Physiotherapy for Circular Frames
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1 Patient Information Physiotherapy for Circular Frames United Bristol Healthcare NHS Trust Tel Minicom If you need an Interpreter or Signer please contact the telephone number on your appointment letter. To get this leaflet: in Large Print, in Braille, by , on disk or on Audio Cassette, phone For 24 Hours NHS Help & Advice call NHS Direct on NHS Direct Website March 2007 United Bristol Healthcare NHS Trust PHYSIO/CIRCULAR/Mar07
2 History Professor Gavril Ilizarov first developed Ilizarov frames in Russia, in the 1950 s. He devised and developed methods to treat people with fractures, deformities and bone defects, involving the use of a circular external fixator / fine wire frame. The common basis for all the procedures is tension stress, where controlled, mechanically applied tension stress produces reliable and reproducible regeneration of bone and soft tissue. These ideas were brought to the west in the 1980 s and have been developed further and now include use of the American designed Taylor - Spatial frame. This also works on the Ilizarov principles, but has evolved from an engineering device called the Stewart Platform. This allows for very accurate 3D deformity correction. Frame class Every Wednesday 1.00pm 2.30pm, Physiotherapy Gym, Level 1, Bristol Royal Infirmary. An opportunity to meet fellow frame patients. Cardiovascular and specific exercises to meet your individual needs, supervised by physiotherapists. If you live far away, it is good to attend if you are attending frame clinic on that day. For more information Celia Wogan, Superintendent Physio Telephone bleep Visit the Ilizarov website at Ilizarov Frame Taylor Spatial Frame 1 14
3 16 Lying face down. Bend your frame knee to a right angle and lift your foot towards the ceiling. Hold for 10 seconds. Then slowly lower. Repeat 10 times. You can then repeat the exercise but now with a straight leg. Circular frames are now used for a wide range of conditions Trauma - acute fractures Fractures which have not healed (non-union) Fractures which have healed but are in poor alignment (mal-union) Infection which may lead to a bone resection Bone transport to restore a defect or limb length. 17 Side lying. Keep the lower leg bent and the frame leg straight. Lift the frame leg up with the toes pointing forwards and the heel leading the movement. Hold for 10 seconds. Then slowly lower. Repeat 10 times. 18 In sitting, put your chin on your chest and slouch so that your back is curved. Hold for 10 seconds and repeat 10 times. 13 2
4 Bristol Limb Reconstruction Unit Bristol Limb Reconstruction Unit is currently the largest in Europe. The Team consists of: Four Consultants Roger Atkins Mark Jackson James Livingstone Fergal Monsell 14 Hip exercises Lie on your back with your knees bent and your hands on your stomach and head resting on the floor. Flatten the small of your back into the floor / bed. Hold for 5 seconds and relax. Repeat 10 times. One Specialist Physio Celia Wogan One Specialist nurse Claire Longhorn One Research Nurse Jane Rowett-Harris One Research Fellow Rotational Ward Round - Wednesday mornings from 9.00am. Outpatient Clinic - Wednesday am or pm. Frame Class - Wednesday from 1.00pm pm in the Physiotherapy Gym, Level 1, Bristol Royal Infirmary. 15 Lie on your back. Bend your hips and knees and place your feet flat on the floor. Lift your bottom by pushing down evenly on both legs. Hold for 10 seconds then lower slowly. (You can only do this exercise if you are allowed to fully weight bear). Repeat 10 times. 3 12
5 Sit with your legs out straight and with your back supported. Pull your foot up towards you and press your frame knee down into the bed. Hold for the count of 10 and relax. Put a pillow / towel under your heel if necessary to get your knee as straight as possible. Repeat 10 times. Sit with a rolled towel under your frame knee to bend it about 15. Raise your foot until your knee is straight. Hold for 10 seconds then relax. Repeat 10 times. Remove the towel after doing this exercise. Keep both legs straight in sitting. Place a rolled pillow / towel between your legs. Squeeze the pillow between your legs for 10 seconds then relax. Repeat 10 times. 