Physiotherapy is the single most important thing you can do to improve your recovery. Performing the exercises as directed by your physiotherapist routinely and persisting with your exercise protocol will help your recovery be better, and less complicated, and much faster . It will also reduce chance of complications and different forms of long-term damage.
Physiotherapy after a TPF has te main objective of helping you heal. Throughout the recovery process there are many smaller objectives for the specific exercise you will be performing. The objective and thus the exercises will be changing over time. Some of the benefits and objectives of physiotherapy are improved range of movement, gaining and improving stability of the knee and the body, , prevention of adhesions, improving motor control, gaining muscle mass and more.
Physiotherapy might start as early as a few days following your surgery or injury, and sometimes even on the same day. It is very important that you start early, and are in tough with a trained physiotherapist from the very beginning. This will have a dramatic effect later on, so if your O/S has not yet discussed this with you, consider asking him about physiotherapy.
At first the exercises will probably be performed at home, later on at a physical rehabilitation center and at some point you might be referred to your local gym to continue exercising there. In some cases several of the exercises may be performed in a pool but this is not at all mandatory. While performing the exercises a good remember that the exercises can be uncomfortable and can also be lightly painful, but should not hurt a lot. If you are in serious pain from the exercises consider slowing down and doing things more gently. Also, try not to do the exercises under heavy painkiller medications (of course, during the first several weeks this is unlikely), as these might mask the fact that you are over-straining your leg. Remember – pain is your friend, helping you know when something is wrong (but unfortunately will probably also prove to be an enemy).
The main objectives of the exercises are:
knee stability – Strengthening the smaller supporting muscles around the knee will contribute to a more stable movement as the knee bends and bears weight in the future.
Range of motion – The knee will be losing ROM due to the surgery and adhesions which form thereafter. Part of the exercise routine is aimed at constantly increasing the ROM though gentle bending, going a little further every week. It is unfortunately unlikely that you will regain 100% full range of motion, but with early and constant exercise you can get a very good result, at almost full range of motion.
Motor control – Some of the exercises will focus on regaining good motor control of the knee and leg muscles. This includes gentle movement exercises as well general stability exercises at a later stage.
Gaining muscle mass – Leg muscle mass is lost in a moment and takes forever to ragain. Many of the exercises will be focused on regaining muscle mass in the main and smaller muscle of the leg.
Below is the description of the different “periods” of physiotherapy:
First Week
During the first week or so exercise will concentrate mainly around “recovering” from the effects of the surgery. This means, for example – icing and leg elevation to reduce inflammation and pain, regaining initial knee range of motion and motor control (the ability to bend your knee), and getting used to getting around on crutches. You should not be alarmed if at the very start you can hardly bend your knee at all. This is quite a standard post-surgery symptom, and will soon improve drastically. Your ROM (range-of-motion) will continue to improve for months to come. Some exercises you can be performing during this time are:
- gentle bending of the knee in the brace, as far as you can go with no pain, many repetitions at a time (tens of repetitions)
- moving you ankle in circles in both directions.
- putting a towel under the knee of a straight leg, and trying to press down on it- straightening the leg
NWB Period
During the NWB period the goal is to gain as much ROM as possible, prevent the formation of permanent adhesions, reduce muscle wastage and build leg muscle. All of this has to be done gently, without putting too much pressure on the leg, and therefore include gentle exercises. These exercises can be done solo, with the help of another person and with the help of accessories(link). Exercises should be performed every day, multiple times daily or as directed by your physiotherapist. A few exercises that can be performed at this stage are:
- Continue with moving your foot in circles by the ankle. after a few weeks pass, use a stretch band (link) as a contradicting force to make the ankle work harder, by putting the middle of the band around your foot, and holding the ends stretched with your hands. Be very gentle as this is a form of putting some weight on the leg and you don’t want to do that too early.
- lying on your back, try to bend your leg, moving the foot towards you while touching the bed, then straighten the leg and repeat.
- lying on your back, try to bring your knee to your chest (obviously you wont be able to, but as close as your can), return and repeat. use your hands to help you go a little further.
- Sit on a couch or the side of a bed, let the leg fall to the floor as much as possible, stretching the ROM. Do this gently, possibly with a pillow on the floor under the foot and/or your hands holding on to the end of your brace, and allow the leg to down so that you feel a stretch and possibly light pain but no more. Lift the leg with the help of your hands and/or stretch band and repeat.
