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..
Good website with good advices. Greetings from Spain
I incurred a tibial plateau fracture on 18 November, had surgery the following day with the insertion of a plate, 6 pins and artificial grafts. I spent 5 nights in hospital and did my hospital physio exercises once I returned home. The turning point was when I had my first private physio session 10 days after the break. He gave me exercises to do, told me to hire some callipers and from that point I was able to get around with touch weight on affected leg. 12 days after my break the surgeon gave me the okay to fully weight bear on my broken leg and now 1 day short of 3 weeks since break I can walk with no crutches for decent periods of time or otherwise just use one crutch. Physio has advised further exercises including walking in our pool and doing several minutes on exercise bike. I’m a reasonably fit 56 year old but am amazed and pleasantly surprised at the progress. I consider myself very fortunate. I had no idea what to expect having never broken anything before.
Wow, you are amazingly fortunate. I too have 6 screws and a plate but they wouldn’t let me bear any weight at all for three months — that is what the surgeon predicted at the beginning, and that’s what the x-rays showed. I’m still working on getting it all back, nearly two years later (of course, it would help if I were more compulsive about my exercises :-)).
LOL I couldn’t imagine how calipers would help you, other than to measure your knee’s range of motion angle, but Google has informed me that “callipers” is also a term for leg braces.
the crutches are called forearm crutches
Louise, think I have a similar injury on Oct. 29 (Type II) and surgery Oct. 30 (plate and 5 screws). What I thought I heard in the hospital before surgery was 8 -10 weeks to fully weight bearing with surgery.
Now at 6 weeks I’m being told non weight bearing until 12 weeks and the x-ray doesn’t matter…
Have full range of motion and all the strength exercises given by home PT are fine. Rode a stationary bike the first time today. Frustrated… Going to office PT in the next day or two and considering pool therapy too.
I found this very helpful. Learning more each day about my recent injury, operation, pt and recovery time.
hi Karen,I am 62,last year fell into an old unused well,fell into a 9ft hole, just had total hip replacement on both hips,they are fine but did have a tibia plateau fracture was told it was a 3,and they operate on 5 and above,so no surgery.After a month of NWB,I had 2months PT,I continue to stretch,now am back to exercise,and all activities,You are correct PATIENCE is key,Take Care MEG
Thanks, progressing slowly, which is fine. See my surgeon on Nov. 17. Hopefully will start weight bearing.
I had an accident on my bike just over two weeks ago (driver pulled out without, I went into it and over the bonnet). I am not NWB for eight weeks. Nobody has said anything about bending my knee and my next appt. at the hospital is in two weeks. Should I be trying to bend my knee unassisted now? I didn’t have an operation. I’m a relatively healthy 31-year-old. Any tips for speeding up recovery are welcome!
I didn’t have surgery for my stage 3. How long until I can PWB?
I suffered a left tibial plateau fracture and also fractured my left fibula two places. I fell all the way off my dining room table while trying to change a light bulb. Yes, that’s only about three feet! I’m about to turn 54. Driving (in a moon boot – automatic car) at 4 weeks. No, my orthopaedic Doctor didn’t really approve of this… Back to work partial hours – 4 hour shifts – in 7 weeks. My “support person” is my 86 yr old father who is terminally ill with prostate & bladder cancer. Needs must that I just suck it up and get on with life. The first week WAS very bad though… I DO recommend being much more careful pf gravity, the older you get.
Janice, hats off to you dear lady. I so understand having to do what you gotta do, but please don’t overdo more than you HAVE to. You are the only “you” you have so take the very best care of yourself you can
Hi all
I had my tibial fracture on 4th June and surgery on the next day with a plate and 3 screws. I’ve been NWB since then and my ROM is at 100° but that’s due to open wound healing that has slowed down my PT.
Now Ive been toe touching for 2weeks and thinking about slowly increasing the weight as its still 2weeks for FWB.
I want you guys to guide me about the physiotherapy and exercises as I don’t have a physiotherapist in my locality.
I would be keen to learn about how to progress to FWB and normal unaided walking
Thank you
At a couple of years short of your age and with 2 TP fractures I sympathise with you and when told it would be 12 weeks NWB or only partial I was sure I would be up and walking long before that….but I did as I was told and now 6 months down the track after swimming pool exercises and physio I am free of wheelchair, crutches and back in high heels. Still have a plate and 3 pins which I can feel but nothing major. Surgeon said when a knee replacement is required these would come out! My aim is to manage without one. 🙂
Maureen, I also sustained a tibial plateau fracture after my shepherd mix ran full speed into the side of my leg!! She’s only 6 months old but very big (60 lbs) and strong. My injury was May 25 and surgery June 3rd. Same deal, bone graft, plate and 7 screws. I’ve been NWB doing the exercises given to me by my PT along with 6 hours a day on a CPM machine. I have a follow up visit with my surgeon on July 18. I hope to hear I can start some type of PWB therapy. I need to get back on my feet. I am the caregiver for my mother and my sister has had to take a leave of absence from her job and come to Virginia from Florida to care for us both.
