Following Your Surgeon's Weight-Bearing Status Prescription

Following Your Surgeon's Weight-Bearing Status Prescription

 

 

Following ankle injury or surgery, your doctor/surgeon may place weight bearing precautions on the affected leg upon allowing you to walk.  There are a few common weight bearing statuses such as:

 

FWB which is Full Weight Bearing (no restrictions)

WBAT means Weight Bearing As Tolerated (still no precautions, but use pain as the guide)

PWB is Partial Weight Bearing (see below)

TTWB stands for Toe Touch Weight Bearing  (practically non weight bearing) which means you can only touch the floor gently with the toes on the affected leg just for balance, not for weight bearing)

NWB is Non Weight Bearing

 

PWB can be specified as a percentage or an actual weight amount.  Your doctor/surgeon may request 25% PWB, 50%, 75%, etc... Or the surgeon may state you can place up to 25 pounds, 50 pounds, etc... on the affected leg.  Most people have no clue what 50 pounds of weight on one leg feels like, and most are discharged home from the hospital without being educated on this.  Usually, it is a matter of simply feeling what the required weight on one leg feels like in order to consistently adhere to the weight bearing status. 

 

I take a dial scale to my client's home in order to provide this education.  I use a dial scale because it allows you to see exactly how much weight you are placing on it, and you can adjust the amount as needed by either shifting more weight onto the scale (and the affected leg) or off the scale onto the unaffected leg.  Most clients already know their total body weight.  So if they weigh 160 pounds, and the doctor places them on 25% PWB, that means they can only place 40 pounds on their affected leg.  I place the scale on the floor and assist the client into standing.  Their stronger, unaffected foot is placed on the floor next to the scale.  They try to stand as close to their usual standing posture as possible (upright, shoulders back, with their feet/ base of support either shoulder or pelvic width apart).  Then they place the affected side's foot on the scale and slowly shift their weight onto the scale until the prescribed weight is reached.  They repeat this a few times until they are comfortable maintaining this weight bearing status.  Then I have them walk while adhering to the weight bearing status.  After walking, I have them go back to the scale and ask them to again place the appropriate weight on the affected leg.  However, this time I do not allow them to look at the scale while doing this.  They must adjust by feel, without the visual feedback of watching the changing scale numbers.  I repeat this process until they are consistently placing the proper weight on their leg.  

First you must know your client's total body weight



Have them add or remove body weight from the scale using the affected leg

 

   



Signs of Infection Following Hip or Knee Surgery

Signs of Infection Following Hip or Knee Surgery

 

 

Following hip or knee joint replacement surgery, approximately 1% of patients are at risk of infection.  Some common signs of infection are:  Increased pain or stiffness in a previously well-functioning joint, swelling, warmth and redness around the surgery site, incision drainage, fevers, chills, night sweats, or increased fatigue.  Below are examples of what an infected knee and hip look like.

 

 

    

 

 

If any of these signs are present, or you are even the least bit suspicious that your surgical site may be infected, you must see your surgeon as soon as possible.



Maintaining Hip Precautions Following Hip Replacement

Maintaining Hip Precautions Following Hip Replacement

 

 

For a few months following a Total Hip Replacement with a Posterior Surgical Approach, the 3 main precautions are: No hip flexion greater than 90 degrees, no hip internal rotation, and no hip adduction past neutral. 

Avoid crossing your legs to minimize hip adduction. 



Avoid standing and crossing your ankles, as this also adducts the hip past neutral

 

When seated, if your knees are in this position, you are in neutral hip rotation

If your knees are in the position shown above, then your hips are internally rotated 

 

 

The photo above shows an acceptable seated hip position.  If you look at the femur bone (thigh) and approximate the spine location, you can see that the hips are flexed less than 90 degrees. 

 

Bending too far forward while sitting in a chair will cause you to flex your hips more than 90 degrees.  This is not good

Seated marching will also flex your hips more than 90 degrees - Also not good

For some patients, these precautions may be difficult to maintain due to forgetfulness.  However, not abiding by these "rules" may lead to hip dislocation during the time immediately following surgery.  Sometimes, the surgeon is very emphatic about these precautions, especially with patients who have already experienced a dislocated hip post-op and have needed a hip revision.  When treating these patients, I am very cautious and follow the precautions as closely as possible.  These precautions should also be considered when the patient is walking, particularly upon changing directions.  If the hip replacement was on the right side, I will advise patients to make all 180 degree turns to the left, avoiding turning to the right.  Or, I will encourage smaller "baby steps" if they must turn to the right, using a marching technique.  With this, I am trying very hard to teach my patient to avoid planting the foot on the operative side prior to turning toward that side, because doing so will create a relative internal rotation of that hip. 

Assuming my right hip was replaced, the following pictures will demonstrate how planting the right foot and turning to the right is actually creating right hip internal rotation:

Standing with hips in neutral
 

Slight right hip internal rotation in stance



This shows what maximum hip internal rotation looks like in stance without attempting to turn.  Notice the angle of my feet are at 90 degrees

 

Maintaining right foot planted, and continuing to turn to the right by leading with the left foot, it can be seen that the right hip is internally rotate excessively.  Again, the angle of my feet is about 90 degrees

 So if you are trying to stick to the surgeon's precautions as closely as possible, remember not only to assess your patient when he/she is in the sitting position but also during dynamic activities such as walking.

 

 

 



The KB Fitness Anchor

The KB Fitness Anchor

 

 

Using a resistance band or tube is very common for both rehab and fitness purposes.  If you are using one band/tube, you can train bilaterally by anchoring the center of the band so that there are two ends that you can grip with each hand

2-arm Row using one band, anchored using your feet



Some tubing or bands are sold with nylon webbing folded over itself for a thicker end, to act as an anchor to be used in a closed door.  However, many times this anchor is still too thin and will be pulled through the door frame during training.

 

The KB Door Anchor provides a thick buckle anchor which will not be pulled through the door.  It can be used with any of your current resistance tube or bands and can be connected to the existing anchor for a more secure hold.

 

 

Go to KB Products and get free shipping within the United States.

 



Standing Hip Exercises

Standing Hip Exercises

 

 

I apologize for the long hiatus in blog posts.  I recently relocated from Florida to Rhode Island and am just now in the process of unpacking. 

 

Today's post deals with a common question I get form my patients.

 

During Physical Therapy treatments for hip, knee, ankle or spine, a common series of exercises that may be prescribed include standing hip extension, abduction and adduction.

HIP EXTENSION

HIP ADDUCTION

HIP ABDUCTION

For most patients, I will have them perform these exercises on both legs, the affected as well as the unaffected, in order to include both open and closed kinetic chain activities.  Not only will these exercises strengthen the free moving hip extensors, abductors and adductors (open chain), but they will also force the patient to stabilize on the non-moving extremity (closed chain).  This allows them to include ankle stability, balance, hip stability, and even trunk stability training to their program.  Many times, weak hip stabilizers can lead to other problems, such as knee pain.  Further explanations of the above exercises can be seen on the S.O.D. Patella-Femoral Pain Syndrome DVD Rehab Set.