- While performing the previous exercise, try to force the leg to “fall” more slowly by holding it with your hamstring muscles (the top part of your leg). Also, try to straighten the leg from a bent position by lifting the foot and straightening the leg (you probably won’t succeed at first, you can use your hands to help).When you are able to lift your foot without any help (approx 3 weeks), continue with these exercises:
- straighten it and hold it at a straight position for 5 seconds, let drop and repeat.
- Use a stretch band to add resistance to all previous exercises.
- Ankle alphabet – Sit on a chair with your foot dangling in the air or on a bed with your foot hanging off the edge, and draw the alphabet on the floor with your toe acting as a pencil, letter by letter (draw ‘A’, then draw ‘B’ etc..)
- Try to pick up marbles or towels off the floor by flexing your toes and grabbing the towel with your foot.
- stretch and flex your heels and toes against stretch bands and against your hands
- Patellar mobilization – Twice a day, use your hands to gently push your kneecap up and down, and left and right. It is best if this is done under the supervision of a trained physiotherapist
- Leg Stretches
- Lie on your back, bend the leg and hold the stretch band with both your hands so that the middle is above the foot. Try to straighten your leg in the air so that it resists the bend and stretches it (a bit logistically complicated)
- Hold the band stretched around the foot, try to bring your knee close to your chest and then push it back out, stretching the band.
- Hold the band stretched around the foot, flex and stretch your ankle as if standing on your toes.
- perform some exercises for the core body muscles as well if possible. These are the stomach and back muscles as well as all the muscles in those areas. This will not directly help the leg, but all of these muscles will also be weakening from inactivity and exercising them could prevent extra pains and strains.
- When possible, begin stationary bike training
More Coming soon..
Initial WB Period
This stage starts around 6-8 weeks During this period you will be putting partial weight on your leg, learning to walk again and slowly raising the amount of strain put on your leg. Generally speaking, at this point in time you will be in less danger of harming or reopening the fracture, but still need to take things slowly and carefully. Some exercises are:
- Continue all previous exercises, adding resistance and stationary bike exercises if possible
- Move from two crutches and tiptoeing to one crutch to a walking stick and eventually unaided walking within 4 -6 more weeks.
- possible.practice very slow, mindful walking, focusing on walking form.
- Use weight machines and ankle weights (link) to strengthen all the muscles of the leg. Practice both legs separately when possible, but don’t forget to train both legs and not only the injured one. Also, make sure train all muscles of the leg
- Stretch often and especially after weight training
- To gain stability and strengthen small muscles stand on a stability board (link) or bosu ball (link), at first with both legs. Try to stay stable while standing. When this is easy make it harded for yourself by bouncing a ball, leaning left and right or light squats. When this is also easy, try standing on just one leg.
- Leg press, heel raises, hamstring curls, Squats (one and two legs), lunges, knee extensions
- When you are able to walk, make sure you walk as much as possible
- Perform advanced Rom exercises such as trying to sit with your buttocks on your feet or using your hands
- A continuous passive motion machine may also be used if available in your physical rehabilitation center.
- Consider trying Aphostherapy (link) to help prevent the onset of osteoarthritis.
Moving Forward
You will need to continue strengthening the leg, improving ROM and stability and performing other exercises for a while. A full year of training and Physiotherapy to some extent is not unlikely, and it might be longer. take in to account that as time goes by Physiotherapy will start to feel more like a Gym session then rehabilitation and you will be able to combine your exercise schedule with cardiovascular training such as stationary or regular bike riding.
Some good exercises are:
- Elliptical trainer
- Weight training
- Leg press, heel raises, hamstring curls, Squats (one and two legs), lunges, knee extensions
- Treadmill walking
- walking in a pool
- continue ROM exercises
- Try to avoid impact exercise (running) as much as possible. Consult your Physiotherapist about when to start
Coming soon..
Feel sorry for all who got injured. I got injured while playing in Beach. My leg was 6 inches deep into the sand and I was not noticing it. Facing sideways when I was picking sea shell a huge tide, really huge tide kind of a mini tsunami hit me and I heard the cracking sound of my tibia. There you go got multiple fractures. .Had a plate and 7 screws. Now I am in 14 th week with 90% ROM and walking with out Any crutches but still limping.
Can someone advice on when can we climb steps with the broken leg first. And when will the limping go away.
Can I cycle?
sriram your limping is due to a lack of extension. I had the same problem until I started focusing more on extention (straightening the leg) rather than flexion (bending). You must get that leg back to 0 degrees, most likely you will never get it to hyper extend but 0 degrees is good enough to get you back to normal.
