Straightening a leg at the knee after a leg break
December 20, 2009 7:12 AM   Subscribe

Niece EvilBreakfast is on the road to recovery after a break of the femur. Although doctors say that the positioning of the pins inserted to help heal the break shouldn't cause a problem, since the bandages came off she's unable to straighten her knee. Physio has not helped, and after 3 months we're starting to get concerned. The doctors and physiotherapists are saying that there's no reason for the problem; you are not my doctor... But has anyone else come across this and have any suggestions?
posted by Mrevilbreakfast to Health & Fitness (11 answers total)
I can't speak to a femur break, but I can tell you that the single element that made the biggest difference for me in terms of range of motion for my knee after surgery was swimming. A friend who spent 9 months limping after waking up one morning and being unable to fully extend his knee had similar results when he finally tried it out of sheer frustration when his regular physio had no real impact.

Other things that can help: elevating her foot above her hip on a pile of cushions so that gravity can extend the knee over time; laying flat on a bed or table and having a physio or someone slowly lower her bent leg until her knee is straight. Both of these should be slow and gentle and help with the ability to extend over time.
posted by DarlingBri at 7:55 AM on December 20, 2009

Just a clarification question to this:

The doctors and physiotherapists are saying that there's no reason for the problem

To be clear - are the doctors and physios:

1. Aware of the problem and not concerned about it (e.g. they feel it will get better over time)?


2. Aware of it, have no explanation for it, and haven't seen this?

I ask because I think sometimes docs and PT's do a lousy job of explaining the general rehab timeline to patients (in their defense, there are tons of variables, unpredictabilities, etc. But still, many could do a better job). I'm 10 weeks post-surgery on an ACL repair, and I don't yet have full range of motion on my knee. In talking about it with my PT this week, she's not surprised, ok with it, and explained that the time required to regain full range of motion varies from person to person.

That's an explanation I can live with. If she'd said "Gee, you should be getting there, there's no reason why you can't fully rotate your knee," I'd be freaking out too.

I apologize that I'm not helping answer your question, I just hope the clarification helps others answer it for you.
posted by swngnmonk at 8:12 AM on December 20, 2009

When I broke my elbow it was about six months before I regained full range of motion (or as full as I was going to get.) But I was in physical therapy the whole time and seeing measurable, if slow, progress. When you say "physio has not helped" do you just mean she still can't straighten the knee, or that the range of motion hasn't been increasing? What do the physical therapists say about the eventual range of motion she can expect?
posted by escabeche at 8:22 AM on December 20, 2009

A year or two ago, I broke my elbow.The physical therapy regimen recommended to me did nothing to help. After three months of following their regimen 3X/day, I got frustrated and started riding bike again, one-handed. Startlingly in a single week I gained more range of motion than I had in the 3 months of doing what I was told to do. Total time was about 6 months and I have, as far as I can tell, full use of my elbow.

In this case, swimming sounds like a much safer, saner alternative.
posted by fake at 8:47 AM on December 20, 2009

How many doctors do you have? Can she get a second opinion from another orthopedist? Every time I have a joint problem, I try to get a second opinion. The first time I did this was geographical (I had to move in the middle of treatment), and the second doctor's treatment plan was radically different from the first, and so was the diagnosis! Whaaat? I have come to understand that this is really common among orthopedists.
posted by kathrineg at 8:49 AM on December 20, 2009

If the therapy regimen isn't helping, tell your PT. There's a wide range of exercises and therapies that PTs have in their toolkit to help your niece get functionality back. Your niece's PT should be soliciting this feedback, but it doesn't sound like that's the case, so go ahead and actively tell him/her. If your niece or sibling is unhappy with the pace of progress, hell, ASK! There's an average timeline for recovery, but obviously people fall on both sides of the mean.
posted by squorch at 11:52 AM on December 20, 2009

I agree; swimming is perfect for this. Just letting your body float free, and wiggle with just a little bit of support/resistance from the water. She won't realize how much she's loosening up.

That's probably what helped me when I broke my elbow and had surgery. It wasn't that it hurt to move my elbow past a certain point; I just COULDN'T, and I was devastated at not seeing what I considered progress. It was like my muscles had forgotten how to do it. But suddenly I got back from a vacation (during which I had hung out in a pool -- not even swimming, just floating and bobbing around), and I had magically gotten there.

My boyfriend also had something similar happen to him; he broke his femur and lost a lot of motion in his ankle due to the immobility, even for years afterward. Finally, about 10 years after the accident, he just tried to wiggle it a lot more and stretch it out. Now he's got a lot more side-to-side motion than he had had. So don't ever think that it's too late.

IANAPT, but is she using heat as well? When I went to my therapy sessions, they'd weight down my arm with some heavy heating pads for about 15 minutes before we worked out. That not only helped stretch the muscles, but loosened things up so I could stretch a little more with effort.
posted by Madamina at 1:42 PM on December 20, 2009

I had knee reconstruction. It took years to get better range of motion, and I still have a lot of difficulty. The physical therapists would weigh my leg down to break up the scar tissue, it helped. Exercise and stretching works, but she may never get back to where she was. My husband broke his humerus about 3 years ago. He lifts weights and exercises a lot, but he still does not have complete range of motion. When my husband asked the doctor about this, he said it was not unusual and that is why he suggests people avoid breaking limbs :0
posted by fifilaru at 6:17 PM on December 20, 2009

I broke my femur fairly high on the leg, so my knee wasn't really involved. Range of motion was not a problem for me. That said, my hip range of motion was definitely impaired, and it was about 6 months before I had the full range of motion back and 9 months before I walked pain free. It's a big bone, and I wouldn't rule out the possibility that 3 months is just too soon for full recovery.

I've read that femur breaks are often associated with knee injuries (not surprising, I guess). I'm assuming that the doctors have already done an MRI of the knee to rule out additional injuries, or explained why that isn't necessary. I also assume that they've given you a somewhat convincing explanation of why the knee is slow to respond. If not, I'd absolutely rush to an unaffiliated bone doc for a second opinion. If they have, I'd still seek an unaffiliated second opinion - I did, and feel that it improved my outcome.

Was your daughter's leg immobilized at all while the bone healed? I understand they try not to do that these days. I never had a cast, and was putting weight on it and crutch-walking around the day of my surgery. If her leg was immobilized, it can easily take more than 3 months for full range of motion to return. I've broken other joints, including an elbow. That didn't fully come back until 5 months had passed.

Good luck to your niece.
posted by centerweight at 9:09 PM on December 20, 2009

Just noticed that you live in the UK. I have no idea if a second opinion is as easily obtained as it is here (assuming you're one of the lucky individuals with good insurance). Perhaps someone who knows more about your health care system can provide more useful advice.
posted by centerweight at 9:12 PM on December 20, 2009

My mom broke her femur, had subsequent knee problems, and it took an MRI many months later to determine that she also had torn a tendon in her knee. Just a data point suggesting looking in to an MRI if she hasn't had one and it continues to be a problem.
posted by supramarginal at 12:59 PM on December 23, 2009

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