Tibial Plateau Fracture Recovery: Physical Therapy Exercises

A tibial plateau fracture is a fracture of the top of the tibia or shin bone. Tibia plateau fractures most commonly occur from motor vehicle accidents, falls, or high-impact sports collisions. For a tibial plateau fracture to heal properly, you will require physical therapy to rehabilitate you back to your prior level of function. 

This article will review physical therapy exercises for a tibial plateau fracture, a general recovery timeline, and tips for getting started with physical therapy.

Location and Pain Sensation of a Tibial Plateau Fracture 

A tibial plateau fracture will cause a deep ache and/or sharp pain within your knee joint and at the top of your shin bone where the fracture occurred. Pain may also radiate down your leg and into your foot, and a visible deformity of your knee and significant swelling will be present. In addition, bearing weight through your leg to stand up or walk will be incredibly difficult and painful, and you may need to go to the emergency room.

When to Begin Rehabilitation  

Rehabilitation for a tibial plateau fracture should start as soon as possible under your healthcare provider’s recommendations. However, if the break is severe enough, you may need to go to the operating room after injury to realign your bone and secure the broken pieces to heal. 

Physical Therapy Exercises for Tibial Plateau Fracture

Exercises for a tibial plateau fracture strengthen your glutes, quadriceps, and hamstrings that support and stabilize your knee and leg. You will start with non-weight-bearing exercises and gradually progress to weight-bearing exercises as you can tolerate putting more weight on your leg as it heals.

Heel Slides

Heel slides help bend your knee to restore the range of motion of your knee.

To perform this exercise:

• Lay on your back and place a towel under the heel of your affected leg. 
• While keeping your heel in contact with the surface you are lying on, pull the towel with both arms to slide your foot closer to your body as you bend your knee. 
• Once you cannot bend your knee any further, hold this position for 5 seconds, then slowly straighten your leg. 
• Repeat for 20 repetitions, holding the stretch for 5 seconds each time. 

Quadriceps Stretch

Stretching your quadriceps muscles helps maintain proper flexibility of your leg muscles and helps improve your ability to bend your knee. 

To perform this exercise:

• Lay on your stomach and place a long towel around the foot of your affected leg. 
• Grab both ends of the towel with one hand and pull your leg, so your foot moves closer to your buttocks. 
• Hold this stretch for 30 seconds, then relax. 
• Repeat for three sets of 30 seconds. 

Bridges

Bridges help improve the strength of your glutes, powerful muscles that help support and stabilize your legs with walking, stepping up when climbing stairs, and standing up from a seated position. The glutes also provide strength and stability for your legs to help balance.

To perform a bridge:

• Lie on your back with both knees bent and feet flat
• Squeeze your glute muscles to lift your hips as high as you can without pain. Keep your back flat, and do not arch your back.
• Hold for three seconds at the top, then lower your hips back down.
• Rest, then repeat for a total of three sets of 10 repetitions.

Clamshells

Clamshells help strengthen the glute muscles, specifically the gluteus medius muscles on the sides of the hips, that help provide support and stability to help you maintain your balance when moving and changing directions.

To perform this exercise:

• Lie on your side with your knees bent and feet flat with a resistance band placed around your thighs above your knees.
• Keeping your feet flat, push your knees out to the sides against the band.
• Hold for three seconds, then bring your knees back together.
• Rest, then repeat for a total of three sets of 10 repetitions.

Straight Leg Raise

Straight leg raises help improve the strength of your hip flexors to lift your leg and quadriceps to stabilize your knee.

To perform this exercise:

• Lie on your back with one leg bent and one leg extended.
• Tighten the thigh muscle of the extended leg and lift your leg while keeping your leg straight the entire time.
• Slowly lower your leg while keeping your thigh muscle tight and your knee straight.
• Repeat for three sets of 10 to 15 repetitions.