Maureen,
I’m so my pathetic with your situation! My 65 lb. Boxer did exactly the same trick! Fortunately, I was luckier, in that no surgery was necc. But I’m going stir crazy!!! I have epilepsy & can’t drive, so I ride my bike everywhere. But the ortho Dr. said no walking or riding til he clears me. Does anyone know why? I wouldn’t think cycling would put pressure on the tibial plateau…?
Well, my comment was for Fonda! And it was supposed to say sympathetic, not “my pathetic”!???? grrr…
Maybe the prohibition is because exercising your muscles and ligaments to ride might pull on the newly forming bone? Everything’s connected in there, remember :-). Although bike-riding isn’t apparently considered a weight-bearing exercise, you do put some pressure on your knees doing it. Also, getting on and off is (at least the way I would do it) a two-legged operation. Good luck with getting back to normal!
Yes this site is great. And if you have Facebook there is a TPF recovery group, it is closed and you do have to fill out a quick form and be accepted but it is great. The people there are caring and cheer you on. This injury is a lot of mental recovery and physical. I go the 19th to see if I can weight bearing, I am praying for a miracle. May our recovery be quick and our lives be back to normal asap.
Oh so sorry you are doing this, too. I knew it was coming but was so disappointed to hear no weight bearing for another month, I am so ready to be healed. I have been given some exercises from home health and the PA at the OS office.
1. Lay on back, bend hurt knee and let hang as far as you can stand it bent for 20 seconds, then straighten and hold for 5 seconds, 10 reps, 2-3x a day.
2. Standing with crutches, stretch hurt leg forward, then back, bend knee up towards sky, 10 reps, 2-3x a day.
3. Lay on bed or couch, raise hurt leg and hold for a few seconds, do several, several times and day
4. Turn onto your side raise hurt leg and hold, same as #3.
I work for the hospital that is treating me just in a different part, and just want to be back at work. When I ask am I going to be walking and normal at 12 weeks, they all say yes. But when we talk time line, another 4 weeks, NWB, then most likely 3-4 weeks PWB, then to WB, it seems far fetched.
So, Amy Kay what did they say to you ? PT for you ?
My fall was May 29th, surgery June 6th, yes the first couple of days, I wish they would have just cut my leg off, better now. I have no brace on at home, and bend and straighten leg all day. My knee and incision throbs and burns, not pain just throbbing. Please write back and tell my your story.
You may just have to be patient :-). But don’t give up! My injury was December 30, 2014, surgery on January 20 (had a misdiagnosis in the meantime), and I was totally NWB until April 14, 2015. First three weeks in a rehab center with PT and a brace, then home with a wheelchair downstairs, walker upstairs.
Even though I got cleared to be WB on April 14, it took a couple of weeks with PT twice a week to really start to use two legs and relinquish the wheelchair. It took another month or so to trade in the walker for a cane, and till the end of the summer to give up the cane (my son dubbed it “Sir Michael” LOL). I kept going to PT until December, when it ran out.
So if you get back to normal more quickly, good for you — you are lucky! But if not, don’t be discouraged — it can take a while to rebuild function. The longer you are NWB the longer it will take. But it does come.
Omg.. My fall accident was June 3rd 2016 and surgery was on June 6..Rht now Im still at the NWB stage. I felt the same exact way you felt. Heal and over with.Every person is different. However, Im still wearimg this hot brace and haven’t started outpatient PT yet..I can’t stand pain either. Dont know what Im in far. Trying to have Faith at 61
Linda, I’m 69 and recovering pretty well. Surgeon sounded surprised that I had this injury, since it is usually younger people, he said. But we can be very active too!
The initial surgeon said 6-8 weeks, but the follow up was three months. I am still working through that. Getting around with a 2wheel walker in the house, and finally getting out on an electric scooter with crutches lashed alongside. Tired of admiring my horses from the deck but at least they are where I can see them. Keeps me motivated, and working on the physio.
Find yourself something that you want to be able to do in September, and work toward that goal.
I fell off my horse April 29 had surgery may 2. NWB for 9 wks .Used walker,crutches, and wheelchair. Each served their purpose. I’m 64 and have always exercised,so I did the PT 3 X day.WB caused a stress fracture in foot????.Had to wear air boot for 3 wks.Back on track now.Walker 2wks cain 1wk. Still walking with a limp but working out of it.Swimming really helped my whole body get stronger.Get moving!!! WE WILL GET THERE.
