Tag Archives: Safety after Total Hip Replacement Surgery

Fracture Rehabilitation

Fracture Treatments Mississauga & Etobicoke _ PhysioNow

Fracture types

Fracture Rehabilitation


Fractures are common injuries .  They can happen to people of all ages, from the very young to the very old.  The majority of fractures occur with trauma to the bone.  It could be  either from a fall or a blunt force.  Most people can readily feel that they have a broken bone. This is because the signs and symptoms can be very obvious.

Some of these indicators of Fracture are:

  • Swelling or bruising over a bone
  • Deformity of an arm or leg
  • Pain that gets worse with any movement or added pressure
  • Inability to put any weight through the injured area
  • Protruding bone through the skin (in the case of open fractures)

In some cases, however, fractures can be less obvious.  Some ankle fractures may look a lot like ankle sprains. You may not even know that it was a fracture until it shows up on an X-ray.

Spine Fractures

Fractures through the spine may feel a lot like back pain initially.  This is due to the  make-up of the spine.  Bony injuries to the back do not produce any of the obvious signs and symptoms .  However, one of the key components of a spinal fracture is that it occurs after some sort of trauma. This is most commonly a fall.  Therefore, if there is a traumatic event reported, the physiotherapist  will rule out any potential spinal fracture. They will  do a thorough assessment.  If the   Physiotherapist suspects a potential fracture, we will refer you back to your doctor to get X-rays done.

Fragility Fractures

In people with osteoporosis, fractures can happen with very minor stumbles or movements.  Osteoporosis is a condition where the bones become fragile or brittle from loss of bone.   Fractures associated with osteoporosis are called fragility fractures.  They occur due to the weakness of the bone itself.

If you have Osteoporosis, your bones can be injured with small traumas that would not normally affect the average person.  If you have  back pain and you have had trauma, the Physiotherapist will ask whether you have osteoporosis. This is to rule out potential fragility fractures.

Diagnostic tests for a Fracture

In any incident where there is a suspicion of a fracture, X-rays are necessary.  This will confirm the presence of the fracture, its exact location and severity.  However, in some cases, an X-ray may not be sensitive enough to show the fracture.   In these situations, if a fracture is still suspected, more sensitive tests like a CT, MRI or bone scan may need to be completed.

Fracture Classifications

There are 4 main classifications of fractures:

  • Displaced – the bone snaps into 2 or more parts and moves so that the two ends are not lined up straight.
  • Non-displaced – the bone breaks partly or all the way through, but the ends remain lined up
  • Closed – the bone breaks but there is no puncture wound in the skin
  • Open –the  bone breaks through the skin

Types of Fractures

There are also 7 different types of fractures to describe the specific nature of the break line:

  • Greenstick – incomplete fracture, where the broken bone is not completely separated
  • Transverse – the break is in a straight line across the bone
  • Spiral – the break spirals around the bone, common in a twisting injury
  • Oblique – the break is in a diagonal line across the bone
  • Compression – the bone is crushed, causing the broken bone to be wider or flatter in appearance
  • Comminuted – the break is in three or more pieces
  • Segmental – the same bone is fractured in two places, so there is a ‘floating’ segment of bone

Fracture Treatment

In terms of management of fractures, the treatment depends on the type of fracture.  The fractured ends of the bone must be set in their proper place and held there for the bone to heal properly.  This process is called reduction.

Fracture Repositioning

Most fractures are repositioned without the need for surgery. This  is called closed reduction.  Once the bones are positioned properly, the joint is casted .  The length of casting is usually 6 weeks.  This is how long it typically takes the fractured bones to heal.  There are circumstances where the period of casting may be either shorter or longer. This depends on the nature of the fracture.  If it is an ankle or foot fracture, the doctor may also recommend that you wear an aircast boot to stop your foot from moving.

PhysioNow carries a full supply of these aircast boots if you need one.

Open Reduction (Surgery) after Fracture

Open reduction (surgery)  is done for fractures that are more complicated. The repositioning of the bones wil be done with surgery in this case.   The surgeon will use screws and or plates to keep the bone fragments in proper position. This  allows for proper healing.   Following open reduction, you will have a period of immobilization .  The length of time for a fracture thathas required surgery will depend on the bone that was fractured. It also depends on  the severity of the fracture.  Also, depending on the fracture and the needs of the patient, the hardware may either be left in permanently or taken out with another surgery.  If removal of the hardware is necessary, it will happen once the fractured bone has completely healed.

Spinal and Rib Fractures

There are however some fractures that cannot be effectively immobilized such as spinal and rib fractures.  For these types of fractures, the affected area is protected with avoiding certain activities or postures.

