tibia plateau fracture, knee straightening

[Judy_W]

Hello everyone, I'am new, and I need to ask a question. I had a tibia plateau fracture 6 inch plate and 8 screws, bone graft done 08/22/02. I have very little, mostly no pain walking, my ROM is getting better. however I have one problem that is really bothering me I cant streighten my leg in the air, and it wont stay streight when I walk. , I have just started doing step ups and trying to get my quads stronger by lifting weights. Has anyone else had this problem, am I on the track for fixing it. I feel my walking would be much better if I could just streighten my leg Please help. I need encouragement. Judy

[Pat_A.E.]

Are you, or have you been in PT? Sounds like a question for your therapist.
This may help. Lie on your stomach on a firm bed or surface. Position yourself so that the end of the surface is above your knee. Let gravity pull down on your straight leg. I used ankle weights to increase the pull.
Others will probably be able to suggest other methods.

[Judy_W]

Pat, Thanks for your suggestion. Yes I have been doing what you suggested for about a month, It has helped and I have finished formal pt. and it was to the point where it was not helping much, they just turned me loose to use the same equipment I have at home weights, stationary bike and total gym. I complained about not being able to streighten my leg Pt told me to do streight leg rises with ankle weights which I had already been doing. Maybe I just need to give it more time. any other suggestions would be greatly appreciated. Judy

[gimpy]

I would say that your therapist did not do a very thorough job. Putting you in a gym and having you "exercise" is not physical therapy. Full extension (staightening) the knee is a must for a normal gait. Are you sure it's your quads that are the problem. Quads have a lot more to do with the active flexion of your knee. Have you been stretching your hamstring? Sounds like your hamstring may be tight. The single most common problem with lower extremity injuries is contaction of the hamstrings and difficulty with full knee extension I am told. I do lots of stretching along with the strengthening exercises. I have full extension but I do notice if I haven't done my stretching even for one day things get very tight. You may want to consult another therapist - you might get insurance to pay if you see the doc specifically about your "abnormal range of motion and impaired gait". Ask the doc for a script for a PT eval - and go to a different PT.

[Kari]

Well, we are both about the same distance out from our tibial plateau fractures. I broke mine August 9, 2002. I have achieved full extension, but it has been a lot of hard work. I have spent months with my ankle/lower leg propped up on a juice can whenever I am resting. I even sleep with a space under my knee so that it encourages the leg to straighten. Most recently my PT has had mejust pushing on my leg above the knee gently to get a further stretch and slowly get straight. I now push above the knee while pulling up on my toe to get a little hyperextension. Hang in there it takes a long time but it does make you walk much more normally.
FYI...I have done this without being able to do much quad work. It has almost all been stretching for me. I am waiting for an osteochondral allograft, and my knee won't tolerate much of anything, so this was the one thing I could work on. How are you doing with flexion? This is where I have reached a plateau.
I agree with the comments about stretching your hamstring. This will help you.
Good luck,
Kari

[Judy_W]

Gimpy, Thank-you for your suggestions. If things dont
soon improve I think I will call OS and try to have PT evaluation for gate training. I don't think my hamstrings are tight because I can sit on the floor and touch my toes without bending my knees. Maybe I should have a PT Check that for me, hopefully one that cares. Thanks again Judy

[Judy_W]

Kari, It looks like we're in this together it is a long tough recovery I'll be glad when its over. I'am thankful that my ROM is still moving 2 to 3 degrees per week today measured 125. I have been taking MSM and glucosamine it seems to have helped things move along. Iam sorry I have to ask you what is an osteochondial allograft? Thank-you for your words of encouragement and your suggestions. Good luck with your recovery Best wishes Judy

[gimpy]

Sounds like everyone is doing a lot of work - ouch! Another thought - if you feel your hams are pretty limber maybe try another exercise my PT has me do. Sit with your leg out straight on the floor - put a rolled small towel under the knee keeping your thigh steady on the floor and your heel on the floor - push your knee (using your muscles not hands) into the towel and hold a few seconds - do about 10 reps. Then to strengthen the "terminal extensors" do the same thing but this time keeping your knee pressed into the towel ( or floor as you get straighter) lift only the foot off the floor. Strengthening the quads are a must but the terminal (means end) extensors get weak too. I started being unable to lift my heel to now having my knee flat on the floor and lifting my heel about 3 inches - keep working I get dicouraged at times but I realize each of us will recover at our own pace - don't wait on that PT eval - this is your function for the rest of your life!