My accident was July 20 2016. I slipped on gravel on an electric bicycle and the heaviest part of the bike went down on my right knee. It was first diagnosed as a bad sprain, but after 2 weeks and no improvement an MRI was done showing the fracture. It had not moved so I was lucky I did not need surgery. Then I went through 6 weeks of NWB, using a wheelchair and crutches. I started PT last week and it has made a big difference. I still have significant swelling at the end of the day, using ice therapy and Advil. I am finally feeling that I may be able to progress to one crutch very soon. I am still using a hinged brace when out of the house, mainly for my own feeling of security, and hope to drive soon. I am a fairly active 61 year old woman. I’m finding this is a long recovery but am told I will regain my previous activity level. Most important advice at this stage, be patient.
Hi
I’m recovering from 2 x tibial plateau fractures. Rt leg healed in 12 weeks with 10 of those none weight bearing; left leg had surgery and today after 5 months I went out without crutches – walking carefully. I can walk around the house unaided, but going out was another milestone – Yeah! Am going to swimming pool twice a week for exercises which are really helping mobility and physio once a week only at the moment. Joyce
Hi, I am so sorry that you have this injury. It must be difficult with children to care for! I had my surgery on Jan 31, 2016.. I did not start PT until I was PWB… 6 weeks of NWB. I was shocked at how my quads turned to mush in that time. My first sessions in PT was to work on my ROM as well as straightening my leg so that the back of my knee hit the floor. Then they started,on strengthening. I can’t imagine that you won’t need some PT; it helps so much! Or at the very least, get an evaluation and some exercises to do at home. Good luck!
Yes, on my backside, with the chair. I thought the same about outpatient PT, especially since I had home health PT, but they seem to think I may not need it, and they wouldn’t allow me yet anyways. I have 4 different exercises home health PT taught me, the drs say keep doing those. Did you go up and down your stairs every day ?
Yep, round trip at least once a day and often more than once (bathroom and bedroom up, kitchen and working space down). The chair was like a miracle — before I knew about that, I had to have my son haul me to my feet (foot). Scary!
When you do get to be WB, walking in a pool might be very helpful at first. My PT place had two pools with treadmills (water was chest high), but you could just walk around the shallow-to-middle depth of a regular pool. I used them as part of my PT appointments, but they also rent them out for $25 per hour.
Wow Melissa we also sound like twins. Mine is left leg also, plate, 5 screws and a cadaver bone graft. My injury was on June 24 and surgery July 1. I was run into by a couple of Great Danes…running full speed across my yard and they ran right into me. The collision was enough force to break my leg. I have not seen the surgeon since right before surgery and no one has said anything about starting physio. I’m a little worried that I should be starting. I Was feeling very sorry for myself these last few days of not being able to wb so finding this site and hearing other stories makes me feel hopeful!
You are very fortunate to be NWB for such a short time! The longer the time, the more your muscles will deteriorate. Even in just 6 weeks, you will likely lose a lot of function. If you can get PT prescribed for you, I would really recommend it. A professional therapist will evaluate you and give you exercises for your specific situation. Only one or two sessions could maybe teach you enough to let you work on your own to restore full function. A lot of insurance policies cover PT. If yours doesn’t, it could be worth paying for a session yourself.
Your good leg and hip are probably doing more work than they are accustomed to, and your movement may be unbalanced, which can cause extra strain on the good side. When your injured leg can do more, the other side will probably feel better. PT will help the good side, too — they always had me doing the exercises on both sides.
I’m curious — what did your home health aide teach you about getting around with steps, etc.? I went up and down for three NWB months on my backside :-). At the top of the stairs, PT told me to put a chair, which served as another top step, and when I sat in it, I was in position to easily use my walker.
I slipped on my children’s bath water and ended up with a LT lateral tibial plateau fracture. I had surgery 1 week post fall, I have 5 screws, 1 plate, and cadaver bone graft. I went today for 2 week post op Dr visit, I am still NWB for another month 🙁 . I had home health to teach me how to get around and out of my house due to steps. However, today my PA said I may not need PT, I can bend, straighten, and move my leg really good. In one month I could be PWB. My question is what are the most beneficial exercises to do at home and my good leg and hip hurt a lot when I move around a good bit, does that get better over time? I am 34 yro, overall good health, just a bit chubby. Please any advice speed this recovery up….. thank you.
Wow Melissa you sound so similar to my injury in every way except for my fracture being on the right side. I’ve developed calluses on both hands because I’ve now been in crutches for 4 weeks with another 3 weeks to go.
How is your leg feeling now? My surgery date was the 30th of May. It was excruciating the first 3 days.
I’ve been looking up online no weight bearing physiotherapy exercises.