
8/5 diagnosed TPF
8/6 surgery plate and 6 screws
8/12 out of hospital NWM
8/21 staples removed
9/18 OS appt - WBAT with crutches
10/10 - WBAT with cane
10/27 - back to work w/cane
12/26 - no cane, slight limp when tired
1/25/08 - released from PT, no limp
2/3/09 - Released by OS

Offline patoregon

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I saw the knee surgeon today and his recommendation is for me to try 21 days on Prednisone with regular physical therapy - he didn't quite say it should be as aggressive as possible, but I got that impression. Since my knee doesn't look particularly inflamed, and the surgeon commented on how little swelling there is, I'm not sure this approach makes sense. As an alternative to surgery, though, I'm certainly willing to try. I think/hope the Prednisone will reduce the pain in my foot, too, and make walking with just a cane possible. I'll post results.

Offline patoregon

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A happy update - the Prednisone seems to be making a significant difference for me. I've got about 119 degrees range of motion after a week on it, with reasonably gentle pressure from the physical therapist and a lot of exercise on my part. The PT and I are wondering if this should be a more common alternative to MUA - it certainly is less expensive, probably less painful and safer.















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