Tag Archives: strength

Physiotherapy after a Fracture

By Courtney Lacey, PT

fractureIf you have recently broken a bone, you may be wondering when you will be able to return to all of your normal activities. While it typically takes 4-8 weeks for a bone to heal, you will likely require physiotherapy to help get you back to full function.

How do fractures happen?

A broken bone, also known as a fracture, can occur in many ways. Most often, broken bones are the result of a traumatic mechanism of injury such as a fall, motor vehicle accident or contact during a sporting event. Fractures can also occur from repetitive motions which place stress on the muscles and bones. A common example of this is stress fractures in the legs from running. Finally, fractures can more easily occur in people with osteoporosis – a disease which weakens bones and makes them more likely to break.

How do you know if you have a fracture?

These are some signs and symptoms which may indicate that you have a fracture:

  • Immediate and severe pain following a fall or accident
  • A “pop” or “click” heard or felt during the incident
  • Swelling in the area
  • A bump or deformity
  • Unable to weight-bear through the injured limb

If you suspect you have a fracture, you will need to see a doctor who will order an X-ray to confirm the diagnosis. Often, those who experience an injury causing a fracture will go to the hospital to be evaluated.

Does a fracture heal?

While bone healing takes approximately 4-8 weeks, the timeline depends on both the person and the type of fracture.  In order for a bone to heal properly, it has to first be set in the proper position, which is called reduction. The doctor may be able to reposition the bones without surgery, which is called a closed reduction. Sometimes, surgery may be required to bring the ends of the bone close together, which is called an open reduction. Pins, plates or screws may also be used to keep the bones in place. If the fracture did not cause any part of the bone to shift out of place, no reduction is needed. Once the doctor has determined the bones are in a good position to allow for healing, the area will be immobilized in a cast or a splint.

When can the cast come off?

To determine if you are ready to have the cast removed, you will have an X-ray done with the cast or splint in place. The doctor will look for the formation of a callus, which demonstrates that healing has taken place. The doctor will then remove the cast and may recommend that you have physiotherapy. Physiotherapists play a key role in returning you to your full function as quickly as possible after a fracture.

Why do I need physiotherapy?

There are several reasons why physiotherapy is needed after fracture. Depending on the amount of healing that has occurred, your doctor may have special instructions (how much weight to put through the limb, certain activities to avoid, etc.) that your physiotherapist can help you understand. Once the cast is removed, you may still have some swelling and pain around the fracture site. Physiotherapists may use modalities (such as ultrasound or TENS) to help decrease pain and swelling and improve your mobility and tolerance for using the injured limb in daily activities. If you had surgery, you may also have a scar which creates scar tissue and can disrupt movement. At BodyTech Physiotherapy your therapist will use manual therapy techniques to help mobilize the scar tissue and the areas around the injury as needed to  restore normal movement around the surgical site.

Physiotherapy is crucial to improve your functional mobility that you may have lost during your time in the splint or cast. Immobilization over 6-8 weeks will cause loss of range of motion and strength, which will make daily tasks difficult to do. Your physiotherapist will help restore your proper range of motion using manual therapy techniques. While the fracture site will be stiff and sore, you may also lose range of motion at surrounding joints that were moving differently during the healing process. For example, if you have broken your elbow, it is also necessary to  assess your shoulder, wrist and hand to ensure that these joints are moving properly. Not correcting the mobility around the fracture site can prolong your healing process and lead to future injuries as well.

Once your range of motion has been restored, you will need to regain strength in order to return to your pre-injury activities. Your physiotherapist will work with you to create a proper strengthening program to re-introduce your bones to loads and stresses that you encounter in your daily activities. Lack of strength or going back to activity too soon puts you at risk of re-injury or prolonging the healing process. Physiotherapy will help you understand the correct exercises to do and will tailor your program to the activities you plan to return to, whether it be high level sport or recreational activity.

How long until I am back to my regular activities?