A few huge tips to help you is to put your leg on a chair across you and let gravity do the work. If you want to push it a little more then place 2-5 lb weights right below and above the knee that will help straighten the leg big time. Do small weights for extended period of time (10-15 minute stretches) and do it sever times a day (2-4 times). You will see a huge improvement over 1-2 weeks.
I made my own extensionator device to help straighten and in 2 weeks I have gotten all the way down to 3 degrees from 0. Get a board long enough to sit on and have your leg on. Buy a tie down strap from Home Depot and a manual blood pressure cuff. I wrap the tie strap around the board and my leg. Place your ankle on a towel to raise your leg 4″ or so. The blood pressure cuff should be right above the knee and the strap on top of it. Tighten as much as you can tolerate then begin to pump up the cuff and it will begin to push your leg down. Do as much as you can tolerate at least 3x a day for 10 minutes each. This will make you improve really fast.
Hope this helps.
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Hi there,
I’m a bit oldie in this trip. I’m still have problems with my knee, clicks and noise from inside, some are painful, I’m in a phase of developing osteoarthritis, an implication that is expected, as my OS told me. Anyway, I ‘m using some supplements as hyaluronic acid and/or glucosamine to stop as much as possible this, even it is expected.
About your PT. I had had a very careful physiotherapist, who was emphasising in whole leg exercises, including thigh and shin, all muscle of leg. She insisted too, not to push my back with exercises. It is a common complication to push your back much with exercise, so having future problems with it. She was prefering smooth movements, not pushing too much and to rest frequently after an exercise. She was reminding me that this injury need its rest, for instance, if your leg is trembling because of effort it is a sign that the muscles have been tired and rest.
Have a good recovery! And, last but not least, patience! One day each time, not the far future, time passes fast, to get recovered.
Hi everyone! Am in my first week of FWB and have my list of physio exercises that I need to do…(knee bends, leg stretches & pushing back of knee into a towel). although I’m fully weight bearing, I still have to use the crutches for stability as my quad muscle is still quite weak. Just wondered how long I have to expect to be on the crutches for until the thigh muscle can hold me up! Frustrating as been given all clear to drive again, but still limited to what I can do as have to use the crutches….
Hi all , suffered a tibial and fibia fracture in a slow motor cycle accident on 12 sep 14. that truck guy just kicked me. Had a quick surgery with 3 nails. and now in post op. Swelling and head pain is there. But feeling more relieved . ROM is good . knee movement is still not full. But hoping it will become functional . doc says will recover speedily. Hoping so.. Take care guys..
This site is great as I find the doctors don’t like to offer alot of information. I am 30 and had a lateral tibial plateau fracture from watching 11/12 year old boys playing rugby league! They flew over the sideline in a tackle and took my leg with them. Bear in mind one of the boys is 90+ kgs! Waited 6 days for surgery and suffered the most excruciating muscle spasms until 3 days after surgery. I have a large plate, 9 screws and a chunk of synthetic bone. 8 weeks on and have been partial weight bearing for 2 weeks now and physio. ROM is not going as I imagined, extension 15degrees, flexion a mere 75 degrees. Physio thinks that this is great considering severity of m injury, but I can’t help but worry that I should be able to bend more? Anyone been in a similar situation?
Gosh, reading all your comments it looks like the 17th and 18th of May weren’t very nice to us!
My motorcycle crash was May 13.
After your comment I looked at injury dates.
HAHAHA…you are right; May was not a good month for us, but a goldmine for ortho docs and PT clinics!
Hi Jasmine.
It is easy to get frustrated and worried about progress or the lack thereof. Please remember that we all have suffered some really traumatic injuries to our legs, and any movement we get back in the first few weeks/months will be good.
I can recall when starting PT the therapist explained this to me, and that there will be days that it seems lack there is no progress and will never be any progress…just the nature of recovering slowly from a serious injury.
Hang in there!
I wish I’d found this site earlier. I too fell off a horse on Easter Sunday. Now fully weight bearing with improving, but not great ROM. Walked 1/2 mile and now ankle too sore to bear weight, so back to 2 crutches!! So a word of warning; listen to your body and stop when it first starts to hurt. My motion must have affected how I used my foot and ankle, so back to the drawing board.
