Thanks to today’s guest blogger, Neal Church, PT

As a physical therapist, I love a challenge. One of my most formidable challenges is patients with tibial plateau fractures. Tibial plateau fractures are one of the most frustrating injuries for patients because it is such a long-drawn-out process. These fractures occur at the top of the tibia, or shin bone, which is a primary weight-bearing surface. Tibial plateau fractures are treated differently than fractures of the tibial shaft. When treating tibial plateau fractures, cartilage covers the top of the tibial plateau, which must be protected after these injuries in order to prevent arthritis. If the fracture is displaced, or isn’t lined up perfectly, the patient usually will need an open reduction internal fixation (ORIF). This means the surgeon will open the knee and use hardware, i.e., screw and plates, to hold the fractured bone in place. Whether displaced or non-displaced, the patient is usually non-weight bearing for an extended period of time, which lasts as long as three months. Additionally, if the meniscus is involved, the physician may immobilize the patient for an extended period of time as well. All of this adds up to a very stiff knee!

an example of a TPF from medical-definitions.com

Regaining range of motion (ROM) is at the top of the list in rehab and does not come easily. Performing patellar joint mobilizations as soon as possible and establishing a solid home exercise program is vital. Gait training is always a part of the patient’s plan of care which progresses the patient from using a walker, to a cane, to independently ambulating without an assisted device. The gait training emphasizes heal strike, which is why straightening the knee is so crucial. Flexion, or bending the knee, can also be quite challenging and can make it difficult for the patient to go down steps, stand up from a sitting position, tie shoes and dress. Physical therapy visits are sometimes limited and there is much to be done while the patient is in the clinic. Utilizing time outside the clinic to regain ROM is crucial. A great modality that can be used at home is a Dynasplint. Dynasplint Knee Systems stretch the patient into extension or flexion and are available for every size patient. Remember, you can always wait to start strengthening, but you can’t wait to regain ROM. The longer you wait to regain ROM , the harder it will be.

NEW GIVEAWAY! You want the rehab victory, but the road to victory is never easy. So here’s a backpack that’s way more than a bag—it’s an extension of your will to achieve. The Under Armour PTH® Victory Backpack has front laundry locker to keep your sweaty gear separate from your daily gear. Tons of compartments keep you organized and wrapped in highly water-resistant, insanely durable material in Royal Blue, Black and White. When victory’s within reach, this bag will get you one step closer. Giveaway starts today and winner will be drawn next Thursday, Feb. 2 at Noon, EST. To enter, leave a comment here mentioning “range of motion.” Good luck!

When we last chatted (translate-I whined to you) about my left foot, I said that I took matter into my own hands. I have mounted a full-on attack to my plantar fasciitis (PF as known by the cool kids.) What exactly is PF? The plantar fascia, or arch tendon, is a thick band of tissue that runs from the heel to the front of the foot and functions to support the arch. Plantar fasciitis is an inflammatory condition that is brought about by overuse of the fascia due to: running, jumping, bearing significant weight for long periods of time, a lack of arch support in shoes or dancing (in aforementioned naughty shoes.)
The pain is the worst in the heel with the first steps of the morning, because the natural position of the foot while sleeping is with the foot relaxed and the toes slightly pointed down. Go ahead and try it, especially if you are reading this in bed. Snuggle in like you are sleeping and check out your feet. See? Toes are down, and in this position the plantar fascia is the shortest. Overnight, the tissue contracts slightly and when we step out onto the floor in the morning, the foot flexes and that terrible pain is actually micro tearing of the fascia. The cycle repeats itself each day and night. Time to shut.this.down. My plan:
1. When I was at the mean foot doctor she asked if I would like for her to tape my foot. I said yes, and the extra support did feel good under my arch. I googled (of course I did, because you know me and that’s how I ride) and ordered some KT Tape and learned how to wrap my foot for PF. Now- they show a trainer taping a foot but the trick is to do this on your own foot, but with practice, I can and I like the extra support.

2. I am taking Advil to reduce the inflammation. My co-worker who has hip issues swears by Aleve for joint pain vs. Advil for headache. Naproxen vs. Ibuprofen? Are all NSAIDs alike? What do you all say? Leave me a comment and I’ll update us in the next post.
3. This is the big one. I was bold and asked the mean podiatrist for an Ankle Dorsiflexion Dynasplint.  She said, “Yea- I can give you a night splint.” Now I don’t know about you, but when I peruse Sky Mall and other foot catalogues (yup-they found me. I am on several mailing lists) for “Night Splints” that sock with band attached to the toes does not look legit. And the black boot thing? I feel like I would get claustrophobic in that thing. And the arch girdle? I think not. So, I was bold. I named the splint that I wanted and got the prescription. A few days later, I met with my consultant for my custom fitting and took my Ankle Dorsiflexion home.

