A fracture of the tibial plateau -- the flat, articulating surface of the tibia at the knee joint -- causes immediate and excruciating pain. There also is noticeable swelling, tenderness and deformity at the injured knee. This type of fracture can result from severe knock-knees, bowed legs or rotational forces when your foot is firmly planted and unable to move. Severe breaks must be surgically fixed before rehabilitation starts. Consult with your physician regarding rehabilitation for your knee.
Considerations
Though a tibial plateau fracture is a direct injury to the tibia bone, other surrounding structures may also be compromised because of their attachment to the bone. On either side of the tibial plateau lie menisci pads of cartilage that help to absorb shock and provide cushion for the bone of your thigh or femur. Ligaments also attach your tibia and femur together, which are likely to tear in a tibial plateau fracture. It can take up to 12 weeks for your tibia to regain its near-normal strength, but damaged ligaments and menisci can take up to 50 weeks.
Control Pain and Swelling
Reducing pain and swelling are the first steps in physical therapy for a tibial plateau fracture. Immobilization, ice packs and non-steroidal anti-inflammatory drugs such as aspirin are used, especially during the initial week or two of rehabilitation. Swelling and pain at the knee joint causes a reflex shutdown of the quadriceps muscles, so it is vital swelling is reduced as quickly as possible.
Enhance Circulation and Protein Synthesis
Physical therapists use an electrical stimulation machine to apply small currents of electricity over a muscle to stimulate the muscle to contract or to control spasms. While the muscular contractions from electrical stimulation do not create movement at the knee joint, stimulation does reduce swelling by pumping excess fluid into the system. As swelling diminishes, so too does the pain. The less pain you feel, the more likely you are to stretch and strengthen your injured knee. Muscular contractions cause protein synthesis, which promotes healing.
Regain Range of Motion and Strength
Flexibility and strengthening exercises may not begin for one to three weeks after your tibial plateau fracture, depending on its extent and your response to the initial physical therapy. Passive static stretches are used first, followed by active static stretches; passive stretches use gravity or a very light ankle weight to stretch your knee while you pull on your own leg to actively stretch your knee. Strengthening exercises begin with isometric exercises or exercises in which you knees stays at the same length while it is contracting. Light ankle weights and exercise bands are introduced, followed by traditional exercise machines to rehabilitate your fracture.
References
- "Examination of Musculoskeletal Injuries"; Sandra Shultz, Ph.D., Peggy Houglum, Ph.D., and David Perrin, Ph.D.; 2005
- "Therapeutic Exercise for Musculoskeletal Injuries"; Peggy Houglum, Ph.D.; 2005
