Rehabilitation of a Broken Femur
Congratulations! You have just broken your femur. They have inserted a titanium rod and released you from the hospital. You have a whole vague collection of rehab instructions. How do you keep track of them all? Here is my list of what I went through and why. Pay attention to the whys. They will help remind you of the importantance of each step. P.S. Yes, the nail is bent when the put it in. It is a bit of a shock to find out that the nail is curved!
  1. Drugs You will have several drugs to take. Their existance and dosage are there for a reason. Believe them. It may help to have someone at home remind you when to take each pill. It is also helpful to create a checklist. Write down all the dates and times for each prescription item and check them off as you go.
  2. NutritionYou are healing several things. Each different item will require different nutrients at different points. Generally speaking a balanced diet will cover most things, but be sure you ask if you have special needs.
  3. Range Of Motion This is the first thing you worry about. Strength will return when you are ready. However there is a two week window before scar tissue starts to harden. The more range of motion you can achieve during this window the less pain you will have later getting the scar tissue to align. Be sure you leave the hospital with an understanding how how you can stretch and improve your range of motion. It helps if you are working with a physical therapist as soon as possible. Make sure you leave the hospital with a prescription for the first couple of weeks of rehabilitation. In my case when I left the hospital I travelled to another state for the first few weeks of recovery. That meant I had to find a new doctor for a follow up and a physical therapy place to learn rehabilitation tricks. Each week there will be different stretches or exercises to do based on how well your recovery is progressing.

    In my case two major muscle groups needed stretching, my hamstrings and my quadriceps. (Back of the thigh and front of the thigh) I found that they could not both be stretched at the same time. Stretching one way limited the range of motion the other day. I stretched four time a day. In the morning I would stretch the quads. An hour later I would stretch hamstrings. This would be repeated two hours before bedtime. I did hamstrings last because I had trouble sleeping because my leg would not straighten out. The steps were the same for both stretches.

    1. Warm up the muscles, either with hot water in the shower or with a heating pad. 10 minutes of heat worked for me.
    2. Massage with an Aloe Vera moisturizing lotion. This was part lubricant and part healing agent. Five minutes of massage helped. The trick was to massage across the grain. The muscles run the long way on your leg. By massaging perpendicular to that you could break up the scar tissue that was not aligned. After scar tissue sets it bonds tissue to bone or other tissue. Scar tissue aligned with muscles will not limit range of motion as much as scar tissue bonding at right angles to muscle direction.
    3. Gentle stretching. Do not go past pain level 3 on a 1-10 scale. You will find that you may need to get into some interesting positions to get the best stretch. Of course if you can get into a heated whirlpool or spa you will find that best. As you stretch the four factors will limit you. Swelling, Scar tissue in muscles, scar tissues in joints, and a stretch reflex. As you stretch a muscle the muscle on the opposite side tightens to protect you from hurting yourself. To keep this reflex from kicking in too strongly you want to move slowly. Any time you can get gravity to help you you may be able to get a better stretch.

    Best Quad Stretches: Sit on a flat surface, like a chair or bed, that will allow you leg to hang over the edge without touching the floor. Early on you will not be to let your leg just hang. You will not be able to bend 90 degrees at the knee. What you can to is use your good leg to control the lowering of the injured leg. The more advanced version of this stretch is to lie on your back near a wall. You should be positioned so that you can rest your good leg on the wall at a 90 degree angle. You will have a show on the good leg and just a sock on the bad leg. Lift the bad leg up high on the wall. Use the good leg underneath the bad leg to control how far down the wall the leg will slide.
    Best Hamstring stretches: Sitting up on a smooth, flat surface extend your leg. You may have difficulty lowering the knee all the way down. Gently tightening the quadriceps muscles to press the leg down should provide a very good stretch.
    • Stretches to not do!
    • Stretches to do.
    • Positions to rest in.

  4. Muscle Tone This is the first thing you will work on. My whole leg felt like a big heavy log that I could not control. Rolling over in bed was almost impossible. Regaining muscle tone will help this. Muscle tone requires simple muscle contractions. Tighten a muscle group and hold it for five seconds. You will do several sets of those at regular intervals. Questions for your doctor or physical therapist include: When do I start these exercises? How often do I do them? In my case I worked up to doing sets hourly. Every hour, for each muscle group I was doing 20 repetitions of 5 second contractions. Muscle groups I found needed work were:
  5. Muscle Strength These exercises will probably start about 5-7 days after you start getting some sense of muscle tone. You will want to procedue with caution. Anything that causes pain should be stopped. You should be working with a physical therapist at this point. They will explain things in greater detail and be charting your progress. Based on how you are doing with whatever your current sets are they will recommend what to add next. The basics though, are as follows. All of these exercises are usually done in two sets of 10-20 reps, twice a day. Each exercise will have two variations. The first one is done for 5-7 days. The second one will be a slightly harder version and you will commence it after sufficient strength has developed to be able to do the exercise without pain.
  6. Crutches Some thoughtful soul will give you a pair of crutches to help you get around. If you are lucky enough to travel on dry, flat surfaces you will have no problem. What little instruction you get for walking will serve you well. The rest of you have some serious worries ahead. You might get instruction, but I suspect it will not help you in two situations, slippery surfaces and steps. The things you need to know about crutches are that you have no use of your hands and your are limited in where you can put your feet down.

    In either case the lesson is that you always need to focus on where your next steps are going to be and where you are putting your feet or your crutches. You will find that you cannot pay any attention to the wonders of life unless you are at a complete stop. The rest of the time you will always have to look where you are going and plan your steps ahead.

  7. Cane At some point in the 3-6 week range you will want to shift from crutches to a cane. The important thing here is that the cane goes in the hand opposite the injured leg. It moves in tandem with the injured leg. The cane and injured leg move forward and plant then the good leg follows through with the next step. Studies show that the cane helps support 40% of the body weight. This means the the injured leg only has to support 60% of the body weight. Following a good physical therapy routine and with normal healing the injured leg will have regained enough strength to support 60% of the body weight about 3-6 weeks. In my case it was just after four weeks that I was able to take short steps. I was thrilled to be able to make the 12 foot trip into the kitchen and return. With crutches or a walker both hands are occupied. With a cane I have a free hand to hold a plate. As with all other steps if it hurts too much (more than three on a scale of 1-10) then discontinue the action until more healing has occurred.

  8. Range of Motion - Update see the Week 19 notes on the main page for more stretching ideas.

  9. Leg Strength - Update see the Week 19 notes on the main page for more exercise ideas. These are exercises I wished I had learned about and tried. I took the doctor's emphasis on weight bearing literally. Walking is the easiest activity to undertake when recovering. If you have access to weights there may be a better way. A lot may depend on how much muscle you lost. I sat for a week before really moving and then spent too much time sitting the following three weeks. That set me back a lot and forced me into a different recovery regimen than most.