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Extra Physical Therapy Restores Function after Hip Fracture

This case report reviews the progress of a 68-year old woman three months after a hip fracture. When she finished her first session of physical therapy she wasn't happy with the final results. She still couldn't walk long distances. She was unable to go shopping because of leg and body fatigue. She also couldn't get up off the floor.

A special eight-week program of exercise was designed based on her goals and physical abilities. Exercises to overload the muscles were used. The idea of overload is to exercise a muscle at an intensity level higher than normal. A training response occurs as more and more nerves and muscles respond.

Exercise specificity was added. Exercising the muscles in a particular direction and movement pattern did this. Then the patient was progressed to aerobic training. Riding the stationary bike helped the patient increase her endurance when walking. She was also measured for a shoe lift since the fractured leg was shorter than the other side.

The patient's strength, walking endurance, and balance improved greatly. She was able to sit down on the floor and play with her grandchildren and then stand up again. She wasn't able to get back to her level of function before the fracture. This may have been because her extreme fear of falling limited her activity. Or perhaps a longer period of exercise(more than eight weeks) was needed to get better results.

This case shows that hip fracture patients can go beyond the basic physical therapy program after hip fracture. Exercise must be specific and give enough overload to make a difference. Each patient must be examined and the best program for each one determined by a physical therapist.

References: Kathleen K. Mangione, PT, PhD, GCS, and Kersten M. Palombaro, PT, MS. Exercise Prescription for a Patient 3 Months after Hip Fracture. In Physical Therapy. July 2005. Vol. 85. No. 7. Pp. 676-687.

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