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..
Thanks for the information. Please can you email me the guidelines of healing stages post injury (fracture or soft tissues) and weight bearing (PWB & NWB) rule of thumb.
Thanks in advance.
I have a tpf (2014, Dec) and now have problems with compressed sciatic nerve on the same leg (2016, Jan) I am still on crutches as don’t have strong thigh mucles (glutes/ hamstrings etc). The surgeon I saw re. Sciatic nerve said that if I remove the plate and screws for tpf it would be better if/when I had another accident with the leg as the plate would protect that part of the tibia but the surrounding bone would probably be badly shattered.
Ouch, doesn’t sound like a good outcome! I am a firm believer in following my doctor’s instructions — but in my case he said it was up to me, didn’t mention those bad possibilities.
Sorry to hear you are still on crutches — are you doing exercises to build up your muscles? I have not regained all my strength either, but I think if I were putting more time into exercising, it would improve. There are a lot you can do just around the house. My surgeon said I should go do leg machines at the gym — is that an option for you?
My fracture happened Sept 2013. I have experienced hip, back and leg pain from nerves. I have received chiropractic care which has helped. I tend to walk a little differently to compensate for knee pain and my leg is not straight. I ended with a valgus deformity. Chiropractic care has helped with walking and nerve pain. Riding a bike has helped my knee and improved leg strength. Biking is easier than walking. I am able to work my leg longer. A stationary bike is a great option if you are not ready for the road. Regaining leg muscles is a long process especially if you are older. Exercise is most helpful but pain can hold you back. Biking helps keep your knee moving and takes some pressure off the knee. Keep moving. That’s the real road to recovery.
Thank you so much for this site. My name is Jackson. Involved in a road accident on 28th Jan. Broke my femur right leg bone and bad fracture on tibia left leg. Fracture @Elbow and a dislocation @ shoulder. Got metal nail rod inserted in my femur bone. Started knee gradual movement just the next day,it has really helped later. Since then have quiet improved from bed ridden to wheel chair and now am gradually using crutches. Started PWB after 21/2months.Am daily practising muscle strengthening,up and down while I lie flat on bed.Haven’t moved out to try things like bike-riding,, or swimming pool. I will do that once I get used to stairs since I stay in 3rd for. My question is can I start practicing on stairs?? And for how long should I stay with the metal rod or nail inserted in my femur bone.?? will it have side affects once removed or what’s your decision. Will appreciate your response. Thank you!
My goodness, Jackson, you had some serious injuries! And now you are asking serious questions — I think your doctor might be the best person to answer. Someone who can see your x-rays and evaluate your specific condition.
Stairs are definitely a challenge — I wasn’t allowed to be weightbearing, so I went up and down on my backside for 3 months, which did curtail my excursions considerably. It didn’t matter inside my house, but that made it tough to go anywhere in the winter especially. (And last winter, 2015, we had record amounts of snow.)
Resistance exercises — with weights and rubber bands — help build up the muscles. But I would check with your doctor that your healing bones are up to the extra strain.
As for the metal rod, it may be up to you whether you keep it or have it removed. Again, I would check with your surgeon or doctor. My metal plate is close to the skin and it’s painful when it gets bumped — my doctor says it’s up to me whether I have it taken out or not. So I don’t know. My sister-in-law broke her wrist about 20 years ago and she still has the metal plate or rod in there — there has been no reason for her to have it taken out, and she didn’t want the bother of the surgery.
Hi Judith
Thank you for your reply.
Hi, I am so happy to find this site! I had tpf 12 weeks ago, and now I have 2 plates and a bunch of screws. I could start WB after 6 weeks and I started PT 3x a week right away. I can now straighten my leg completely and my ROM is 130 (started out at 85!) My good leg is 140. So that is good, I think.
My quads, however, despite working out at PT, are still SO, SO weak. It is very, very difficult going up and down stairs. Walking is slow, but I expected that. I just didn’t realize that quads atrophy so quickly and are hard to get back in shape.
My question – Will the quads EVER be like the other leg? And how long will that take? What can I do to make it go faster?
This whole thing is starting to wear on me …. Thanks for any advice you can give me!
