Tibial Plateau Fracture Recovery

[soonerstacy]

Well I had an interesting experience to say the least in PT today. I'm full weight bearing now (14 weeks out), but having heel and foot pain that causes an annoying limp. The senior therapist got wind of it today, and they decided I needed to have some ASTYM done. What is ASTYM, you ask?? MEDIEVAL TORTURE, OR PRETTY CLOSE!

Basically, they take a hard plastic stick, put a bunch of lotion on your leg, and scrape poke and prod you with it. Over and over. She went over my whole leg from hip to toes. This took about 15 minutes of grueling pain. I thought I was going to die. It took all I had not to scream bloody murder in front of the other patients. I guess the whole idea behind it is to break up any scar tissue. Hurt the most going over the scar and foot, obviously since I have really sensitive feet. But basically it hurt everywhere for a constant 15 minutes. I think I almost kicked the therapist a few times.

So, just a warning to all of you out there in PT.....If you hear the word ASTYM (a-stem), RUN, WALK, OR CRUTCH AS FAST AS POSSIBLE! No, just kidding. I will keep you guys updated if it helps. I may refuse to have it done again though.

Other than that, I can't complain too much.

[Casper2012]

I had 8-9 weeks, 3 times a week of ASTYM and your right it's definitely torture. It does get less painful over time and it definitely helps to break up the scar tissue that forms due to atrophied muscles. I absolutely dreaded it, the only good part was the cocoa butter they used first. Take something for pain before you go.

[Casper2012]

I can only bare partial weight on my leg and the base of the insides of my hands are always red, ache and I'm starting to get calasis (sp?). I bought some padded grips but they don't seem to be helping much. Does anyone have any tips?

[Casper2012]

Mine is my right leg

[crystalteras]

So I'm 11 weeks post op now and just got cleared to start putting 25 lbs of pressure for 2 weeks. I had pT in the pool for the first time and did nothing but ball my eyes out the whole time bc I was so afraid to get in and even worse to get out of the pool. Once I was in, it was really cool to be able to walk somewhat under water. I over exerted myself tho and I'm just SOOO sore and in pain all day since that. Can barely move to get myself off the couch. It sucks :-(

[peaton]

Interesting, I had to look this up since I'm about 3 wks out from starting PT. I am attaching the link for others to read. It helped me to understand why they do it and why it hurts.

http://www.astym.com/patients/treatment.asp

Well I had an interesting experience to say the least in PT today. I'm full weight bearing now (14 weeks out), but having heel and foot pain that causes an annoying limp. The senior therapist got wind of it today, and they decided I needed to have some ASTYM done. What is ASTYM, you ask?? MEDIEVAL TORTURE, OR PRETTY CLOSE!

Basically, they take a hard plastic stick, put a bunch of lotion on your leg, and scrape poke and prod you with it. Over and over. She went over my whole leg from hip to toes. This took about 15 minutes of grueling pain. I thought I was going to die. It took all I had not to scream bloody murder in front of the other patients. I guess the whole idea behind it is to break up any scar tissue. Hurt the most going over the scar and foot, obviously since I have really sensitive feet. But basically it hurt everywhere for a constant 15 minutes. I think I almost kicked the therapist a few times.

So, just a warning to all of you out there in PT.....If you hear the word ASTYM (a-stem), RUN, WALK, OR CRUTCH AS FAST AS POSSIBLE! No, just kidding. I will keep you guys updated if it helps. I may refuse to have it done again though.

Other than that, I can't complain too much.

[peaton]

I don't have any tips for you, sorry. I am almost 10wks into using my walker, not sure it is any less painful than the use of crutches. I too have the same issues as you and I also have had a numb pinky for about a week now. I start PTW in 5 days with crutches so I have been practicing with them when I can around the house. Good luck!

I can only bare partial weight on my leg and the base of the insides of my hands are always red, ache and I'm starting to get calasis (sp?). I bought some padded grips but they don't seem to be helping much. Does anyone have any tips?

[Casper2012]

I was the same the first time I went in the pool at therapy. I can't fully weight bear so I leaned partially over the rail and then lowered my bad leg on the first step. The first time in my leg just felt awful and like a foreign object. It got better after a couple times and then I really looked forward to it. Good luck!

