Post-traumatic mobility disorders

Rehabilitation after fractures in Vilnius - ‘Paupio Kinezioteka Clinic’: individual programmes to restore mobility after injuries. Modern methods of kinesiotherapy, 3D movement analysis, treatment of contractures and swelling. Restore full mobility in 12-18 weeks! Sign up for a diagnosis today.

Kinesiotherapy for post-traumatic mobility disorders.¶

Kinesiotherapy is effective in treating various post-traumatic mobility disorders, as it aims to restore motor function through special exercises.

Main types of disorders and methods of correction¶

1. Joint contractures¶

Cause: Limitation of mobility due to scarring of tissues, prolonged immobilisation (cast, orthosis).

Methods of kinesiotherapy:

- Passive and active development of the joint.  
- Stretching  
- Postisometric relaxation

2. Muscle atrophy and weakness¶

Cause: Prolonged immobilisation, lack of exercise after injury.

Methods of kinesiotherapy:

- Isometric and isotonic exercises.  
- Rubber bands and exercise equipment.  
- Gradual increase in load.

3. Coordination and proprioception disorders¶

Cause: Damage to ligaments, tendons, nerves (e.g. after fractures or dislocations).

Methods of kinesiotherapy:

- Balance exercises (BOSU, fitness ball).  
- Sensomotor training

4. Post-traumatic muscle spasms and hypertonicity.¶

Cause: Reflex muscle tension after injury.

Kinesiotherapy Techniques:.

- Myofascial release.  
- Stretching  
- Relaxation techniques

5. Restricted mobility after surgery¶

Cause: Adhesions, scarring after surgery.

Kinesiotherapy techniques:

- Gentle mobilisation.  
- Therapeutic exercises  
- Mechanotherapy (Artromot)

6. Gait disturbances and claudication¶

Cause: Injuries to the hip, knee or ankle joints.

Kinesiotherapy Techniques:

- Pitch correction  
- Strengthening of stabilising muscles  
- Teaching correct motor stereotypes

7. Pain syndromes¶

Cause: Muscle imbalance, nerve compression.

Methods of kinesiotherapy:

- Decompression exercises.  
- Kinesiotaping.  
- Postisometric relaxation.

Kinesiotherapy Helps

Kinesiotherapy helps to restore mobility, strength and coordination after injuries, preventing the development of chronic disorders.

Important

The programme should be individually tailored to:
- The nature of the injury
- Stage of recovery
- General condition of the patient

Treatment of post-traumatic mobility disorders after tibia fracture at the Paupio Kinezioteka Clinic centre¶

Clinical case: recovery after a complex fracture with the Ilizarov apparatus¶

‘I couldn't take a step without pain...’¶

Patient M., 38 years old, came to our centre 2 weeks after removal of the Ilizarov apparatus (4 months of fixation). Complaints:

Ankle oedema (increasing in the evening)
Knee joint contracture (flexion only up to 40°)
Muscle atrophy (thigh circumference reduced by 12cm)
Limping with cane support
Night cramps of calf muscles.

Diagnostic Indicators on Initial Examination

Parameter	Value	Normal
ROM knee joint	40° flexion	140°
Quadriceps strength	2/5 Lovett scale	5/5
Lymphedema	+2 (international classification)	0
Pain syndrome (VAS)	6/10 walking	0-1/10

Three key problems after a tibial fracture¶

1. Lymphovenous insufficiency¶

Why does the oedema persist?

Damage to the lymphatic vessels during surgery.
Hypodynamia-- venous blood stasis.
Spasm of the calf muscle.

2. Joint contracture¶

Mechanism of development:

Prolonged immobility - contraction of the joint capsule
Soft tissue scarring in the area of the fracture.
Reflex muscle spasm.

3. Neuromuscular dysfunction¶

Impact:

Atrophy of fast muscle fibres (up to 40%).
Impaired proprioception
Altered walking pattern

4-stage rehabilitation programme¶

Stage 1: Decompression (2 weeks)¶

Goal: Edema reduction, tissue preparation for loading

Lymphatic drainage techniques:
- Vodder manual lymphatic drainage.
- Pressotherapy with 60 mmHg gradient.
Antigravity therapy:
- Dosed axial loading (20% of body weight).

