Tag Archives: 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!

Heat therapy

Heat and Cold therapy

How it works

When we apply Heat therapy, it improves circulation and blood flow to  that area due to increased temperature. Heat therapy can relax and soothe muscles and heal damaged tissue.

Heat therapy


  • Dry Heat therapy includes sources like heating pads, dry heating packs, and even saunas. This heat is easy to apply.
  • Moist Heat therapy includes sources like steamed towels, moist heating packs, Theratherm heating pads that take moisture from the air, or hot baths. Moist heat may be slightly more effective as well as require less application time for the same results.


  • diabetes
  • dermatitis
  • vascular diseases
  • deep vein thrombosis
  • multiple sclerosis (MS)

 Heat is useful for relieving:

  • osteoarthritis
  • strains and sprains
  • tendonitis, or chronic irritation and stiffness in the tendons
  • warming up stiff muscles or tissue before activity
  • relieving pain or spasms relating to neck or back injury, including the lower back

Cold therapy

How it works

Cold therapy is also known as cryotherapy. It works by Louis- hunting reaction theory. When we apply Ice to an injured site, it reduces the blood flow by vasoconstriction. After some time, it causes vasodilatation and increases the blood flow to the area. This process goes on continuously. This reduces inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.

Types of Cold Therapy

There are a number of different ways to apply cold therapy to an affected area. Treatment options include:

  • ice packs or frozen gel packs
  • coolant sprays
  • ice massage
  • ice baths

Cold treatment can help in cases of:

  • osteoarthritis
  • a recent injury
  • gout
  • strains
  • tendinitis, or irritation in the tendons following activity


  • people with sensory disorders
  • uncontrolled diabetes
  • You should not use cold therapy on stiff muscles or joints.
  • Cold therapy should not be used if you have poor circulation.

Here’s a general guide that helps you to decide which to use heat or ice : https://www.healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold#cold-therapy

In General,  use ice for the first few days after an injury.  Beyond that, heat usually does the trick.  There is some evidence that suggests that using ice beyond the first few days can actually slow down injury healing.  It pushes away the healing agents that help you to get better.

If you have been injured and need advice or treatment, please call PhysioNow today.  We are always happy to help!

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!



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.

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

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.


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

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.

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

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

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

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.

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.

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.

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.

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 .

Total hip replacement surgery

Total hip replacement surgery
In total hip replacement surgery (also called total hip arthroplasty), the affected hip joint is removed and replaced with a metallic implant. Total hip replacement surgery is usually performed in people who have severe arthritic changes. Normally they have a lot of pain in their hip and find difficulty walking or walk with a limp. Its an extensive surgical procedure that involves slitting open the muscles around the hip and buttock. Muscles that are usually cut are those that are required for walking and using the stairs. These are some of the functional activities that can be affected with hip arthritis.

You don’t have to wait until your hip surgery to come and see a Registered Physiotherapist Mississauga. In fact, seeing a Registered Physiotherapist right after your decision to undergo a replacement surgery can get you back on your feet quicker after your surgery. You can set up a pre surgical appointment with PhysioNow to get you ready for your surgery. One appointment before the surgery can save you recovery time after the surgery. We can go over all of the things you need to know for after the surgery.

What to expect
Before the surgery
– Physiotherapists at PhysioNow Mississauga will closely work with you to get you back on your feet early after surgery. Check out this video if you want to see a bit more of what to expect with Total Hip replacement surgery. It is from the University of California, but it gives a comprehensive overview of the procedure and explains it quite well.

Physiotherapy Treatment will consist of:

– Assisting you to get the right size walker/cane to offload excessive stress during the initial phases of recovery
– Managing your pain and swelling during the initial phases of recovery by providing compression to the area using a compression stocking and applying ice around your hip joint
– Electrical modalities such as interferential therapy to decrease post-surgical hip pain
– Registered Massage Therapy to relax the muscles around the surgical area and your low back
– Using different exercise equipment such as theraband , weights and exercise machines
– Strengthening of the muscles around your hip to help you walk without a limp
– Various exercises to strengthen and maintain adequate flexibility in your hip/leg muscles
– Education on home modifications (elevated toilet seat, use of grabber) to facilitate your mobility in the house
– Simple foot/ankle exercises to prevent pooling of blood around your calf

Registered Physiotherapy Mississauga will help with functional recovery after your total hip replacement surgery. Total recovery from Total Hip replacement surgery takes an average of three months. The surgeon should send you home with a list of instructions to follow immediately after surgery. It is very important to follow the precautions that the surgeon gives you to avoid serious complications. Your physiotherapist can review these precautions with you!

After Total Hip replacement surgery, you will be ready to see a physiotherapist for further treatment outside of the hospital within 5- 7 days after discharge from the hospital.
You should expect to see your physiotherapist 1-2 times per week depending on your progress for up to 3 months after surgery.
Total Hip Replacement Surgery
The goals of physiotherapy are:
– to have no limp when walking
– ability to climb stairs with normal alternating gait
– ability to walk as far as you want to walk without developing a limp from fatigue or weakness
– able to get out of a chair easily
– excellent balance while standing on one foot: up to 60 seconds without losing balance

Good Luck with your Surgery! Please call us to get started on recovery or to prepare you for your surgery! Call today! 289-724-0448.