Kieran came to me when he was still in the very early stages of post-surgical recovery from a tibial plateau fracture and re-surfacing, meaning the surgeon had to fix the top of his tibia where his lower leg meets his knee. This point is particularly bad to break as it is a connection point for several muscles in his leg. He was still on crutches and presented with numerous challenges to overcome, including:
• Decreasing the swelling and inflammation in his lower leg and knee.
• Learning to fully weight bear without the use of crutches.
• Minimising the limp in his walk caused by weakness, pain and lack of mobility
• Regaining the strength and muscle mass in his lower leg / calf and his thigh which had significantly deteriorated.
• Increasing movement, mobility and flexibility predominantly in his injured knee and adjoining hip but also focusing on overall flexibility as both legs were extremely tight due to too much walking and a lack of stretching.
Kieran came to me about 10 weeks after his accident, 7 weeks since surgery and 1 week post weight bearing. He had been working with an experienced physiotherapist, Dave Sheppard from MGS Physiotherapy at Manly and continued to do so while under my care. During his period of rehabilitation he was diagnosed with a DVT in his injured leg which further complicated the recovery process. While Kieran had little experience in gyms and was new to most of the equipment, he was aided by excellent cardio-vascular fitness from swimming, engaged in regular exercise, did not smoke and was not overweight.
To attack all these challenges we broke our sessions into 3 different parts: Movement, mobility and strengthening.
Movement: This consists of light cycling on a stationary bike to increase blood flow to the area and gently increase range of motion in the ankle and knee joint. This then built into slightly more functional movements which are used in everyday life such as stepping up and down on a step.
Mobility: This is to increase the range of motion (ROM) through stretching, use of a vibration plate and active stretching. Optimally the goal is getting both legs back to similar flexibility levels and ROM.
Strengthening: Working both legs together and separately to get back to the same level through traditional strengthening exercises such as a leg press and light leg extension, then mixing it with more functional exercises including squats, lunges and deadlifts. We also incorporated bosu balls to work in stability. This helped increase his muscle mass bringing it more back to its original level.
As of September 2015 we have been working on Kieran’s rehabilitation for 6 months. He has made progress despite having some setbacks including knee stiffness and soreness after a long bushwalk in the Northern Territory, which necessitated a temporary break from training. He has maintained a disciplined approach to the regular weekly sessions with me in the gym. I am still working on his strength and mobility starting to incorporate all 3 planes of motion focusing on transverse / rotational movements. As Kieran wants to get back to skiing, hopefully in February 2016, core, glutes and inner / outer thigh strength is important.