Hi — it does take time, but it sounds as if you are doing quite well, comparatively. You are actually lucky to have started weight-bearing so soon, so your muscles had less time to lose function. Besides time, it takes patience — and lots of focus on doing the exercises outside of your PT sessions. Good luck!
Thanks, Judith! It is helpful to know that others confirm the length of time it takes. I started back to work, so exercising at home is not as easy because I am tired. I guess I need to make myself! Thanks again!
Yes, alas, sometimes you do have to make yourself do it! I work from home and yet it’s not much easier to carve out the time I should. (But I know I should.) When I broke my wrist a long time ago, I used part of my lunch break to do those exercises at the office, maybe you could develop a routine like that?
I had a TPF in august 2015 and did not get the purported “much needed” surgery, i.e. screws and plate, to correct the injury. I’ve been totally NWB in a wheelchair until about a month ago. I’m experiencing a lot of stiffness and loss of ROM. for other reasons, I’ve lost my insurance coverage now and need to try to rehabilitate this injury myself at home. does anyone have any suggestions they can give me about PT an tips or tricks to get thru this??? ANY/ALL help would be greatly appreciated.
What a long rehabilitation you have had, my sympathies! If your finances are up to it, I would invest in a session or two of physical therapy with expert practitioners. They can evaluate your situation and show you exercises you can do on your own. If you have access to a pool you can try walking around in the water (at chest height I think is best), also. (I did my first exercising after leaving the wheelchair in the PT’s pool with a treadmill and a barre.)
If you can’t afford paying for a couple of PT sessions, you can Google “tibial plateau fracture physical therapy exercises” and look through the results — I found some YouTube videos, even. Also, if you can get to a library, they may have helpful books. Check with a reference librarian if you don’t find something on your own — if your library doesn’t have what you need, maybe it’s available via inter-library loan. I wish you the best of luck!
I have been partial weight bearing since the operation (tibia plateau fracture) which my surgeon Instructed.
I have now started to weight bear but have a lot of tingling in my foot and foot is quite swollen at the end of the day.
I am 12 weeks post operation hope to start driving soon.
Any advice.
That sounds like how it went for me. I couldn’t wear all my shoes (on both feet anyway) for some weeks, while my muscles were getting back in shape. Elevation helped. As for the tingling, can you ask your doctor? It’s likely that in your operation some nerves were bumped or moved around, and you are feeling the aftermath of that and/or its healing. But it’s good to be sure.
You don’t mention physical therapy, which I and I think a lot of the people on this board (not to mention the founder!) believe is key to good recovery. Ask your doctor for a prescription for PT so that your insurance may pay for at least some of it — if that’s not a possibility, then find a reputable therapist and pay for a couple of sessions yourself. Then you can do the exercises they’ve shown you on your own. I really think it makes a big difference. If you are in greater Boston I can give you a recommendation :-).
I had a tibial plateau fracture in early dec 2015. I still cannot walk without excruciating pain in my foot and knee. I saw OS last week and he didn’t care and told me I didn’t need to see him anymore. I believe from my symptoms that I have chronic exertional compartment syndrome but can’t find a doctor to perform a NIRS test to rule out this condition 5 months in and the pain and feeling very upset at not being able to walk is wearing on me. Any suggestions?
That sounds terribly frustrating! Do you have a regular doctor who would give you a referral to another specialist? Your orthopedist doesn’t seem very helpful — but then, being surgeons, maybe they are not so focused on function. My own surgeon, whom I really like, also didn’t seem very interested in my questions about function (but not as bad as yours :-().
I think if your surgeon has cleared you to be walking, then you ought to be able to do that. I can see how it must be upsetting, both the lack of function and the pain.
Because I am a curious person, I looked up chronic exertional compartment syndrome — I also found just plain exertional compartment syndrome, see http://emedicine.medscape.com/article/307668-overview. The chronic variety is supposedly only with athletes — could your surgeon have just dismissed your complaint because he didn’t think you could have that form of the condition?