Tomorrow’s post- The Saga of My Left Foot- Dynasplint-ing! (with a cool giveaway)

My left foot is a mess. The right one is no champion, but is in much better shape than her sister on the left. I shall now list my 3… um. . . – “incidents and diagnosis” via the internet (I confess to being a Google doc. My daughter begs me to get off Web MD. I drive her crazy with my diagnosis of the week) and finally from a legit podiatrist. (more about that later)

1. I had a shoe malfunction. Actually it may have been fashion malfunction, or in fact a user error. I bought some really cool higher wedges to go with some white bell bottom jeans. Whilst posing in front of the mirror, I “fell off” my left wedge. Do not laugh or judge- you know it either has or could happen to you. At any rate, I sprained my ankle and to this day it swells up at the end of a long day or workout. Puffy and sad looking, it eliminates my malleolus (ankle bone) and makes my ankle look fat. Who needs that?
2. I have struggled with plantar fasciitis on and off for the last 15-20 years. Sometimes, I behave myself and wear the right shoes and inserts and do just fine. Then, I’ll get fresh and wear flip flops with lousy instep support all summer and get on a Zumba kick and go all crazy and irritate the heck out of my foot. Heel pain will ensue, and it’s back to my “ugly” shoes, ice and Advil.
3. When I actually went to a podiatrist (who shall remain nameless because of meanness and a discouraging and bad attitude) an x-ray was taken only to reveal that there was no bone spur, but arthritis in the mid foot. Arthritis is such a grandmother (read older lady) word. But I am a grandmother and late fifties, so if the shoe fits. . (forgive the foot humor…) The podiatrist sent me packing with a list of “approved shoes” and by that I do not mean Manolos, Torys,  Nine West or Michael Kors, I also received instructions for icing and Advil. Really? Good shoes, ice and Advil? Because after 20 years of this I had no idea.

All of this adds up to the most awful pain with my first steps out of bed in the morning. A wretched combination of tip-toe, slide, scuff, wall grabbing and ouch groans on the way to the bathroom is how my day starts.
This week, I took matters into my own hands. This may not be a range of motion issue, but is sure is a pain issue and I am in that business. Stay tuned until Part 2 next Thursday along with a totally great giveaway that you can use even in you have a saga with your foot!

The scene of the crime

It happens in the blink of an eye. One moment you are walking down the street, and the next one you miss the step down from the curb and you’re tumbling forward. Instinct says, “Stretch out your arm and break the fall!” Result- face is saved and arm is hurt. Could be just a strain, but sometimes it is a fracture or dislocation of the elbow or wrist.
Now- the elbow is complex and fussy to rehab when it’s injured. It’s a joint that is both a hinge joint and a ball and socket joint. As we move our arm open and closed, it is the hinge joint that allows that extension and flexion to take place. As we rotate our forearm, palm up and palm down, it is the ball joint that allows that supination and pronation to happen.
An injury like a dislocation to the elbow can affect either or both of these motions, and certainly requires a period of immobilization. For range of motion, the injury combined with the immobilization is a deadly duo, and elbow joint stiffness in both directions will ensue. You can count on it. Stretching is the way back to full range of motion, and it is work. You may be at physical or occupational therapy several times a week. You will definitely have a series of home exercises to perform. You may also be prescribed a dynamic splint that will stretch you while you are at rest. Studies have demonstrated that stretching induces lasting increases in joint ROM.
Shirley had lost range of motion in elbow extension and supination, but found her answer with the Dynasplint Elbow Extension and Supination Systems.

Recipe for shortened elbow range of motion: 1 part traumatic injury blended with surgery and 4-6 parts immobilization and voila- you have one stiff elbow. Symptoms of a fracture include pain on the outside of the elbow, swelling in the elbow joint, difficulty in bending or straightening the elbow and inability in turning the forearm. The soft tissue, made up of ligaments, tendons and muscles, needs to be lengthened and remodeled to return full mobility of the joint.  Patient may lack extension (straightening) flexion (bending) supination (turning forearm, palm up) or pronation (turning forearm, palm down.)  In conjunction with physical therapy, the low-load, prolonged-duration stretch of dynamic splinting can help regain elbow ROM while the patient is at rest. What to expect with an Elbow Fracture? Check this out: Elbow Fracture-What To Expect