Rehabilitation After Hip Fracture: Restoring Function and Mobility

Hip fragility fractures are a common injury often affecting the elderly population due to falls or weakened bones. The prevalence of this form of injury is increasing globally as life expectancy rises, with an incidence rate of 350 per 100,000 people per year in developed countries. Despite recent advances in medical technologies, hip fractures continue to have a significant impact on elderly patients. They often lead to decreased mobility, decreased muscle strength, joint stiffness, and an increased risk of complications such as blood clots and pneumonia. Additionally, hip fractures are associated with significant social and economic consequences including fear of re-injury, as well as increased hospitalization and healthcare expenses.

Following a hip fracture, many patients are unable to return to their pre-fracture level of autonomy. This is because prolonged periods of immobility can decrease future functionality and raise the risk of subsequent injuries. As a result, patients become dependent on family or caretakers to assist them in completing regular tasks.

THE ROLE OF PHYSIOTHERAPY IN HIP FRACTURE REHABILITATION:

Although prolonged immobility following a hip fracture can lead to serious negative impacts on quality of life, post-operative rehabilitation can help patients return to preoperative functional capacity. The journey to recovery from a hip fracture involves more than just healing the bone – it’s about restoring function and mobility to ensure a high quality of life. A skilled physiotherapist will work to design a personalized treatment plan based on each patient’s specific needs, medical history, and future goals. The primary aims of physiotherapy for hip fracture rehabilitation are:

1. Pain Management: Gentle exercises and a variety of therapy including Dry Needling, Shockwave therapy, and Manual Therapy are employed to manage pain and reduce discomfort as the fracture heals.

2. Restoring Range of Motion: Similar to pain management, gentle exercises and various manual techniques are utilized to restore joint flexibility, preventing stiffness and improving overall joint function.

3. Rebuilding Muscle Strength: Muscle atrophy is common after prolonged immobilization stemming from acute treatment for hip fractures. Progressive resistance exercises are prescribed to rebuild muscle strength, particularly around the hip joint.

4. Improving Balance and Coordination: To prevent future falls, exercises that challenge balance and coordination are incorporated into the rehabilitation program. This helps patients regain their confidence and reduce the fear of falling.

5. Gait Training: Walking again after a hip fracture can be challenging. An effective treatment plan will include gait training to ensure patients walk safely and efficiently during their postoperative recovery.

STAGES OF REHABILITATION:

Rehabilitation following a hip fracture tends to follow a phased approach:

1. Acute and Subacute Phase: This phase starts soon after surgery or injury. Initially, it focuses on pain management, gentle range-of-motion exercises, and preventing complications like blood clots. As healing progresses, the emphasis shifts towards more intensive treatment to restore strength, flexibility, and balance.

2. Functional Phase: This phase aims to restore a patient’s ability to perform daily tasks independently. Treatment is geared towards musculoskeletal areas required for activities like climbing stairs, getting up from a chair, and walking without assistance.

3. Maintenance Phase: After achieving functional goals, continued treatment is focused on allowing patients to maintain their progress, as well as prevent any future injuries.

THE IMPORTANCE OF MINDSET DURING REHABILITATION:

Recovery from a hip fracture can be challenging, both physically and emotionally. Therefore, patience and optimism are critical. Maintaining a positive attitude throughout the rehabilitation process can significantly impact the outcomes. Setting realistic goals, celebrating small victories, and seeking support from friends, family, and your physiotherapist can help boost motivation and maintain good mental health.