Post Fracture Stiffness Expert Therapy with Care

I. Comprehensive Assessment

The physiotherapist will:-

• Evaluate joint range of motion (active and passive).
• Assess muscle strength and endurance.
• Identify specific soft tissue restrictions and adhesions.
• Palpate for trigger points or areas of tenderness.
• Analyze movement patterns and functional limitations.
• Review imaging (X-rays) to understand the fracture’s healing status and any bone alignment issues.

Advanced Manual Therapy Techniques:

II. Manual therapy :

• Joint Mobilizations/Manipulations :
  • Purpose: To restore normal joint mechanics, improve articular cartilage nutrition, and reduce pain. These are graded oscillatory or sustained movements applied to the joint surfaces, respecting the healing fracture.
  • Techniques:
    • Grades I-IV Mobilizations: Gentle, rhythmic oscillations or sustained glides within the joint’s available range to reduce pain and improve joint play.
    • Grade V (Manipulation): A high-velocity, low-amplitude thrust (often associated with a “pop”) applied to restore joint movement. This is used cautiously and only when indicated and appropriate for the specific joint and fracture, and by highly skilled practitioners.
  • Traction: Gentle pulling apart of joint surfaces to decrease compression and improve mobility.
• Soft Tissue Mobilization (STM):
  • Purpose: To release tight muscles, fascia, and scar tissue, improve tissue extensibility, and reduce pain
  • Techniques:
    • Deep Transverse Friction Massage: Applied across the muscle fibers to break down adhesions in tendons, ligaments, and muscle bellies.
    • Myofascial Release (MFR): Sustained pressure and stretching to release restrictions in the fascia, the connective tissue surrounding muscles and organs.
    • Instrument-Assisted Soft Tissue Mobilization (IASTM): Using specialized tools (e.g., Graston, HawkGrips) to detect and treat soft tissue restrictions and scar tissue more effectively.
• Neurodynamic Mobilization:
  • Purpose: To improve the mobility of nerves that may have become compressed or adhered due to swelling or scar tissue, which can contribute to pain and stiffness.
  • Techniques: Gentle gliding movements that specifically stretch and mobilize peripheral nerves along their pathways.

III. Therapeutic Exercises:

Exercise progression is crucial, moving from passive/assisted to active, then resisted, and finally functional/sport-specific movements.

• Proprioceptive Neuromuscular Facilitation (PNF):
  • Purpose: To improve range of motion, strength, and coordination by stimulating specific reflexes.
  • Techniques: Involves diagonal movement patterns with resistance, often incorporating “hold-relax” or “contract-relax” techniques to maximize muscle lengthening and joint range.
• Dynamic Stretching and Mobility Drills:
  • Purpose: To improve active range of motion and prepare the joint for functional movements.
  • Techniques: Controlled, fluid movements through the full range of motion, rather than static holds (e.g., arm circles, leg swings).
• Progressive Resistance Training:
  • Purpose: To rebuild muscle strength and endurance, which is essential for stabilizing the joint and supporting full movement.
  • Techniques: Incorporates free weights, resistance bands, cable machines, and bodyweight exercises, gradually increasing load and complexity. Emphasis on both concentric (shortening) and eccentric (lengthening) muscle contractions.
• Functional Movement Retraining:
  • Purpose: To integrate restored mobility and strength into activities of daily living, work, or sport.
  • Techniques: Exercises that mimic real-life movements, such as reaching overhead, squatting, lunging, pushing, pulling, carrying, and specific drills for walking, running, or sport-specific movements. This often involves incorporating balance and coordination challenges.
• End-Range Loading and Sustained Stretches:
  • Purpose: To apply prolonged stretch at the end of the available range of motion to promote plastic deformation of shortened tissues.
  • Techniques: Can involve using weights, straps, or sustained therapist pressure to hold the joint at its maximum tolerable stretch for extended periods (e.g., 30-60 seconds or longer, repeated).

IV.Modalities :

• Heat Therapy: (e.g., hot packs, warm water immersion) to increase blood flow, relax muscles, and prepare tissues for stretching.
• Cold Therapy: (e.g., ice packs) to manage residual swelling and reduce pain after intense mobilization or exercise.
• Electrotherapy: (e.g., Ultrasound, TENS) to aid tissue healing, reduce pain, and sometimes stimulate muscle activity.
• Dry Needling: To release myofascial trigger points that contribute to muscle tightness and pain.