Your rehab program will vary in length depending on the type of fracture, if there was surgical intervention, and the type of activity you plan to return to. Depending on the nature of the injury, physiotherapy can take anywhere from 8 weeks to one year for more complex fractures. Your physiotherapist will guide you through your rehab program, ensuring you are progressing at an appropriate rate and prevent complications or future injury.

BodyTech Physiotherapy

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Why dancers need the perfect balance of strength and flexibility

By Kelsey Jack, PT

My ballet teacher once told me that given a choice between having strength and flexibility, she would choose strength. This has always stuck with me as there is such an emphasis on flexibility within the dance world that often there is a lack of focus on building the strength required to make use of that flexibility. This enhanced focus on flexibility instead of a balance between strength and flexibility creates muscle imbalances. If dancers work to improve their flexibility and ignore balancing the strength around the joints, it leaves the dancer vulnerable to injury.

Why is balancing strength and flexibility important?

Stability is provided to joints from a combination of passive and active structures. Passive structures include the bones that make up the joint and the ligaments that surround it and support it. Active structures are the muscles and tendons that act to both maintain stability and move the joint. Focusing on passive, static stretching, as is often the case in dance, can lead to instability of joints as the ligaments that are meant to stabilize the joint become stretched out and no longer provide joint support.

Flexibility, or range of motion can be divided into two categories: passive and active. Passive range of motion is demonstrated by how high a dancer is able to lift their leg using their hands whereas active range of motion is how high a dancer is able to lift their leg using their hip muscles and is demonstrated by doing a step like a developpé.  Practically speaking, flexibility without strength limits active range of motion and will hinder the height of legs when performing steps that involve controlled movements and sustained positions.

Back bends are a good example of a movement that is common in dance where strength is required to balance the flexibility of the spine. Dancers without good core strength and control will hinge through their spine, relying on one or two segments to gain all of their movement through. This leaves the spine vulnerable to injury as the ligaments and discs are relied on for support. Ideally when doing a back bend the spine should form a “C” curve. Many teachers instruct dancers to breathe up and extend through the top of their head into their back bend to encourage control into this movement pattern. Engagement of the abdominals and stabilizer muscles of the spine are required to move through each segment of the spine in a way that supports the passive structures of the back to create the desired curve.  It is subtle differences such as these in how a dancer moves, using strength to control their flexibility, that improves the quality of movement and decrease the future risk of injury.

Evidence to support strengthening to increase flexibility

As dancers are often concerned about their hip flexibility, a study was done looking into the best way to increase hip active range of motion. The researchers compared three stretching programs over a six week period. The first group of dancers completed a strengthening program where they worked at strengthening their hip flexors at the end of their available range of motion. The second group completed a “light” stretching program for their gluteals, hamstrings, calves, and quadriceps muscles, holding each stretch for 1 minute. This group was asked to perform stretches at an intensity of 3/10 on a scale where 0 is no stretch and 10 is an intense stretch that elicits a burning sensation. The third group performed the same stretches but at a “moderate-high” intensity which was rated as 8/10 on the same scale. The study found that all three groups had an increase in their passive range of motion but only the strength training and the low intensity stretching groups improved their active range of motion. The strengthening group saw the greatest improvements in both passive and active range of motion which is explained by the hamstrings relaxing as the hip flexor is contracted. This allows the hamstring to lengthen while the hip flexor is strengthened. Intense stretching without strengthening (as in the high intensity group) leads to lengthened, weakened muscles which functionally hinder a dancer’s ability to make use of their range of motion. This study demonstrates that exercises that specifically train the hip flexors progress flexibility in a way that translates into dance.

Strengthening allows dancers to maximize their flexibility without compromising the integrity of their passive support structures and increasing their risk of injury. A physiotherapist can assess a dancer’s strength and flexibility and develop a program that will safely allow a dancer to increase their flexibility while strengthening the muscles needed to support their joints, improve performance, and decrease risk of future injury.