I guess all I can say is, keep trying! This sounds pretty important, definitely worth whatever effort you can put into getting help for the problem. Is there a medical school in your area, with faculty members you can communicate with? Do you have any medical people — doctors, nurses, etc. — as friends or neighbors who could give you referrals? I do wish you the best, and hope you find a solution.
My tpf happened Sep 2013. I also had pain in my knee ankle and foot when walking. It took over 18 months before I could walk with bearable pain and limping. It is a slow process. Keep moving it does get better. Pain still happens on occasion. Cold rainy weather really affects my knee and leg. Exercise is very important. Taking an anti-inflammatory before exercising may be helpful. Hang in there. Keep moving.
This Friday I’ll be 12 weeks out from tpf surgery. 1 rod and 3 screws. I was hit in the side of my left knee 1/8/16 by a dog and knocked off my feet. I started light weight barring 4 weeks ago. Been doing exercises at home. On my own been 1 crutching around apartment with/without the brace. Trying to push myself a little. My problem is I’ve been experiencing left outer/inner knee pain along with left outer ankle pain. Also the top middle of my left foot tingles like when your foot goes to sleep. We live up stairs, 17 to be exact. I have been doing them since day 1. I feel I’ve mastered the stairs as much as can be exspected at this point. On Tuesday this week was playing with my dog Roland who weighs 104lbs in our apartment. He didn’t mean to but his but hit the side of my left knee. Instant tears for 5 minutes after I caught my breath. Experienceing a bit more pain since then. I have my 12 week f/u appointment Friday. I plan on letting the doctor know. I’m glad I found this sight. It’s helped me to understand what to expect. My surgeon has been a lttle vague.
I hope your doctors have approved your weight-bearing? The new bone tissue that heals a fracture can be very delicate. Anyway, sorry to second-guess your medical team :-). I mention this only because my doctor was very clear that I could not bear any weight at all for at least 3 months, and I went up and down stairs — on my backside for that whole time. Didn’t leave the house much LOL.
About the pain — when you were off your feet entirely, your muscles and ligaments got very out of shape from disuse. It takes a long time and a lot of concerted effort to bring them back to what they were. Also, during your surgery, they probably moved things around and maybe interfered with a nerve or two in the process. That can give you the tingling, etc. I still have numbness on a lot of my lower leg, 15 months after surgery. But do mention it to your doctor, and rush to see him/her if it gets worse. (Oops, you are going to see him/her soon…)
It’s also possible that you injured ligaments as well as fracturing your TP with the initial impact. Ask your doctor if that was the case — I was worried about some inner knee pains, too, and so I asked my surgeon, and sure enough, I had ripped that ligament when I fell. It was nowhere near as serious as the TPF so he didn’t even mention it till I asked. He said those usually heal fine on their own so he didn’t even repair it. Now it doesn’t bother me at all.
Finally, my plate (with the 6 lovely screws) comes close to the surface at the outside of my knee. Just lightly bumping against something is painful — and when my puppy has bounced at me, excruciating! So I can certainly sympathize, and understand that you might be concerned. They can tell on x-rays if the plate got displaced, good thing your appointment is so soon. Best of luck and keep us informed!
Thanks Judith. My doctor cleared me for minimal weight bearing 4 weeks ago. I have little problem bendi g my knee/flexing it flate. I don’t know for sure the amount of rom I have. Maybe they’ll test me Friday.
Yeah, it takes a while to get the ligaments etc. to stretch out and do the right thing. Physical therapy helps — can you get some of that? My surgeon “prescribed” it, so my insurance covered quite a few sessions for me. They did periodic testing of ROM etc. to document my progress — it was helpful to know about, and of course the actual therapy did a lot for me. And they gave me exercises to do between sessions, so that I could make progress on my own.
I think it is really valuable to work with a professional who can tell you if your pain is OK — some of my stretching exercises really hurt at first — and what things mean, what is most important to work on, what not to worry about, etc. Even if you can’t get insurance to pay, going to a knowledgeable therapist for a couple of sessions on your own could really help you. Then you can work on your own with what they’ve shown you. Good luck tomorrow!
