Tibial Plateau Fracture Tibia Plateau Fracture - Extremely Limited ROM

[ALofGA]

This is my first time here. I sustained a tibia plateau fracture on March 16, had surgery on 3/26. I'm almost 12 weeks post surgery at this point. I was non weight bearing for 9 weeks, currently at 50% of weight bearing, using a walker. I am 70, a former marathoner and prior to this injury worked out nearly every day on my spin bike at home or weights/resistance at the gym.

I used a CPM in the hospital and for 5 weeks at home. I just started PT this week. I currently have 40 degree bend, got to 50 today but it was agonizing. My quad is strong and I'm flexible (today I swung my injured leg over the top of the stationary bike to exit on the side where my walker was). I'm walking a mile daily in my walker, trying to simulate as best I can a normal step (push off on the toe, land on the heel). I took two pain meds before PT today and still cried most of the way through it. It's absolute agony. My knee does not want to bend, and its extremely painful when they force it.

Has anyone else had this issue? It seems that every story I've read, every YouTube video I've watched, although Pt is difficult for people with the fracture, no one talks about how hard/painful it is to bend the knee. People talk about being 90 degrees soon after starting PT. I'm getting very concerned that it is going to even get close to full ROM.

I am going to have the hardware removed and a knee replacement approximately a year from the injury.

Has anyone had a similar issue with limited ROM for the knee?

 

[Jockette]

Hi and Welcome!

I’m sorry you’ve sustained this injury and are having such a hard time at PT. I have not had such a fracture, but I do have painful experiences with PT. I’m thinking maybe you should consider looking for a different PT office, with a PT that would have a more gentle rehab plan for you.

I do know that after a knee replacement, forcing the knee to bend more than what it’s ready for is very painful, and it’s actually counterproductive, because forcing it increases pain and swelling, both of which limits ROM from improving. I can only think this also applies to your injury.

A knee replacement does take a full year, on average, to recover, and that may be similar in your case also.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

​

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[ALofGA]

Thank you for this information. The PT is working toward the goals I set, so perhaps I need to revise my expectations, I thought range of motion would come fairly quickly but I did not expect it to be without pain. In fact my ortho prescribed pain meds (Tramadol) to take before PT. It did not help. I recognize that agonizing pain that reduced me to tears is not going to be sustainable for the next 7 weeks. Today, after PT yesterday, my knee is sore and I cannot reach the level of home exercise that I have been doing.

I have a plate and 4 screws. Per the ortho, my bone is healed as much as it can be at this point. I have 'fallen into valgus" and have instability due to vagus' stress. I've been fitted for a lateral unloader brace and have been advised to get a flexinator for use at home.

So, you are saying to avoid therapy that is this painful, and just be patient and let it work itself out? And it could be months, not weeks. I'm told I need to get to 70 degrees flex to walk, so I assume I can expect to be using my walker until then.

 

[ALofGA]

FYI, I am 5'5" and weigh 125. Obesity is not a contributing factor to the valgus.

 

[Jaycey]

So, you are saying to avoid therapy that is this painful, and just be patient and let it work itself out?

Yes, this is what we recommend. And the recommendation is based on literally thousands of members who took this approach. It does take time and patience. But if you give that knee the the surrounding soft tissues a chance to heal you will regain your ROM.

In fact my ortho prescribed pain meds (Tramadol) to take before PT.

You should not need to take pain medication before any PT. You will see much better results with the gentle approach. Work at your own pace and listen to that knee. As you have already seen - that knee will quickly tell you when you have gone too far.

 

[SkiBum]

When I had my tibial plateau fracture I was 6 weeks non weight bearing. The surgeon told me to get some ankle weights on the way home from the hospital. I put that 2 1/2lb. weight around my ankle and sat in a chair doing extensions several times a day while I was healing. It was very helpful.