Comprehensive Guide on Hip Fracture Physiotherapy

Hip fractures are a serious medical condition that usually requires an operation. Fortunately, hip fracture physiotherapy treatment can significantly improve recovery and help you regain mobility after surgery.

Patients benefit from starting rehabilitation exercises as early as a day after hip surgery. These therapies focus on keeping them mobile, which not only helps restore strength but also potentially reduces prolonged bed rest. This early intervention gets patients back on their feet faster.

This guide will provide a comprehensive overview of hip fractures, treatment options, and the role of physiotherapy in achieving the best possible recovery outcomes.

Overview of Hip Fractures

Hip fractures occur when the bones in your hip joint break. The most common type is a femoral neck fracture, which affects the upper part of the femur (thigh bone). These fractures can be disruptive, causing severe pain and limiting mobility.

Most hip fractures are caused by falls, especially among older adults with weaker bones or balance problems. Singapore's fracture rates are expected to surge to a staggering 9,000 by 2050 from the current 2,500 per year due to age-related factors.

Thanks to research, treatment for hip fractures is constantly evolving. A randomised clinical trial and a peer-reviewed study published in BMJ Open Journal investigated the effectiveness of intensive physical therapy following hip fracture surgery. This study found that patients experienced improved outcomes in hospital length of stay and functional recovery compared to those receiving standard care.

Hip Fracture Classifications

*Maybe we can include a photo (of the bones) here like the one used for physiotherapy for labral tear hip

Fractures in the hip can be classified based on their location within the hip joint:

• Intracapsular fractures: These fractures occur within the joint capsule, typically involving the femoral neck.
• Extracapsular fractures: These fractures happen outside the joint capsule, often affecting the trochanter, the upper rounded area of the femur.

Understanding the specific type of fracture is crucial for determining the most suitable treatment approach.

Who Usually Suffers from These Risk Factors?

Hip fracture risks most commonly rise with age. Several factors can increase the risk of sustaining a hip fracture, including:

• Osteoporosis: This disease weakens bones, making them more susceptible to breaking even from minor falls.
• Falls: A leading cause of hip fractures, falls are particularly dangerous for older adults with balance problems.
• Previous fractures: Having a prior fracture increases the risk of future fractures due to weakened bone structure.
• Underlying medical conditions: Certain medical conditions like arthritis, medications that affect bone density, and vision problems can also contribute to an increased risk.

This knowledge about risk factors empowers healthcare professionals to make informed decisions. Studies have shown that increased awareness and education on hip fractures can contribute to a decline in such cases, highlighting the importance of proactive measures.

Hip Fracture Treatment

Hip fracture surgery aims to stabilise the broken bone and promote healing. Common surgical procedures include:

• Internal fixation: Screws or pins are used to hold the bone fragments together.
• Hip replacement: The damaged joint is replaced with an artificial implant.

The choice of surgery depends on the type and severity of the fracture, as well as the patient's overall health. Physiotherapists then tailor treatment strategies compatible with the surgical approach, designed for the patient's specific needs and limitations.

Similar to hip impingement physiotherapy, which focuses on restoring function after injuries within the hip joint, post-surgical rehabilitation for hip fractures plays a vital role in recovery.

What Are the Goals of Hip Fracture Physiotherapy?

Hip fracture physiotherapy has several key objectives to optimise recovery and regain lost function.

As a physical therapy provider specialising in muscle, bone, and joint health, Phoenix Rehab in Singapore understands the importance of comprehensive rehabilitation after a hip fracture. Their team of experienced physiotherapists works closely with patients to create a personalised treatment plan that addresses their unique needs.

Below are some of the key goals in physiotherapy treatment.

Pain Management

Physiotherapy techniques can effectively reduce pain and inflammation, improving comfort and facilitating participation in rehabilitation exercises. This method also applies to physiotherapy for osteoarthritis of the hip, a common condition characterised by the breakdown of cartilage in the hip joint.

Improved Range of Motion

Regaining flexibility and a normal range of motion in the hip joint is essential for daily activities. Physical therapy helps achieve this by incorporating specific stretching and mobilisation exercises. These exercises also apply to physiotherapy for labral tear hip and other hip conditions.

Enhanced Muscle Strength

Strengthening the muscles surrounding the hip joint is crucial for stability and supporting the fracture site during fracture healing. Physiotherapy incorporates targeted exercises to rebuild muscle strength progressively.

Balance and Coordination Training

Restoring balance and coordination is essential to prevent falls and regain confidence in movement. Physiotherapists utilise specific balance exercises to achieve this goal.

Weight-Bearing Progression

A crucial aspect of physiotherapy involves gradually increasing the amount of weight placed on the injured leg as tolerated. This promotes bone healing and helps retrain the body for weight-bearing activities.

Functional Mobility Restoration

The ultimate goal of physiotherapy is to help patients regain functional mobility for performing daily activities like walking, climbing stairs, and dressing independently.

By addressing these critical areas, physical therapy empowers patients to achieve optimal recovery and return to their desired level of function.

What Is Involved in Hip Fracture Physiotherapy?