I’m 7weeks post-op with TPF, 4 screws and 1 plate put in. I’m still non-weight bearing for another 3 weeks. At my 6 week check-in my surgeon was unhappy with the amount of flexion I had. I’m at about 40%, he wants me to be at 90%. My Physio does not begin until next Friday, at which point I’m almost 8 weeks by then. In the meantime I’m trying to bend as much as I can on my own, but seeing only slight improvement (maybe about 60% now). My surgeon recommended coming in next week if I was not at 90% by then, for Manipulation Under Anesthesia. I’m wondering if anyone has any suggestions whether or not I should wait and do Physio first, or go ahead with the MUA? I’ve read that waiting too long does more harm than good. Any thoughts??? I’m 44 and was fairly active before this injury (shattered my knee when I tripped on uneven sidewalk power walking May 17th 2014). I’ve found the information here invaluable, and reading of others experiences very helpful. Hang in there everyone! 🙂
hi so sorry to hear how your injury occurred,and how r u now, u r at u r 12+ weeks, hope u r rom is good, i think u r in WB positions, mine was caused by low impact motorcycle accident, u know how it happened? One monkey suddenly came on to the road, i’m at 30 ml/h speed and skidded, mine is type-1 fracture, happened on jun 15th, surgery done on 16th, one Plate with 6 screws, i have finished 4 weeks and 3 days, now i’m in NWB, i’m at my 30, unmarried planning to get marry this Oct, but my bad luck, we should be dare enough to handle this situation, one thing our OS told to me, “there is a magic with the human bones, they can heal and form bone as fast as possible, so don’t worry about u r bone fracture, but due to the immobilization in NWB period the other parts like mussels, etc get week and non functional so do exercise more and be patient, it needs more time to recovery, but it will”
Shattered my tpf in a horse riding accident 4/17/14. Type V with displacement and compression. 2 plates, 12 screws. I’m 11 weeks post op and today got the go ahead to begin pwb. It feels pretty good, but is swollen a little bit tonight. I was prepared for that. I am so eager to just be able to walk!! I’ve got 3 kids, including an 11 month old baby who might beat me to walking :(.
I would love some details on what to expect in this transition to walking. (At this point I don’t care about all my other activities and will never again take for granted being able to carry objects, esp my babe.) How much discomfort is progress vs harm? Is it better to push it then pull back or slow and steady? Is a cane totally necessary? Any tips are hugely appreciated!
I have been going to pt since the beginning and my rom is pretty good. I guess now that I am pwb the intensity will pick up. I’m so ready. I’m so sorry that this injury has happened to all of you. It is a tough one!
Hi Hilary
Sorry to hear of your injury and especially with young family. My TF happened 30 June and just on PWB, ROM 90degree and next appointment 30 September. It’s a slow process and don’t over do the excercise it might put you back. The cane is necessary to keep balance until the leg muscle are strong. Good Luck Sarla
I injured my right leg when I was playing football on 18th of May. I put high pressure on my straightened leg as I was turning my running direction to chase the other player. My doctor told me that I had non-displaced tibial plateau fracture, and it heals without surgical intervention and no need of casting too. After a week, the swelling was away and I can able to do most of the exercises during NWB Period. During the Initial WB Period, 6 week of my injury, I have started to walk with two crutches and slowly raising the amount of strain put on my injured leg. As I progress to train, however; I start to feel inflamation/burning pain (just similar to 1-2 weeks of my injury) around the patella tendon (and some times to the right and left of patella tendon) area. Now I have pain and not progressing as I expected. Could anyone advice me on it?
Kim
Broke my Tibial Plateau May 17th power walking, and caught uneven sidewalk then SPLAT!!! Spent a week in the hospital and have a plate and 4 screws now. I’m 5 weeks post-op still NWB with next check-up scheduled for July 7th. I stumbled upon this website and am blown away by how comprehensive it is. The accounts from others is somewhat scary but encouraging. Settling in for a loooong recovery!
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Broke my tibial plateau about 10 days ago.got jumped by two men forced to the ground and they jumped on my knee.i got a plate and four screws put in .this was the most painful injury I have ever had. Specialist has told me my break is really bad in the way it has broken. Its all going to be down hill from now on and I will need a knee replacement in about 3 years.not much conferdince I no.not feeling the best mentally. Iam 34 and have a 10 yr old son to raise
Starting to do some excises but finding it very difficult. This is going to be a long road to recovery
Anthony, I am very sorry about your injury. I just found this site today, and I am wondering if you explored the forum. I found it helpful to see what others are experiencing and suggesting.God bless you in your struggles.