[Righttibia]

Hi Guyz,

second day in office, yesterday by the time i reached home from office, leg swelled very badly,

kept hotwater so swell came down a bit by morning, ny ideas to reduce swell.

lyin on knee bendin is 100, sittin position its 130, lyin on tummy... pain is unbearable,, ny suggestions pls

im bit confused in choosing cruches, which one will be best, main use wil be to climb stairs.. only 5 though

wish u speedy recovery
Jay

[soonerstacy]

Hi Guyz,

second day in office, yesterday by the time i reached home from office, leg swelled very badly,

kept hotwater so swell came down a bit by morning, ny ideas to reduce swell.

lyin on knee bendin is 100, sittin position its 130, lyin on tummy... pain is unbearable,, ny suggestions pls

im bit confused in choosing cruches, which one will be best, main use wil be to climb stairs.. only 5 though

wish u speedy recovery
Jay

I'm a little confused by your post. How haven't you chosen crutches yet if you are six weeks out from surgery? A walker should be used when you are full weight bearing. I didn't know there were different types of crutches?? Never ever use hot water for swelling, ice is always for swelling. And as many people on this board have said, use a compression sock during the day. If you go back and read some of the older posts the info is there about compression socks. Hope this helps. Get those crutches ASAP.

[itsdeenah]

Hi Righttibia, sorry to hear of your injury.
I went back to work (office sit down) 4 1/2 weeks after surgery. I was on crutches (under arm not forearm crutches) and I brought a large size beanbag to keep under my desk so I could keep elevating my leg (it was quite comfy too). Also, I agree with Soonerstacy...ICE only for swelling. I use heat right before PT to warm up the muscles and ice alot after. Ibuprofen for pain and inflamation. Check out www.crutcheze.com for accessories I have a velco pouch that lets me carry paperwork and things for mtg. at work (very handy) and I got arm and hand pads on clearence that are great! I used 1 crutch to go up & down stairs. Use the good leg to climb up with crutch supporting bag leg and going down start with bad leg with crutch on good side to support plus railing. I couldn't master 2 crutches up and down. Best of Luck! Keep us posted
/

Hi Guyz,

second day in office, yesterday by the time i reached home from office, leg swelled very badly,

kept hotwater so swell came down a bit by morning, ny ideas to reduce swell.

lyin on knee bendin is 100, sittin position its 130, lyin on tummy... pain is unbearable,, ny suggestions pls

im bit confused in choosing cruches, which one will be best, main use wil be to climb stairs.. only 5 though

wish u speedy recovery
Jay

[peaton]

Word of warning: Do NOT use Ibuprofen (or any NSAID's) if your fracture has not healed completely. NSAID's retard bone growth, fusion and spinal healing. You should consult with your doctor before taking these for any bone fracture.

[iam_ultrasonic]

Take calcium supplements.

Sent from my SAMSUNG-SGH-I747 using TGR Forums

[Righttibia]

I'm a little confused by your post. How haven't you chosen crutches yet if you are six weeks out from surgery? A walker should be used when you are full weight bearing. I didn't know there were different types of crutches?? Never ever use hot water for swelling, ice is always for swelling. And as many people on this board have said, use a compression sock during the day. If you go back and read some of the older posts the info is there about compression socks. Hope this helps. Get those crutches ASAP.

Hi soonerstacy, i was using crutches, but bought walker thinking it wil be safe as i had fear that i will fall due to crutches... dint want to break another leg

Thanks

[Righttibia]

Hi Deena,

Thx for beanbag idea

[pbrmeasap]

Nice to meet y'all. Been reading this thread for a couple days on and off - thanks to everyone for the information and condolences on the acquisition of it. Hope you can stand one more story.

Had my accident 6/10 while mountain biking - coming down a rocky trail on an XC bike north of 30mph, I hit a baby-head off-center, went down sideways, and got my leg caught between the bike and my body. I had a splashing sensation in my knee, and immediately knew something very, very bad was wrong, though no pain yet. Weird accident - for such high speed, the only mark on me was a very small, light patch of trail rash on my hip.

Tried to stand up and take a step. That didn't go so well. Had to get carried out of the woods, as the trail was way too rough to use my bike as a crutch. Fortunately I was only about 1mi. from a trailhead.