Healing times for Fractures

In terms of healing times, most uncomplicated fractures take approximately 6 weeks for the bones to fuse.  Although medically, the fracture would have healed,  there may still be a lot of limitations. For fractures that are more complicated and required surgery, the healing times may be a little longer due the surgery.

Delayed Healing of Fractures

There are also some people who will heal at a slower rate because of various health conditions or medication use.  So, if you have diabetes, osteoporosis or are a long time user of prednisone, you may fall into this category.  Scaphoid Fractures also may have delayed healing because there is a poor blood supply to the bone.

Registered Physiotherapy after Fractures

Once the fracture itself is healed, there may still be some remaining problems from the injury.  Since the fracture would have been immobilized for several weeks, there will be a significant loss of movement and strength around the broken bone.

It is important to follow up with Physiotherapy for Fracture Rehabilitaton.  This helps to ensure that there can be a safe return to all previous activities.  A Registered Physiotherapist will be able to assess the limitations.  They will prescribe the necessary range of motion and  strengthening exercises and  then you can get back  to  all of your normal activities quickly!

PhysioNow Etobicoke and Mississauga

PhysioNow has highly trained Registered Physiotherapists on staff to help you after a Fracture.  We are open evenings and weekends to help meet your needs.  We also do direct billing to your insurance plan if you have one and if they allow us to do so on your behalf.

Call today to get started on your Fracture Rehabilitation!

Hip fracture

Anatomy of Hip
A hip fracture is a break in the upper quarter of the femur (thigh) bone. The extent of the break depends on the forces that are involved. The type of surgery used to treat a hip fracture is based on the bones and soft tissues affected or on the level of the fracture.
Older people are at a higher risk of hip fracture because bones tend to weaken with age (osteoporosis). Multiple medications, poor vision and balance problems also make older people more likely to trip and fall — one of the most common causes of hip fracture.

ϖ Signs and symptoms of a hip fracture include:
• Inability to move immediately after a fall
• Severe pain in your hip or groin
• Inability to put weight on your leg on the side of your injured hip
• Stiffness, bruising and swelling in and around your hip area
• Shorter leg on the side of your injured hip
• Turning outward of your leg on the side of your injured hip

ϖ Causes of Hip fracture
• falling on a hard surface or from a great height.
• blunt trauma to the hip, such as from a car crash.
• diseases such as osteoporosis, which is a condition that causes a loss of bone tissue.
• obesity, which leads to too much pressure on the hip bones.

ϖ Types of Fractures
In general, there are three different types of hip fractures. The type of fracture depends on what area of the upper femur is involved.
Intracapsular Fracture
These fractures occur at the level of the neck and the head of the femur, and are generally within the capsule. The capsule is the soft-tissue envelope that contains the lubricating and nourishing fluid of the hip joint itself.

Intertrochanteric Fracture

This fracture occurs between the neck of the femur and a lower bony prominence called the lesser trochanter. The lesser trochanter is an attachment point for one of the major muscles of the hip. Intertrochanteric fractures generally cross in the area between the lesser trochanter and the greater trochanter. The greater trochanter is the bump you can feel under the skin on the outside of the hip. It acts as another muscle attachment point.

Subtrochanteric Fracture

This fracture occurs below the lesser trochanter, in a region that is between the lesser trochanter and an area approximately 2 1/2 inches below .

In more complicated cases, the amount of breakage of the bone can involve more than one of these zones. This is taken into consideration when surgical repair is considered.

Treatment for hip fracture: usually involves a combination of surgery, rehabilitation and medication.

ϖ Surgery
The type of surgery you have generally depends on the location and severity of the fracture. Are the broken bones properly aligned? (displaced fracture. What is your age? What are your underlying health conditions?

The options include:

• Internal repair using screws. Metal screws are inserted into the bone to hold it together while the fracture heals. Sometimes screws are attached to a metal plate that runs down the upper thigh.

• Partial hip replacement. If the ends of the broken bone are not lined up or damaged, your surgeon may remove the head and neck of the femur and install a metal replacement (prosthesis).

• Total hip replacement. Your upper thigh and your hip socket are replaced with an artificial one (prostheses). Total hip replacement may be a good option if arthritis or a prior injury has damaged your joint. This may have been affecting your hip function even before the fracture.

ϖ Rehabilitation

Rehabilitation is begun as soon as possible after hip fracture surgery, often within a day. The initial goals are to help people retain the level of strength they had before the fracture. You want to keep moving to prevent loss of muscle. You also want to prevent problems that result from bed rest. The ultimate goal is to restore your ability to walk properly without a limp.

Benefits of Rehab

Rehab will help you:

• Restore normal movement in your joint
• Build up strength in the joint and surrounding muscles
• Ease pain and swelling
• Let you get back to your normal activities including walking without a limp
• Help with circulation, particularly right after surgery, so you don’t have problems with blood clots

If you have or someone you know has fractured a hip or had hip replacement surgery, please call PhysioNow. Our experienced physiotherapists would be happy to help with your recovery! Call today to book an appointment!

