Basic physical therapy methods
A wide range of physical modalities is used to normalize tissue trophism and accelerate regeneration. The choice of a specific method depends on the healing stage and the patient's condition.
- Ultraviolet irradiation (UVI): used to stimulate microcirculation. In the postoperative period, the wound itself is irradiated, and at later stages, symmetrical or reflexogenic zones are targeted.
- Interferential currents and electrostatic field: effectively relieve edema, improve local blood flow, and manage pain.
- Electrophoresis: essential in bone pathology. The electric field transports calcium ions directly to the fracture site, stimulating osteogenesis.
- Massage: manual intervention normalizes muscle tone and improves tissue nutrition.
Stages of postoperative rehabilitation
Rehabilitation after surgical intervention (osteosynthesis) is divided into two key periods, each with its own strict objectives.
Early period (up to 2 weeks) The main goal is to create optimal anatomical and physiological conditions for healing. Physicians focus on preventing complications from the gastrointestinal, respiratory, and cardiovascular systems, as well as preventing trophic disorders. Magnetotherapy, pulsed currents, and wound UVI are prescribed to reduce pain and edema.
Late period (2–12 weeks) At this stage, it is necessary to eliminate residual edema, mobilize the postoperative scar, and prevent the development of contractures. Weight-bearing capacity is restored, and gait biomechanics are corrected in the patient.
Methods used:
- Intra-articular infrared laser therapy.
- Low-frequency magnetotherapy and electrical muscle stimulation.
- Electrophoresis with pulsed currents.
- Underwater jet massage.
- Hyperbaric oxygenation (indicated for crush syndrome).
Features of foot and lower leg recovery
Patient management tactics heavily depend on the localization of the injury. The program is always supervised by a multidisciplinary rehabilitation team (MDRT).
Distal lower leg fractures If stable osteosynthesis has been performed, active movements in the ankle joint start from the first days after surgery. Early initiation statistically significantly improves treatment outcomes. However, axial loading (gait training with support) is permitted strictly on an individual basis — usually after 3–4 months, when radiographic signs of fracture consolidation are visible.
Foot fractures (after cast removal)
- Stage 1 (immediately after immobilization): focus on restoring mobility to the ankle and toes. Hydrokinesiotherapy, whirlpool baths, pneumatic compression (barotherapy), UHF, and low-level laser therapy are prescribed.
- Stage 2 (after 5–8 days): strengthening the muscles that support the arch of the foot to restore its shock-absorbing function. The patient performs supination and pronation exercises, and picks up small objects, balls, and cylinders with their toes.
Kinesiotherapy and mechanotherapy
Physical therapy always works in conjunction with exercise therapy (physical therapy/kinesiotherapy). Individual gymnastics include breathing exercises, isometric muscle contraction in the injury zone, and dynamic movements for healthy limbs.
Mechanotherapy is actively used to restore complex daily skills and coordination:
- Exercises on basic devices.
- Robotic mechanotherapy (especially important for the upper extremities).
- Biofeedback (BFB) training based on support reaction.
- Balance therapy to improve stability.
Injury prevention
Prevention of fractures (e.g., femur or lower leg) is divided into two levels:
- Personal responsibility: exercising caution in everyday life, during sports, in traffic areas, and when walking on ice or poor-quality road surfaces.
- State control: ensuring road safety to reduce the risk of traffic accidents, as well as monitoring infrastructure and industries with increased risk.
To remember the tasks of the early postoperative period, use the "PRE" rule: Prevention of complications, Regeneration (creating conditions for healing), Oedema and pain management.
Class and exam questions
When can axial loading be applied to the leg after lower leg osteosynthesis?
Timelines are determined strictly on an individual basis. Weight-bearing gait training is usually permitted 3–4 months after surgery, but only in the presence of radiological signs of bone union.
Why is electrophoresis prescribed for fractures?
The electric field allows for the targeted delivery of calcium ions directly to the injury zone. This is necessary for the active formation of new bone tissue.
Who creates and supervises the outpatient rehabilitation program?
The process is supervised by a multidisciplinary rehabilitation team (MDRT). The exercise plan is directly drawn up by a physical and rehabilitation medicine (PRM) physician or an exercise therapy specialist.
What else to study on this topic
- Methods of hydrokinesiotherapy and underwater jet massage
- Use of hyperbaric oxygenation (HBO) in crush syndrome
- Gait biomechanics and biofeedback (BFB) training
- Prevention of adjacent joint contractures in the post-immobilization period
- Robotic mechanotherapy: types of devices and indications
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