[Judy_W]

Gimpy, Sounds like a good exercise ;D Ill give it a try.
Thank-you for your advise and encouragement.

[Kathy_G]

Hi, all! I've read your comments, and it sounds like I am doing all the right things. I'm behind most of you in my break (Sep 02) and you are right in that it is WORK!! A lot of great suggestions here - some I already do, some I will try - especially the exercises for the hamstrings, as I think that may be one of my problems as well! ;D

I have a suggestion that you may find helpful. Get in the bath tub (or a hot tub if you have one) with the warmest water you can stand, place a inverted bowl under your calf, press your knee into the "ground" with your quad muscles. You can also press down on your leg and hold for about 3-5 sec. at a time. Repeat about 10-15 times. The warm water helps to relax the muscles, the water itself helps to cushion the joints. I found this has helped me quite a bit in straightening.

Re: bending, I found the best thing is to get in the pool and do bike movements in the deep end. You can get a water belt or wear a life jacket - either way, the water works to cushion the joints so you are able to push harder. I've gained so much ROM in bending doing this, and it has also helped strengthen my quads as a side benefit. I am after about a month down to one crutch, and I can walk without it though I limp badly (am currently seeking approval to work with a water therapist to help with all that stuff!!). I found that traditional PT didn't work for me after a certain point in flexion, so my OS suggested going to the pool, which was the best thing he could have said. I am making incremental progress, which has been a boost to my overall morale and confidence.

I pray continued healing for all of us, thanks for sharing! ;D

[Janet]

While your hamstring may need stretching and strengthening as Gimpy suggested, he/she is wrong about the quads. The quads are part of the extensor mechanism....they straighten the leg. The hamstrings let you bend (flex) your knee. That's why straight leg raises and the leg press are used to strengthen the quads....they work on straightening the leg.

Janet

[Judy_W]

I want to thank everyone for their suggestions. I tried Gimpy suggestion and found that when I sat on the floor I am very close to being streight. still have a little way to go, Soo I will be stretching my knee streight for a little while. I also have a hot tub so I will also try Kathy's suggestion for stretching in hot water. I used my husband weight lifting machine and found that my quads and hamstrings are still a little weak, but not as bad as I thought. I still have a lot of work to do to recover from this injury. I feel that Iam on my way at last. I have to stretch and steighten quads and hamstrings. Thanks again for your help. I wish everyone a speedy recovery.

[Kathy_G]

Hi, Judy - hadn't heard from ya in awhile, wondering how you are doing. Take care, and happy healing to ya!

[Judy_W]

Hi, Kathy Thanks for thinking of me. I am still working on streightening, and I actually wore out my stationary bike peddles fell off. Tee Hee. I bought a used spinner bike It has a longer range of motion which seems to be helping. I lift weights every other day and have been gaining strength I gain a rep with each session and when I get to 15 reps I add 2 1/2 lbs. Iam building both quads and hamstrings. I read both need to be equal to support the knee and it seems to be helping a lot. My leg is getting streighter I can stretch it completely streight, I still cant get it completely streight when I lift it in the air. My biggest problem is stiffness if I streighten it bending is stiff and when I bend streightening is stiff. Iam hoping it will go away in time. How are you doing?

[Kathy_G]

Thanks for the update, Judy - glad to hear you are progressing! I am doing relatively well myself - I am walking unaided, working on gait, as well as continued work in ROM (which I am still gaining, YAY!!) and strengthening leg muscles. I am doing leg lifts and exercises in the water to strengthen quads and calf muscles, still stretching in the hot tub, and I use a stationary bike for strength and bending. It is a slow process, but I can tell I have come a long way. My leg still gets stiff, but it becomes less and less so as I use it more and more. I have a lot of swelling if I am on my leg for too long, then I just ice and elevate.

Let's hear it for all of us and our progress - yippee!!! ;D