ER, CT, Dx, FUBAR. I have a nice, clean but big Schatzker IV (medial posterior break) plus a bonus chunk out of the anterior right between the condyles, not anywhere near as bad as some folks on here but definitely not good.

Surgeon was supposed to be the head of ortho at Hospital of the University of Pennsylvania (who is awesome - he didn't blink an eye when I told him I needed to regain full use of the leg as soon as possible so I could go right back to doing the same stupid $@*% that landed me in his office in the first place, and in fact showed off his scar from the tibial nail he earned playing hockey), but the day I was scheduled, all hell broke loose in Philly and he was tied up all day with car crash and gunshot victims. Ended up getting done the following day by his partner, who I'm now convinced did and excellent job with the surgery, but have had ongoing problems with him in followup. If you see Dr. Jaimo Ahn, you're in good hands for the procedure but be prepared to seek outside help for aftercare.

Now, at 8wks post-surgery, I've got 0-140 ROM, still missing about 8degs of hyperextension which I doubt I'll get much of back, touchdown weightbearing only, and have been doing a ton of PT which has worked very well for minimizing atrophy. Last followup showed better than expected bone growth, so I'm optimistic for FWB soon. Reading some of y'all's accounts of the painfully slow process of regaining strength and flexibility, I feel lucky.

To those freshly initiated into the club:

-No smoking, no antacids, no ibuprofen, no drinking, and minimal caffeine, in descending order of importance. If you're in the habit of any of these, sucks to be you, but quit right the hell now. Seriously.

-Calcium Supplements (make sure it's calcium citrate, or if the more common calcium carbonate, that you take 'em with acidic beverages), sunlight, Vitamin D supplements, and multivitamins, IN ADDITION TO a healthy diet. You want lots of dairy, fresh produce, and good-quality protein. If you're vegetarian, you might consider giving that up for a few months - if you can't bear to, now is the time to pay more than usual attention to complementary foods that give you complete proteins, and other foods that help with absorption. If not, treat yourself to a bunch of grass-fed steaks, grilled chicken breasts, egg whites, etc. There will be time for donuts and potato chips later. Also, glucosamine supplements are a good idea, especially if you have ligament/cartilage damage.

-Always good investments: a good surgeon, a bath stool, compression socks, e-stim unit (bike shops can order you in one made by Contour for about $190 that's as good or better than theraputic models. It hurts like hell to use but it works), ankle weights, Netflix. Good investments depending on your situation: CPM rental, extra PT sessions, a lawyer (seriously - even if you don't intend to sue anyone, your health insurance may try to screw you over), massage therapy, a stationary bike trainer. Bad investments - more than one PT session between followup appts. before FWB, more narcotics than are absolutely necessary, most alternative medicine (acupuncture may be helpful for some, that's about it).

-About that stationary trainer - this has been absolutely key in my recovery. Your mileage may vary (literally and figuratively), but among the tips and tricks for those who want to try it: you can and should get shorter crank arms so you can get full rotation even with limited ROM. They might not be cheap, but you can just sell them on Craigslist later. They don't need to be fancy, they don't need to be the same gearing you had before, they don't even need to be exactly compatible with your drivetrain, 'cause it's not like you're gonna need to shift for awhile and you're probably not using much if any resistance. When you can get full rotation and have built up stamina to ride for more than 1/2hr., alternate sets of easy spinning, high cadence (moving legs fast), and one-legged drills with BOTH legs. High gearing/resistance for the good leg (maintains muscle tone and cardio), low for the bad. Focus on a nice even pedal stroke all the way around, with the knee moving straight up and down and the pedal constantly driving the wheel, no hiccups as you move the pedal forward and back at the top and bottom of the pedal stroke. This is absolutely key, because it works the smaller stabilizing muscle groups you're gonna need soon. It's better to be in easier gear and slower cadence, than to skimp on the technique. Start each set at 1minute and build up to at least 5 minutes, as much as you can take.

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To those who have been through to the other side of this: PLEASE keep posting! You know how long the recovery is, and the mental toll it takes. We who are still playing the waiting game need to know we'll be able to go back to a normal life at some point, and this is such a rare injury, almost no one we know in real life can tell us that. I was lucky enough to meet someone last week who did her TBP skiing 4 years back, and just watching her walk around and do a squat put me in a good mood for a week.

Thanks y'all. Hope this helps - the first 800-some posts helped me.