11 After your operation A physiotherapist will come and see you the day after your operation (Monday to Friday). They will assess your movement, sensation and power of your muscles on the frame leg. You will be shown exercises which you will need to perform, some of which are shown within this booklet. You will also be mobilised with an appropriate walking aid e.g. crutches or a zimmer frame, depending on your weight bearing status. The majority of frame patients are allowed to fully weight bear through their limb, (as pain allows), this is because the frame is designed to allow weightbearing. This encourages bone growth and helps with muscle stretching. Some frame patients are not allowed to weight bear through their limb initially. This tends to be when the fracture goes into the joint. With these types of fractures you are normally not allowed to weight bear for about 6-8 weeks to allow cartilage healing within the joint. The frame team will advise you on this. Your exercise regime and mobility will then be progressed each day. You will be discharged from hospital once you are independent with a walking aid, managing stairs, carrying out your exercise regime, and the frame team are happy for you to be discharged home. Your ward physiotherapist will refer you to your local Physiotherapy Service on discharge from hospital, so they can continue your care on a one to one basis. If you live locally you will also attend the frame class in the Physiotherapy Gym on Wednesdays from 1.00pm pm. 4
6 General advice Footwear Initially after your operation you will be given a special shoe known as a squashed frog to wear on your frame leg foot. However we do advise you to try and wear normal supportive footwear e.g. shoes / trainers as soon as possible, unless you have a foot frame. The squashed frog should only be worn at night. Knee exercises 9 Lie on your back with your legs out straight and relaxed. Keep your kneecaps pointed towards the ceiling throughout the exercise. Slide your frame foot towards your buttocks, bending the hip and knee. Slowly return to the starting position. Repeat 10 times. Place a plastic bag under your heel to help decrease friction. 10 You can also repeat the above exercise in a sitting position bending your knee as much as possible underneath you. Hold for 10 seconds and repeat 10 times. Squashed Frog A physiotherapist will also ensure your foot is tied up with a band. This is to ensure your foot is maintained in a good position, and your calf muscles do not become tight after your operation or during the lengthening / adjustment phase. The band should be worn at all times until informed otherwise by your physiotherapist. 5 10
7 Toe exercises 7 Bend and straighten your toes using your hands to help and hold the stretch for 20 seconds in each position. Positioning To encourage your knee to straighten it is important to position your knee correctly, especially immediately following your operation. 8 With your foot resting on a towel on a shiny floor, scrunch the towel up with your toes and hold for 5 seconds. Repeat 10 times. Rest your frame leg on a stool with pillows under the ankle and the knee hanging free. This will help stretch out the muscles at the back of the knee. If tolerated, leave your leg in this position for 20 minutes every hour, especially if you cannot straighten your leg completely. This will prevent your hamstring muscles getting tight. 9 6
8 Exercises The following exercises can: Increase the movement in your joints. Maintain your muscle length. Help to strengthen your muscles. It is important to perform the exercises regularly while your frame is on, (which will be some months), as it will help prevent complications and speed up your rehabilitation once the frame has been removed. If the exercises cause excessive pain then stop and seek advice from your physiotherapist. Only do exercises you have been advised to do: try to do each of them 10 times, 3 times a day. These are general exercises; your physiotherapist may add individual exercises to meet your needs. Ankle exercises 1 Sit on a bed or a firm chair holding your leg straight out in front of you. Loop a towel around the ball of your foot holding one end of the towel in each hand. Without bending your knee, steadily pull the towel to stretch your calf. Hold this for 30 seconds and then relax. Repeat 5 times. Now repeat with a slightly bent knee Loop the towel around your foot and use the towel to help turn the foot inwards and outwards, holding for 30 seconds each way. Repeat 5 times. Repeat the above exercise not using the towel in order to strengthen the muscles. Sit on a chair. Cross your frame leg over your other knee. Place your hand on the top of your foot and stretch your foot downwards. Hold for approximately 30 seconds. You should feel the stretch in your shin. Sit on a chair with your feet flat on the floor. Raise your heels so that you push up onto the ball of your foot. Then very slowly lower to the starting position. 2 Pull your feet up towards you and then point them away. Make this movement slow and rhythmical. Holding 10 seconds each way. 7 8
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