Following a hip fracture diagnosis, the road to recovery begins with a combination of pre-operative and post-operative physiotherapy interventions.

Pre-Operative Exercises

While initial bed rest might be necessary for pain management and pre-surgical preparation, early mobilisation exercises are crucial for preventing complications like blood clots and muscle wasting. Pre-operative physiotherapy often includes:

• Ankle pumps: Simple yet effective, these exercises involve repeatedly flexing and extending the ankle joint, promoting circulation and preventing blood clots.
• Knee extensions: Straightening and bending the knee joint helps maintain some muscle tone in the quadriceps, which are critical for supporting the hip joint.
• Isometric exercises: These exercises involve tensing specific muscles without actual movement. This helps maintain muscle activation and strength without putting undue stress on the fracture site.

Early intervention with these gentle exercises can significantly improve outcomes and prepare the patient for a smoother transition to post-operative physiotherapy.

Post-Operative Exercises

Post-operative physiotherapy typically commences within 24 hours after surgery and is just as important as the surgical intervention. It must be a personalised program based on the patient's progress and specific needs.

Here's a closer look at some common post-operative physiotherapy exercises:

• Hip flexion exercises: These exercises progressively increase the ability to bend and lift the leg towards the chest, regaining flexibility and range of motion in the hip joint.
• Strengthening exercises: Targeted exercises focus on strengthening the muscles around the hip and leg, improving stability and supporting the healing fracture. These exercises may involve using weights, resistance bands, or bodyweight exercises as tolerated.
• Balance exercises: Activities like standing on one leg or practising walking with a walking aid help improve balance and coordination, reducing the risk of falls during recovery.
• Gait training: This phase focuses on relearning proper walking mechanics with weight-bearing on the injured leg. Initially, therapists may utilise walking aids for support, gradually progressing towards independent walking.

Partial weight-bearing, as mentioned earlier, is a cornerstone of post-operative physiotherapy. This involves putting a specific percentage of body weight on the injured leg while walking or performing exercises. The physiotherapist will guide patients on the appropriate weight-bearing progression based on their individual healing process.

Tips for Your Hospital Stay

A hospital stay after a hip fracture is an opportunity to begin your recovery journey. Here are some tips to help you make the most of your time in the hospital and promote a smooth transition to physiotherapy at home:

• Be an Active Participant: Don't hesitate to ask questions and voice any concerns you have about your surgery, recovery process, or physiotherapy plan. The more informed you are, the more empowered you'll feel to participate actively in your recovery.
• Embrace Early Mobilisation: While initial rest might be necessary, participate in prescribed physiotherapy exercises as soon as possible. This helps prevent complications, maintain muscle tone, and prepares you for more advanced physiotherapy after surgery.
• Practice with Assistive Devices: Familiarise yourself with using walking aids like walkers or crutches under the guidance of your physiotherapist. This builds confidence and prepares you for independent mobility after discharge.
• Pain Management is Essential: Communicate any pain you experience to your doctor and nurses. Effective pain management allows you to participate more actively in physiotherapy and daily activities, promoting faster recovery.
• Maintain Good Posture: When sitting or lying in bed, focus on maintaining good posture to prevent muscle contractures and pressure sores. Your physiotherapist can provide specific instructions on proper positioning.
• Engage with Your Support System: Don't hesitate to ask family and friends for assistance with personal care needs or emotional support. Having a strong support system can significantly enhance your recovery experience.
• Prepare for Home: Discuss discharge plans with your doctor and physiotherapist. This includes understanding any restrictions you might have, home modifications needed to ensure safety, and how to manage your physiotherapy program at home.

Following these tips and actively participating in your care plan can transform your hospital stay into a positive foundation for a successful recovery journey.

Tips for When You Get Home

Following discharge from the hospital, the focus shifts to maintaining the momentum gained through physiotherapy and continuing the rehabilitation process when you get home. Here are some valuable tips for a successful recovery at home:

• Home-based exercise program: Diligently follow the personalised exercise program prescribed by your physiotherapist. Consistency is key to maintaining progress and achieving long-term functional goals.
• Fall Prevention: Modify your home environment to minimise fall risks. This may involve removing clutter, installing grab bars in bathrooms, and ensuring proper lighting throughout the house.
• Assistive Devices: Continue using walking aids or other assistive devices as recommended by your physiotherapist. These provide essential support and promote safe mobility during recovery.
• Pain Management with Medication: Manage any lingering pain with medication as prescribed by your doctor. Effective pain control allows for better participation in physiotherapy exercises and daily activities.
• Fuelling Your Recovery: Maintain a well-balanced diet rich in calcium and vitamin D to support bone health and healing. Adequate hydration is also crucial for overall recovery.

Conclusion

Knowing the nature of hip fractures, the risk factors involved, and the power of physiotherapy in the recovery process, you can take proactive steps to prevent falls and maintain bone health. Following a hip fracture, comprehensive physiotherapy provides a roadmap for regaining mobility, rebuilding strength, and ultimately, returning to a fulfilling and independent life.