[greg33]

So I'm just over four months post surgery, and have been "full weight bearing as tolerated" for just over a month. My P/T and I worked the other day on walking with one crutch. I just can't do it. I know its psychological at this point because I've seen how much weight I can put on my bad leg on a scale. So I know my leg is strong enough to support just about all of my body weight. I just can't get over the psychological barrier to take away that one crutch. I can walk with both crutches using the slightest bit of assistance. Some days I feel like I'm so close to walking. But try and do it with one crutch and I'm a mess!! Anyone have any suggestions on how to try and work through this? At this point I it's me that's holding up my recovery!! Thanks and I hope everyone is feeling better!!!! Oh 9.5 miles in 35 minutes on the exercise bike this morning!!!

[Casper2012]

Greg33-have you tried walking in a pool? My PT says it really helps you to learn to trust your leg. A cane will also help wean you off the crutch. Good luck!

[scotiadallas]

any ideas to reduce swell.

COMPRESSION STOCKINGS!

[scotiadallas]

I have been slowly transferring more weight to my bad leg and here's what I'm experiencing:

1. My quads are absolutely mush. When I bear weight and my quad needs to kick in to take the load, it's the quad that is too weak to support the weight not the knee. I'm working to improve quad strength.

2. I'm having a lot of pain in my foot, and it's holding up the process.

What I've done so far:

I've been in the pool and I've "walked" with the water level at the middle of my chest. This takes enough weight off my leg to allow me to walk. It's a great way to gain some confidence and go through the motion of walking. It almost feels normal.

Once I walk in the pool for a while, I go to the side and stand only on my bad leg (water chest deep). I hold onto the side for balance and do "squats" on the bad leg. I feel the quad working and after 8 reps, really starts to burn. I do between 4 to 6 sets of this exercise and slowly move to more and more shallow water. This puts more load on the leg. I eventually hit a point where I no longer have enough strength to lift myself up. Every time in the pool, I notice I get a little stronger and can do more.

As far as the pain in the centre of my foot, the docs are telling me it just needs more repetition and more weight. It's hard to trust that but I'm finding that they are right, the more I walk on it, the less it seems to hurt. I figure that in a week or two, most of the pain in the foot will be gone.

Shoes really help. I find I can do more walking, more weight bearing when I have a good pair of shoes on. Trying to walk barefoot is very difficult as there is so little support.

As everyone has been saying - every day is a slight improvement. Everything is about small gains. There is very little way to rush this recovery. Every day try and do something to push your personal threshold in some way.

Try to recognize the improvements and note (and celebrate) the small gains.

D

[Casper2012]

Congrats on your progress. When I initially started weight bearing my Achilles and calf were very tight and I really had difficulty getting my foot flat. I found that wearing shoes helped because of the heal. My PT had me use a leg extension machine where you placed your feet on a board and then pushed backward and forward using light weight. This type of machine normally works your quads but the first several times I used it it felt like my calf was being cut with a knife. I can't use it anymore because of my knee collapsing but some of you struggling with ankle and foot issues may find it helpful. I'm doing leg lifts and side kicks for the bad leg, back of the knee presses to keep my leg straight and use a bow flex for upper body and my good leg to try to keep the rest of me strong. I agree with everyone on this board that it helps to communicate with others who have similar injuries and recovery challenges. It's interesting to hear about the various ways each of us suffered our TPFs. Mine occurred on March 18, 2012. I have two Bengal cats who I took out in my yard because it was such a beautiful day My silver spotted Bengal,Casper, decided to jump the fence in the front of my house and was sitting in the middle of our street by the time I got to the fence. I debated for a split second whether to jump the fence or go around the back of the house,down the driveway which was on the other side of my home as you can guess I made the wrong choice and flung myself over the fence. I felt the crunch as soon as I landed and there I stood on one leg yelling for help. My husband and my son were both out of town but thank god for good neighbors who got my cats back in the house, got my moms old wheelchair out of my basement and took me to Immediate Care. I didn't find this forum until last month and it would have been so helpful to find it sooner. Keep the experiences and info coming! I've had many bad, blue days like most folks on this site but when I start feeling sorry for myself I think about how so many other people are far worse off than me. I'm scheduled for surgery in a month to remove hardware then 3 months later knee replacement. Doc says 6 month recovery after that, so I'm looking at June of next year which is most depressing. I expect to be on this site for a while and am taking it one day at a time.