So sorry to hear how your injury occurred, mine was caused by low impact motorcycle accident 14weeks ago. I am 56 years old and also told I may require a new knee due to the amount of damage sustained. I know your frustration as all you get told is how bad it is and how long it will be before recovery. I have a type 4 fracture and had surgery to rebuild it will two grafts and a plate. I am now mobile with no brace and have just returned from two weeks holiday in Portugal( I live in the uk). I walk without aides, but suffer swelling and discomfort when I have been on my feet too long. Don’t despair as you will start to recover, the emotional damage is as bad as the physical so look after that as well. Wishing you a good recovery and this site is a great informer but each of us are different so yours will not be like the next mans recover or woman’s as in my case.
i do know what you are going through. this summer I have not been able to take my kids everywhere I wanted to but We have spent a lot of time at the beach and they have love me being at home more. So keep your head up. My injury happened in April two week later beach side! I have pushed myself a little and I started riding my bike last week. just keep trying. You will get there. by the way I found a walker with a seat is awsome. My husbane works out of town and my kids are 4 and 8 one boy and one girl.
Anthony, i’m sorry about your injury, and especially the way it happened! You are about a month ahead of me in recovery and I wondered how things are coming along for you. My injury is very similar to yours…comminuted fracture, rod and five screws. I’m a little older, at 58 but have been very active til now. The hardest for me is the mental aspects–losing independence and needing help and being restricted. I am not finding much info on how things generally go both before and after weight bearing, and how far should one push the exercises. Do you have any advice for me on those things? I seem to have good range of motion with only a little pain, but I cramp up at night and can’t sleep. Don’t know whether I should push more, or less!
Wishing for you the best recovery possible! -Susan
Hi Anthony, so sorry to hear how your injury occurred, mine was caused by low impact motorcycle accident, u know how it happened? One monkey suddenly came on to the road, i’m at 30 ml/h speed and skidded, mine is type-1 fracture, happened on jun 15th, surgery done on 16th, one Plate with 6 screws, i have finished 4 weeks and 3 days, now i’m in NWB, i’m at my 30, unmarried planning to get marry this Oct, but my bad luck, we should be dare enough to handle this situation, one thing our OS told to me, “there is a magic with the human bones, they can heal and form bone as fast as possible, so don’t worry about u r bone fracture, but due to the immobilization in NWB period the other parts like mussels, etc get week and non functional so do exercise more and be patient, it needs more time to recovery, but it will”
Suffered my TPF as a result of a dog running into my knee October 23rd 2013. Now 7 months into the rehab and feel somewhat lost as to whether I’m on/behind or in front of expected targets for recovery. I realise that everyone’s recovery is very different but would love to know what should be expected at what interval and have never had anyone articulate that to me despite asking.
I now have a ROM that is only 1 degree out on extension but I’m at 140 degrees (heel to bum) so at least 12 degrees off the other leg. Its still incredibly skinny and I’m terribly self conscious in pants as the other leg looks like a body builders leg by comparison!
I’ve recently started hydrotherapy and was offered a therma band to provide some variety in the rehab exercises and they aremaking big improvements mentally and physically – especially the hydro as I finally feel like I get a workout and achieve something.
Does anyone know where I can source or have you been given a resource on milestone/recovery points? I feel I really need this to inspire me through the drudgery that the physio becomes. Sticking with it even on the bad days as I am determined to be fitter/better than I was pre injury.
I shattered my TP on 1/27/13 at 49 in slow speed motorcycle wipeout also. Had compartement syndrome, it was a Grade VI and have 20 screws and 4 plates. Recovery has been very difficult but I have been quite dilegent with my therapy. I can straighten my leg completely but it will not hyperextend that 5 extra degrees like my good leg which is ok. I can’t quite bend it all the way either – about 2 inches from my heal to my butt. I feel a pressure in my shin and have numbness in my shin between my scars all the way down to my big toe. Getting my quad definition back is hard. It feels strong but it doesn’t look strong. I’m gonna keep working at it. Takes a lot of conscience effort to not favor the good leg. My goal it to get the ROM back and touch my arse with my heel.
12/28/13 TPF and torn meniscus in right leg, 54 year male, injured in a slow speed motorcycle accident. Rode the stationary bike for 5 minutes today and was an emotional experience. I have ridden bicycles for all my life and to spin once again, Right On. Tomorrow I go to PT and start to transfer a little bit of weight to my leg, thus exiting from NWB 7 week period. I have been pretty close to what is described on this site and have referred to it daily for inspiration. Thank you and all the people who have contributed. You have kept me sane in the midst of going stir crazy.