Trochantric bursitis


Trochanteric bursitis

 

The Trochanteric Bursa is a fluid filled sac near the hip joint. It cushions between the bones and the muscle and acts as a shock absorber. Trochanteric bursitis is the inflammation of the bursa which is at the outside of the hip.

When this bursa is irritated it causes pain on the outside of the hip and thigh.  Sometimes you may feel the pain down to the knee on the same side.  Another symptom is pain which will stop you from lying on your painful side.  It will be painful when you press on a specific spot on the outside of the hip.  The pain gets worse when climbing stairs, getting up from a low chair getting out of a car.  Sitting with crossed legs hurts.  Both  walking and running may also cause increased pain.

Causes of Trochanteric Bursitis

  • Any direct Injury to the outside of the hip like falling, or bumping into an object.
  • Incorrect posture due to muscle imbalance
  • Leg length difference.
  • Stress of soft tissues surrounding the hip due to hip Osteoarthritis
  • Friction of the ITB (Ilio Tibial Band: a muscle along the side of the hip)
  • Overuse injuries like standing for long periods of time
  • Other diseases which affect the hip like Rheumatoid Arthritis
  • Previous surgeries around the hip
  • Very rarely infection of the bursa

Registered Physiotherapy Treatment

Your Registered Physiotherapist can help you to reduce the pain and inflammation.  They will use electrotherapy modalities, taping, or acupuncture.  They will give you  advice on activity limitations in the early stages.

Later the treatment is focussed towards increasing the flexibility and strength in the muscles.  Your Physiotherapist will  increase the hip joint range of movement and correct your hip joint mechanics.

Trochanteric bursitis

Trochanteric bursitisTrochanteric bursitis

Finally the focus is towards preventing it from happening again.

General Advice on prevention

Your Registered Physiotherapist will look at your posture, hip stability, and core strength.  They will look to see if you  need Orthotics to address any problems with your legs or feet.

 Tips for prevention of Trochanteric Bursitis:

  • Whenever you start a new activity, try to take it slow and build up your activity level gradually.
  • Start with  less force or resistance, less repetitions and progress gradually.
  • Avoid or modify repetitive activities if it is putting any stress on the hip joint
  • Your footwear should be comfortable
  • Maintain flexibility and strength in your lower extremity muscles
  • Improve your core muscle strength

If you or someone you know may have Trochanteric bursitis, call PhysioNow Today!  We would be happy to get you started on your treatment and back to enjoying all the things you love to do!

 

Physiotherapy : Total Hip Replacement

Physiotherapy : Total Hip Replacement – Do I really need it?
Physiotherapy: total Hip Replacement

Surgeons often recommend that patients seek out community Physiotherapy

Surgeons often recommend that patients seek out community Physiotherapy : Total Hip Replacement services to continue with your recovery after you have had a total hip replacement (THR). You may wonder how doing extra treatment would help? – isn’t the surgery enough to correct your hip pain?

What is important to remember is that the surgery does take care of the affected joint. However, there is still work to be done to get you back on your feet and back to your desired activities. The surgery involves a cut through the muscles that stabilize the hip. Also, the body has to relearn how to move and function with a new joint.

Normally, the usual process for Physiotherapy: Total Hip Replacement surgery involves:

• Receiving Physiotherapy : Total Hip Replacement as an in-patient for 3-4 days for learning to walk with a walker, using the stairs and initiation of strengthening exercises for the hip
• You also receive education with respect to their precautions and how to ensure you are protecting your new joint and preventing dislocation
• Once you are safe to return home, you will be discharged
• At home, you are usually entitled to receive home care physiotherapy sessions for a few sessions.
During these sessions, the physiotherapist will re-assess your ability to move and progress your exercises as able.

After receiving homecare treatments, it’s then usually up to you to continue with your exercises. This includes progressing your strengthening and conditioning. However, a lot of people have difficulty doing this on their own and need help to further progress. It can be difficult to assess your own strength and safely progress your exercises. Seeking help from a Registered Physiotherapist will help with this process. It will get you back to your optimal function. The physiotherapist can assess where there are still remaining limitations. They will prescribe the necessary treatments to address the issues.
Please check out this link for further information regarding Physiotherapy: Total Hip Replacement.

In addition, we often see patients that have had a Total Hip Replacement, develop Low Back Pain. This happens because the muscles in the hip get very tight after surgery, and tend to tighten up into the Low Back. It is also caused by increased sitting during the recovery process. The good news is that we can help! Registered Physiotherapy and Registered Massage Therapy will help these symptoms to go away.

