Mike Silva, MS, PT, CSCS
21 year-old active male fractured his left acetabulum in a dirt biking accident. He underwent a complicated ORIF surgical procedure. The patient was active, as he works in construction and enjoys activities such as riding dirt bikes and snowmobiles.
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- Initiate an independent home exercise program
- Be able to get back into normal activities
- Develop a normal gait pattern without assistive devices
- Return to normal strength and range of motion
- Independent in gym program
History / Progression
Patient was 4 weeks post-op at time of initial evaluation. He had orders for touch down weight-bearing status, with use of axillary crutches. His surgeon was excited to find out that we would be incorporating the AlterG in the treatment plan and allowed for gait training sooner.
There was significant atrophy in the gluteus and thigh musculature of the involved lower extremity, and hip strength was grossly 4-/5 in all planes, 4/5 in knee flexion and extension.
Hip ROM was measured as follows:
- Flexion 130°
- Extension 40°
- Abduction 30°
- Adduction 15°
- Internal Rotation 15° (hip in 0°flxn)
- External Rotation 25°(hip in 0°flxn)
- Internal Rotation 15° (hip in 90°flxn)
- External Rotation 15°(hip in 90°flxn)
Patient’s initial treatment included A/PROM, NWB PREs, and soft tissue mobilization to noted areas of restriction throughout involved lower extremity. Initial home exercise program included heel slides, lying knee flexion, and lying hip rotation.
At 8 weeks post-op, use of the AlterG began with gait training at 20% BW, walking forwards at 1.3 MPH for 10 minutes, and walking backwards at 1.0 MPH for 5 minutes. BW progressed weekly, duration increased weekly, and speed was kept to tolerable walking pace. Walking progressed on the AlterG to 60% BW at a moderate pace for 45 minutes by 12 weeks post-op.
Patient treatment progressed to WBAT, ROM, and strengthening after his doctor appointment at 12 weeks post-op. When crutches were discharged, patient demonstrated only a very slight trendelenburg, but otherwise normal gait due to 4 weeks of gait training via AlterG while at PWB status New home exercise program was formed, which included an increase in hip and lower extremity PREs . After improving overall strength and continued training on the AlterG, patient was able to return to work in construction without limitations in less than 4 months post-op and with three months of PT.