Side-Lying Straight Leg Raise

Side-lying leg raises can help strengthen your gluteus medius, a muscle that helps stabilize the leg.

To perform this exercise:

• Lie on your side with your body in a straight line– hips, knees, and ankles stacked on top of each other, keeping your legs straight.
• Slowly lift your top leg up while keeping your leg straight the entire time. Do not let your body or hips roll backward or forward.
• Hold your leg at the top position for one second.
• Slowly lower your leg while keeping your knee straight.
• Repeat 10 to 15 times, completing a total of three sets.

Sit to Stand

This exercise helps strengthen the glute and quadricep muscles to improve your ability to bend down, squat, and get in and out of a chair.

To perform this exercise:

• Sit in a chair with a hard surface (using a soft chair or couch will make it harder to stand up).
• Lean your body forward so your nose is aligned with your toes.
• Use your legs to push yourself up from the chair. Try not to use your hands to help you push up from the chair surface.
• Squeeze your glutes at the top to fully extend your hips once standing upright.
• Hold for 1 second, then push your hips back and slowly lower yourself back onto the chair.
• Rest, then repeat for a total of three sets of 10 repetitions.

Step-Ups

Step-ups help improve the overall strength of your leg by targeting multiple muscle groups, including the hip flexors, quadriceps, and glutes, to support your ability to lift your leg and bear weight on your leg, especially with going upstairs.

To perform this exercise:

• Stand in front of a small step with handrails on each side.
• While holding onto the handrails, lift your affected leg to place your foot on the step.
• Step up with the affected leg, then follow with the other leg.
• Then step down backward with the unaffected leg first, followed by the affected leg.
• Rest, then repeat for a total of three sets of 10 repetitions.

Tools and Exercise Aids 

In the beginning stages of recovery from a tibial plateau fracture, you will need crutches or a walker to help support your body weight. If you are not allowed to stand on your leg, you may need a wheelchair for the initial weeks following surgery to get around.

Once you build up enough strength in your leg to support your body weight and improve your balance, you may progress to using a cane or no assistive device to help you walk.

Estimated Recovery Timeline 

A tibial plateau fracture can take three to six months or more to heal completely depending on the severity of your fracture. Pain levels will decrease, and walking will be easier after one month of being able to put weight on your leg after surgery.

During your recovery, walking and standing for long periods will be difficult at first, which can impact your ability to work and engage in family and social activities. In addition, jobs that have more physically demanding work duties will require a more extended amount of time to recover and return to work.

For most cases, you will need to attend physical therapy visits two to three times per week for generally up to three months. During and after your physical therapy sessions, you should also expect to keep up with your progress by performing a home exercise program. 

How to Find a Physical Therapist 

To find a physical therapist, you can use an internet search engine with the keywords “physical therapy” and your town to find physical therapy practices near your location. You can also use the “find a provider” search function on the website of your health insurance company to find physical therapy providers in your area that accept your insurance. In addition, homecare services can be used to deliver physical therapy in your home for people who have difficulty getting to and from a facility. 

Insurance Coverage and Costs 

The cost of your physical therapy visits will depend on your individual health insurance coverage. Most insurance companies approve a certain amount of visits at a time or per year, but these visits can often be extended if treatment is considered medically necessary. Your health insurance may fully cover your visits, or you may have to pay a certain amount for each visit.

Summary

Physical therapy for a tibial plateau fracture should start as soon as possible after your injury and surgery to restore your range of motion and strength as quickly as possible. Depending on the severity of your injury, you may or may not be able to bear weight through your leg after surgery and will need some type of assistive device like crutches, a walker, or a wheelchair to get around.

A physical therapist will work with you to improve your ability to move your leg, the strength of surrounding muscles, your ability to walk, and balance with exercises that move your leg through different planes of movement. 

A Word From Verywell

Getting up and moving after a tibial plateau fracture is crucial. The more actively engaged you are in your rehabilitation process, the better the chance of a successful recovery.