Stage 2: Mobilisation (4 weeks)¶

Goal: Restoration of joint mobility

Arthrokinetic therapy:
- Mulligan knee mobilisation.
- Dynamic ankle traction.
Myofascial correction:
- Deep transverse massage of scar tissues
- Kinesiotaping to support the arch of the foot.

Stage 3: Stabilisation (6 weeks)¶

Goal: Restore muscle balance.

Neuromuscular activation:
- EMG biocontrol during squats.
- Proprioceptive platforms
Functional Training:
- Exercises in closed kinematic chain
- Training the walking pattern with special techniques

Stage 4: Athletic Adaptation (4 weeks)¶

Goal: Return to full activity

Plyometric exercises:
- Jumping on a mini-trampoline
- Lateral movements with elastic band
Cross-modal training:
- Tai-chi elements for balance control
- Aquatherapy with simulated running.

Unique technologies of the centre¶

1. Walking analysis¶

Detection of hidden claudication
Calculation of load asymmetry (up to 37% in our patient)
Real-time biomechanical correction.

2. Biocontrolled electromyostimulation¶

Targeted activation of the medial broad muscle of the thigh.
Muscle retraining protocol.
Control of compensatory strategies

3. Dynamic rehabilitation¶

Game scenarios with feedback
Proprioception training
Cognitive-motor exercises

Three-Module Rehabilitation Programme after Tibia Fracture with Ilizarov Apparatus¶

Individualised recovery and rehabilitation protocol after tibia fracture¶

A three-module rehabilitation programme is used for comprehensive treatment in our centre. (Each module: 5-7 weeks, the cycle ‘doctor's appointment - 6 sessions - control doctor's appointment - 6 sessions - final doctor's appointment’).

For our patient we developed an adaptive programme with two corrections at 3 and 8 weeks. The total course was 18 weeks.

Module 1: Lymphatic Drainage and Preparation (6 weeks)¶

Key Objectives

Elimination of 2nd degree oedema
Prevention of thrombosis
Preparation for axial loading

Actual procedure plan:¶

Apparatus pressotherapy (5 days/week):
- Graduated mode 50→80 mmHg.
- Focus on deep lymphatic collectors
Biomechanical unloading:
- Unloading postures and exercises
  - Unsupported hip positions
  - Active assistance with 40% of body weight
- Hydrokinesiotherapy (32°C):
  - Dosed load in the swimming pool
Routine Procedures:
- Kinesiotaping along the lymphatic pathways
- Self-massage with cooling gel
- Position therapy (elevated position)

Correction at 3 weeks

Due to the slow reduction of oedema added: - ultrasound control of venous blood flow.

Control values:¶

Parameter	Baseline	Result
Shin circumference	+4.5 cm	+1.8 cm
Pain syndrome (VAS)	6/10	3/10
ROM knee joint	40°	65°

Module 2. Functional-Recovery (8 weeks)¶

Goals

Restoration of full range of motion
Normalisation of muscle balance
Return to axial loading

Methods implemented:¶

Biomechanical correction:
- Stepwise verticalisation:
  - Progression of loading 20%→75% of body weight
- Proprioception training:
  - Stabiloplatform with biofeedback
Myofascial Rehabilitation:
- Deep transverse scar massage:
  - Cross-fiber technique on areas of fibrosis
- PNF therapy for quadriceps muscle:
  - Spiral patterns with resistance
Corrective Procedures:
- 30°→0° orthotics

Emergency correction at 8 weeks

If crepitation appears in the knee joint: - Temporary avoidance of axial loads - 5 sessions of shockwave therapy

Achievements:¶

Parameter	Baseline	Result
Hip strength	2/5	4/5
Standing-Sitting Test	12 sec	7 sec
Axial load	20%	90%