[vaper]

almost 12 weeks post-op and a week since fwb. i don't walk with a limp but sometimes my foot just hurts so bad! apparently i have slight tendinitis, boo. my knee still feels fine though! my quad is still smaller than my other leg's idk by how much but i can just encircle my hands around my good thigh and my fingers will just touch but on the other my thumbs will start to overlap. it also just feels softer.

for anyone who still isn't walking properly, the best way i had learned was to walk while using both crutches! i never used just one crutch? that would make me feel too off-balance. over time you'll start using the crutches less and less and walk with your leg more, while also getting your gait back!

and if it's the psychological barrier, you can do it! don't be scared, it'll feel really weird at first but you get used to it very quickly. i started very small by just going around my kitchen bc it feels so good to be able to walk and hold things! also going into the pool helped me feel normal again lol

also i just moved all of my things into my apartment! i'm going to officially move in on wednesday and so i know i'm really gonna have to get my leg in shape to start walking around the city all the time. i'm so excited!

[vaper]

also my advice to everyone is to take your vitamin and calcium supplements!!! i'm so sure i would've healed faster if i had taken it when i first broke my leg.

[imajypsee]

Hi, I found this forum today after having a TBF on May 6th, surgery on May 8th, surgery ward for 5 days, followed by 20 days in a rehab/nursing home with PT in the rehab and then no PT til I was weight bearing, which happened on July 9th. I had to insist on some home PT as my surgeon didn't think I needed it (surgeons are pretty dim witted outside the operating room, IMO). I had ROM in the rehab and some upper body strengthening stuff and lots of assessment and LOTS of conversation with the PT person there (did you know that PT people get Master's and Doctorate degrees these days??). It was the PT person who really put things in perspective for me since my surgeon was not telling me anything. I had a hip to knee articulated brace and was immobile for the first three weeks after surgery and then got the ROM training (leg lifts, pushing left leg back with right leg, etc.) The brace held my leg fully extended and I was supposed to sleep in the damn thing but it wasn't in the orders and I never did sleep in it (the surgeon blew a gasket when he discovered the error, but by then I was really good at getting it on and off). I also had a distal and proximal fibular fracture, so that was the reason for the brace and immobility more than the TPF.
I've been at home for 6 weeks and have been walking (walked from car to the last DR appt on Aug 6th) for about a month; first with a walker and then with a cane. Surgeon put me in a GenuTrain S knee brace and I wore it for a month and then had to wash the thing and have left it off for about 3-4 days since. My knee is still really weak and wants to buckle. I climbed the steps in front of my house with the brace on but haven't tried it without the brace. I sometimes use a cane but mostly I don't. Stiffness after I've been sitting is sorta problematic, and I take a whole lot of time... BTW, I'm 67 years old and compared to the other people whose posts I've read here, I'm recovering really well. I never had the extension problems, but I do have quad issues and need to do the "put your TPF knee on a beach ball and lift the knee" exercise to get that strengthened. It hurts like the dickens!! Like others here, I go through bad days when the whole leg hurts; I had the foot pain and the burning sensation in my heel, etc. Since my surgeon was so unforthcoming, I've sought information wherever I could find it. The biggest problem was the reliance on others and the feeling of hopelessness - and the lack of information about this injury and recovery. Frankly, I'm still feeling overwhelmed, but less so not that I've found this forum. Knitting, reading and endless BBC serials have kept me sane, but I want to get back to my favorite hobby, which is photography.

[itsdeenah]

Apparently ROM is coming to a standstill and not too happy about it Over the last 3 weeks I've only stayed at 110 degrees bending it and it's not budging past that. Extending is good it flattens out once I start pushing it. Bummed out to say the least & going back to the OS next Thur. to discuss ortho sugergy to remove debris from the smashed up cartilage and any bone fragments. PT said walking w/out a limp and climbing stairs is going to turn out ok but running, etc. prob. isn't going to happen. I've pushed it as hard as I can but the joint damage is getting the best of me. Sad Face today

Date of Injury 4/20/12
Surgery 4/27/12
Type IV TPF with 1+" communited depression of the plateau surface
1 - Fx's Tibial Shaft
Shattered medial meniscus