At PhysioNow, we have well trained Registered Physiotherapists and Registered Massage Therapists available to help you with your recovery. We will help to find the areas that you need in order to walk properly without an aid and get back to all the things you like to do. Call today to get started on your full recovery!

HIP REPLACEMENT TREATMENT

HIP REPLACEMENT TREATMENT

HIP REPLACEMENT TREATMENT will help speed up the recovery process. Healing and recovery time varies between patients. Proper management is important after hip replacement surgery to minimize complications. Supervised Hip Replacement Treatment will help to restore strength and range of motion.

This guide can help you better understand your exercise and activity program. At PhysioNow, our Registered Physiotherapists will help you return to your daily activities. To ensure your safe recovery, be sure to check with your physiotherapist at PhysioNow or surgeon before performing any of the exercises shown.

SAFETY PRECAUTIONS AFTER TOTAL HIP REPLACEMENT UP TO 12 WEEKS MINIMUM:
After hip replacement surgery precautions must be taken to allow proper healing. It is important that you must follow the safety precaution at all times in the first 12 weeks after your surgery.

– Avoid extremes range of motion at all times
– When seated, ensure your knees should always be lower than your hips
– Use a raised toilet seat
– Use a cushion when sitting in a vehicle
– Sit on a high, firm chair at the level of your knees or higher.
– Do NOT lean forward from a sitting position to reach for items or put on shoes
– Use a long-handled shoe horn or reacher instead
– Do NOT twist your leg or turn your hip or knee
– Do NOT twist your trunk. Move your feet to turn when you are standing
– Do NOT sit cross-legged
– Do NOT cross your ankles when lying on back

DECIDING HOW MUCH WEIGHT TO PUT ON YOUR NEW HIP?
Your surgeon will decide your weight bearing status based upon the following:
-The type of surgery and prostheses used
-The condition of the your natural bone
-How the prostheses was fixated to the natural bone

Follow instructions from your surgeon at the hospital and at home upon discharge. Initially you will be advised to put a small percentage of weight on the affected leg. With proper exercise and keeping safety precautions in mind, you should be able to restore strength to your new hip over time.

TOTAL HIP REPLACEMENT TREATMENT GUIDE FOR WEEK 1 TO 4

1) ANKLE PUMPS:
Slowly point the toes as far as possible then pull them back toward you as far as possible.
Repeat this exercise several times a day, as often as every 10 to 15 minutes.

Ankle Pumps #1

2) ANKLE ROTATIONS:
Move your ankle inward toward your other foot and then outward away from your other foot.
Repeat 5 times in each direction.
Perform 3 to 4 sessions a day.

3) BUTTOCK CONTRACTIONS
Tighten your buttock muscles.
Hold for 5 second. Repeat 10 times.
Perform 3 or 4 sessions a day


4) HIP ABDUCTION
Slide your leg out to the side as far as you can and then back.
Repeat 10 times.
Perform 3 or 4 sessions a day

5) QUADRACIPS SET
Tighten your thigh muscle. Try to straighten your knee. Hold for 5 to 10 seconds, repeat 10 times.

6) STRAIGHT LEG RAISES
Tighten your thigh muscle with your knee fully straightened on the bed. Lift your leg several inches off of floor. Hold for 5 to 10 seconds. Slowly return, repeat 10 times.

7) STANDING EXERCISES
Make sure you are holding on to a firm surface such as a bar attached to your bed or a wall when performing standing exercises.

8) STANDING KNEE RAISES
Lift your operated leg only few inches off the floor, below your waist.
Hold for 2 to 3 seconds, and put your leg down. Repeat 10 times both legs.
Perform 3 or 4 sessions a day.

9) STANDING HIP ABDUCTION
While standing, raise your leg out to the side. Keep your knee straight and maintain your toes pointed forward the entire time. Slowly lower your leg so your foot is back on the floor.
Repeat 10 times on each leg.
Perform 3 or 4 sessions a day.

10) STANDING HIP EXTENSIONS
Standing tall and keeping knee straight, extend one leg back without leaning forward or arching your back. Return to the starting position.
Repeat 10 times for each leg.
Perform 3 or 4 sessions a day.

Always attempt any exercises within your pain tolerance. Hip replacement surgery can be a rewarding experience, as it will allow you to return to your daily living activities. Please contact our Registered Physiotherapist at PhysioNow to help you assist with your safe recovery.

Registered Massage Therapy is another excellent treatment after having had a Total Hip Replacement. The muscles in the low back and hip area tend to get quite tight after surgery and Registered Massage Therapists are very skilled at releasing this muscle tension. This speeds up recovery time! We have Registered Massage Therapists available daily Monday to Saturday.

If you are considering having hip replacement surgery, check out this link to the Mayo Clinic with some information that may be useful .