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Wednesday, September 12, 2012

Strengthening After An Injury: Email Advice

Dear Dr Blake

Re: Left leg fracture: Closed non-displaced lateral tibial plateau

I really need some help. I've been scanning the internet looking for advice and your's is the first site I've found that addresses by question. You see, I'm living temporarily in Thailand and it's almost impossible to advice from the doctor here, he just says - keep the leg still.

Two weeks ago I tripped over and caused this injury. I now have a full leg plaster which I will keep on for two months, maybe longer. It was only two days ago that I even began to consider atrophy, and now I realise this is a big problem.  I really wish to lessen the affects of atrophy as much as possible. You mention isometric strengthening exercises in your blog, but then say to consult my physio..  which I can't do.  I have started to use the exercise you described, but wondered if there anything else you can suggest? Is contracting and releasing the whole leg useful? I wiggle my toes up and down several times throughout the day (is that useful?)  I am an active and fit 57 year old woman (yoga and swimming) and wish to return to full fitness in the most efficient way. 

Your advice would be very much appreciated
Kind regards,
Jill (name changed)

Dr Blake's Response: 
Jill, I will try to get one of our physios to respond also, but I will also put a call out to any readers that have knowledge that can comment directly on the blog. Since I am a podiatrist, treating a fracture at the knee is not within my scope, but I sure talk to patients who have it. 

The full leg plaster casts will certainly cause tremendous atrophy and will take 6-12 months to regain strength and motion. So, your question is perfectly timed. Any area of your lower leg that you can move, you should move. The simpliest, but still powerful, form of muscle strengthening is active range of motion. The exercises can not put stress on your injury, or any other body part. Simply taking the hip muscles 3 times through their range of motion will be very helpful. The hip moves in 6 planes (front, back, in, out and inward rotation and outward rotation). If the ankle is out of the cast, do the same (up, down, in, and out) with it's 4 directions. Try to do these motions every few hours and it should take less than 5 minutes.

The knee muscles to strengthen are the hamstrings and quads. The hamstrings pull the lower leg backward and the quads pull the leg straight. To perform an isometic exercise you attempt to move the body part in the desired direction (for the quad you are trying to straighten your knee). The cast will not allow you to move, so you push against the cast for a count of 6, rest 4 seconds, and then repeat 10 times. You try to do this every 2-3 hours. 

If you are doing the exercises, the area of the fracture can not hurt. 

Please ask the doctor, if you promise to completely stay off the leg, how much faster can you get out the the cast!! I sure hope this helps. Rich

Another response from Dr Blake:

Jill, I talked to our orthopedist Dr Susan Lewis. She says that this fracture can be very unstable, even if nondisplaced, and should be immobilized for minimum of 8 weeks. She did not like the idea of you getting out of the cast early, so sorry!! Best to overprotect it now, and then rehab the leg after. The exercises however are still fine. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.