BodyTech Physiotherapy

References:

Wyon MA, Smith A, Koutedakis Y. A Comparison of Strength and Stretch Interventions on Active and Passive Ranges of Movement in Dancers: A Randomized Controlled Trial. Journal of Strength and Conditioning Research. 2013. 27(11)3053.

How Physiotherapy Can Help With Osteoporosis

By Lana Kovacevic, PT

Exercise step classOsteoporosis is a condition of reduced bone strength that causes bones to be more likely to break (1). It is a progressive disease in which the density and quality of bone decreases over time making it more fragile. Current trends show that more and more people are affected by osteoporosis each year (1). Among Canadian men and women, an estimated 1 in 4 women have osteoporosis compared to 1 in 8 men (1).

Why is osteoporosis so concerning?

The major threat to healthy aging and independent mobility for those with osteoporosis is the risk of sustaining a fragility fracture. A fragility fracture is a broken bone that results from minimal trauma or stress – stress which typically would not cause a bone to break (1). An example would be breaking a bone in the wrist or hip after falling from standing height (1). After an initial fragility fracture, you become more than two times as likely to sustain another fracture in the future (1). The most common bones to be injured are those of the wrist, upper arm, ribs, spine, pelvis, and hip (1).

Who is at risk for osteoporosis?

Canadian guidelines recommend that all postmenopausal women and men over the age of 50 years be screened for their risk of osteoporosis (1). A diagnosis is made following an X-ray that measures bone mineral density. This test is recommended for those who have at least 1 major or 2 minor risk factors (1).

Figure 1: Some key major and minor risk factors for osteoporosis (1)

Major Risk Factors Minor Risk Factors
  • Age over 65 years
  • Family history of osteoporosis fracture
  • Early menopause (before age 45)
  • Glucocorticoid therapy for more than 3 months
  • Falls
  • Smoking
  • Diet low in calcium
  • Body weight less than 57 kg
  • Rheumatoid arthritis

How can I check if I am at risk for osteoporosis?

A convenient online tool for estimating the risk of osteoporosis fracture exists called the FRAX® Fracture Risk Assessment Tool. Click on this link to get an estimate of your personal risk. If you are concerned about your risk for osteoporosis, it is best to consult your family doctor.

How is osteoporosis treated?

Apart from medical management with medication and supplementation, exercise is a key component of treatment. Exercise has been shown to slow the loss of bone mineral density and reduce the risk of falling (1). This means that exercise can be beneficial for both preventing osteoporosis as well as managing symptoms for those already diagnosed with osteoporosis.

Can physiotherapy and exercise help if…

…I’m concerned about developing osteoporosis in the future?

For anyone at an increased risk of osteoporosis or those with a family history of osteoporosis, taking part in weight-bearing physical activity and activity that involves some impact is best for preventing bone loss. Starting this type of exercise at a younger age may make you less likely to suffer from osteoporosis in older age.

…I’ve already been diagnosed with osteoporosis?

For those with osteoporosis, exercise is important to help minimize bone density loss. It is also critical for reducing the risk of falling and therefore, a broken bone. Risk of falling is higher for people with poor strength, balance, posture, and with poor postural stability. All of these factors can be addressed and improved with a proper exercise program.

…I’ve already had a fragility fracture and want to avoid having another one in the future?

A safe exercise program is also beneficial for those who have already suffered a broken bone associated with osteoporosis. Less than 20% of women (or 1 in 5) and 10% of men (or 1 in 10) who have had a fracture are given the appropriate treatment to prevent a future fracture (2). It is important to restore safe movement patterns during recovery from a fracture as well as to reduce the risk of sustaining another fracture.

Each person is unique and should have an exercise program that is tailored to their specific needs. A physiotherapist can assess, treat, and teach you how to reduce your risk of osteoporosis, manage your symptoms, and improve your general health and physical functioning.

Reference:

  1. Brown JP, Josse RG. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002. 167(10); S1-34.
  2. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010. 182(17): 1-10.

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