Interested to read preceding messages. I have 2 x TP fractures but thankfully only one needed surgery. Already have 2 x hip replacements (about a year ago) so keen to find out how long my recovery might take. Already into week 10 post surgery and on crutches with slight weight bearing on operated leg. No physio for another 4 weeks or so.
You are doing well, seems to me! And what a lot of issues you’ve had to overcome, wow. I went from my 12 weeks in a wheelchair to a walker — made the most sense for me given my house with stairs (had 2 walkers, one upstairs and one down), rugs, and pets — and started PT at that time. I found that progress was rapid in the beginning of PT (I suppose part of it was their helpful confidence building) and I went from the walker to a cane in just a month. Then a couple of months later I shed the cane. Perhaps you will experience the same? Good luck!
I am 58 and I have a tibia plateau fracture caused by a wave that depressed the plateau at the back under my knee cap. This happened 6 weeks ago. I have not weight bared yet and was advised by doctor to start this in a pool. When is the best time to start walking in a pool?
Ask your doctor! He or she can be monitoring the progress of your fracture’s healing through X-rays — if you start weight-bearing too soon, even in a pool, you could mess up the fragile new bone that is knitting your break. I went 12 weeks without bearing weight on my leg after surgery, and only then could I start PT, which included a lot of pool time to begin with.
Hello
Your information was so thorough and informative. I broke my tibia plateau in Aug 2015. First doctor didn’t perform a much needed surgery. I eventually got a very successful surgery by a Hopkins doctor in Dec 2015.
My question is this. With all my relentless exercise the knee will not fold back into the leg. It extends out from the leg. Is this common?
Thanks for any feedback you have
Colleen Altuna
I had two surgeries. First surgery was to repair the tibia with hardware. The second surgery was to remove the hardware and to do a manual manipulation on my knee. I only had 90 degrees of flexion before the 2nd surgery. I now have 140 degrees. PT was happy with the results. He didn’t think I would regain that much. You may need to discuss with your doctor if the flexion does not improve. Pay attention to your pain. That is your body telling you it needs help. Keep moving. It really is a slow process. Hang in there, Colleen.
That sounds like more than just a limited range of motion. I would definitely consult with your surgeon or someone in orthopedics.
Thanks Phyllis,need to be patient,will continue with biking and stretching.
Yeah i too have this problem and iam almost close to 2 years post type 6 tpf. I have knee pain upon long walk beyond 2 kms. In fact if i do more i tend to shift my balance on to other leg thereby creating discomfort in hip. Climbing stairs is another activity that gives me discomfort in the knee so i can’t climb more than 4 to 5
floors
Sriram
I’m not sure how to reply to your question about pain and recovery. I’m learning that it is a long road. I am able to do many things and function pretty well, but I’m still not 100 per cent. I still have some pain. I’m always aware of my knee. I believe that riding the bike has done a great deal to help keep my knee moving. Rainy, cold weather really effects my knee. Keeping it warm and moving has been most helpful. I do feel I’m still improving. Be patient. Keep moving. Give it time.
So glad to read your reply. I too have trouble with stairs. It is getting better. I am encouraged that I am not alone in this slow process. I was getting down mentally over the length of time for recovery. Keep moving. Best wishes.
Stairs are challenging,but they are getting easier.I am trying to stand on 1 leg to improve balance and strength.Seems to help to massage knee as often as possible.Next week the gym and leg press and knee extensions.
I am almost 2 1/2 years after my fracture. I am trying to walk a longer distance. I experience leg and knee pain. I believe I just need to strengthen my leg and knee a little more. I have been riding a bike for 4 to 5 miles. That doesn’t bother me, but walking can put me in a great deal of pain. Has anyone discussed this aspect of recovery?
I fractured my tibia plateau 5 months ago,this accident the result of a fall happened just 8 months after total hip replacement on that same leg.After the accident I was NWB for 6 weeks than followed by 6 weeks of PT,now doing the exercises at home.My hip is painful and my knee hurts some.I ride the bike 30 minutes a day,and do my exercises..when will the pain go away?when will I have full recovery? Pls respond.
That’s great news — do keep us informed!
You must be a good omen! I have just had a call to say my physiotherapy will start on Monday! Will make a post about how I go on.