General Goals of Physiotherapy:
- Pain management
- Preventing complications (e.g., deep vein thrombosis, pneumonia, muscle atrophy, joint stiffness)
- Restoring range of motion (ROM)
- Regaining muscle strength and endurance
- Improving balance and proprioception
- Restoring gait and functional mobility
- Facilitating return to daily activities, work, and sport.
Phases of Advanced Physiotherapy:
Phase 1: Acute/Post-Operative Phase (Hospital Stay – Days to Weeks)
Pain and Edema Management:
- Manual Therapy: Gentle soft tissue massage around the fracture site (once cleared by the surgeon) to manage swelling and pain. Lymphatic drainage techniques.
- Elevation and Compression: To reduce swelling.
- Cryotherapy: Application of ice packs (with caution around surgical sites).
- Early Mobilization (as per surgical protocol):
- Bed Mobility: Teaching safe rolling, scooting, and getting in/out of bed.
- Deep Breathing and Coughing Exercises: To prevent pulmonary complications.
- Ankle Pumps and Foot/Toe Exercises: To improve circulation and prevent DVT.
- Gentle Isometric Exercises: Activating muscles without joint movement (e.g., gluteal sets, quadriceps sets) as soon as permitted, to prevent muscle atrophy.
- Passive/Assisted Range of Motion (PROM/AAROM): Gentle movements of the hip and knee, within pain-free limits and respecting surgical precautions.
- Transfers: Teaching safe sit-to-stand transfers, often with assistive devices (walker, crutches).
- Weight-Bearing Status Education: Strict adherence to surgeon’s instructions (e.g., non-weight bearing, toe-touch weight bearing, partial weight bearing, weight bearing as tolerated).
Phase 2: Subacute/Early Rehabilitation Phase (Weeks to Months)
- Progressive Weight Bearing & Gait Training:
- Gradually progressing weight-bearing on the affected leg as bone healing allows, under the guidance of the surgeon.
- Gait Re-education: Teaching proper walking patterns with appropriate assistive devices, focusing on stride length, rhythm, and safety.
- Balance Training: Static balance exercises (standing on one leg) progressing to dynamic balance (tandem stance, reaching tasks).
Range of Motion Restoration:
- Manual Therapy:
- Joint Mobilization: Gentle, specific gliding techniques to the hip and knee joints to restore normal joint play and improve range of motion, especially if stiffness develops. This helps to release joint capsule restrictions.
- Myofascial Release (MFR): Applying sustained pressure and gentle stretching to release tightness in the fascia (connective tissue) surrounding the thigh and hip muscles (quadriceps, hamstrings, glutes, adductors). This addresses pain, improves tissue elasticity, and restores flexibility that might be restricted by scarring or muscle guarding.
- Stretching: Gentle, sustained stretches for tight muscles (e.g., hip flexors, hamstrings, quadriceps) to improve flexibility.
- Progressive Strengthening:
- Resisted Exercises: Using resistance bands, body weight, light weights, or gym equipment for all major muscle groups around the hip, thigh, and core. Examples include hip abduction/adduction, knee extension/flexion, leg presses, step-ups.
- Core Stability Exercises: To improve trunk control and support for lower limb movements.
- Neuromuscular Control Exercises: Focusing on precise muscle activation and coordination, often involving proprioceptive challenges.
- Dry Needling:
- Application: Inserting thin needles into trigger points (hyperirritable spots) or taut bands within muscles of the affected limb and surrounding areas (e.g., quadriceps, hamstrings, glutes, adductors, lower back).
- Benefits: Can help to:
- Reduce muscle spasm and guarding (common post-fracture).
- Alleviate pain.
- Improve muscle activation and reduce inhibition, allowing for more effective strengthening and range of motion gains.
- Address compensatory muscle tightness that develops due to altered movement patterns.