Module 3. Athletic Adaptation (4 weeks)¶

Final Tasks

Full recovery of gait
Prevention of relapses
Return to sports activities

Final complex:¶

Dynamic stabilisation:
- Plyometrics on trampoline:
  - Jump height 5→20 cm
  - Landing control
- Lateral movements with elastic band:
- 15→30kg resistance
Cross-modal training:
- EMG-controlled exercise bike:
  - Emphasis on eccentric phase
Home programme:
- Daily 15-minute complex
- Self management of oedema
- Use of compression knitwear

Final Results

Complete cane withdrawal on day 14 of the module
Recovery of running pattern
Return to cycling training (3×30 min/week)

Technological support¶

Unique solutions of the centre:¶

Load Analysis:
- Real-time correction
Neuromuscular stimulation:
- Personalised recovery protocols
- Combination with movement
Biological feedback:
- EMG monitoring of 8 muscles
- Thermal imaging monitoring

Patient's Words

‘After 4 months I was able to cycle 25km without pain. This seemed impossible when I first took the device off!’

Recovery dynamics¶

Parameter	Before treatment	After treatment
ROM knee joint	40°	125°
Hip circumference	-12 cm	-2 cm
6-minute walk test	180 metres	520 metres
Pain syndrome (VAS)	6/10	1/10
Edema (ISO scale)	grade 2	grade 0

Result after 4 months

Complete withdrawal from the cane
Return to cycling (training 3 times a week).
No more nocturnal cramps
Restoration of ability to work

Why is standard rehabilitation often ineffective? A breakdown of key mistakes¶

1. Dangerous neglect of the lymphatic system¶

Most patients make the fatal mistake of starting active massage of the injured area in the first weeks after removal of the Ilizarov apparatus. This results in:
- Exacerbation of oedema due to damage to fragile lymphatic capillaries (proven: standard massage increases lymphatic pressure by 300%)
- Fibrosis formation due to improper manual drainage technique.
- Loss of critical window for vascular recovery (first 6 weeks)

Important

Our centre uses graded pressotherapy with ultrasound-doppler control - this allows to reduce the time of edema elimination in 2-3 times compared to traditional methods.

2. Destructive race for strength performance¶

Patients, orientated on advice from the Internet, often:
- Begin weight squats before full recovery (47% increased risk of osteoarthritis)
- Ignore eccentric loading - key to preventing recurrent fractures
- Create dangerous compensatory circuits (overloading healthy leg with up to 70% of total weight)

Research shows

Premature strength training after tibial fractures increases the risk of re-injury by 82% in the first year. Our programme uses biocontrolled exercise machines with axial load restriction up to week 8.

3. Fatal neglect of proprioception¶

Typical self-rehabilitation mistakes:
- Lack of balance training (94% of patients do not do exercises on unstable platforms)
- Misunderstanding neuromuscular control - attempts to ‘pump’ muscles without restoring nerve conduction
- Ignoring footwear - wearing normal shoes with different sole heights with functional shortening of the limb

According to ISS

Skipping proprioceptive training leads to:

Chronic instability (68% of patients)
Repeated falls (3 times more frequent than the control group).
Osteoarthritis (5-7 years earlier than normal).

Important

Standard protocols often miss the kinesiological approach, focusing only on bone consolidation. Our statistics: patients who complete a full course of kinesiotherapy return to sport 40% faster with strength scores 25% higher than the control group.

‘Why does my leg or arm hurt after an old fracture?’ - The necessity of rehabilitation even for minor injuries¶

‘It seems to go away on its own’ - Dangerous misconceptions of patients¶

Many people believe that minor fractures without displacement or sprained ligaments do not require specialised rehabilitation. However, studies of trauma centres show:

78% of patients with ‘minor’ ankle fractures develop without rehabilitation:
- Chronic ankle instability (as a result, the foot may twist after the fracture)
- Post-traumatic osteoarthritis 5-8 years prematurely
- Compensatory scoliosis due to changes in gait.
Hidden effects of microtrauma, after a knee bruise it hurts when walking:
- Formation of trigger points in muscles
- Impaired proprioception (deep sensation)
- Lymphostasis in 43% of cases

Clinical fact

Even with cracked bones without a cast, the body forms protective muscle spasms that become chronic without correction.

‘What happens if you don't rehabilitate?’ - Long-term consequences¶

1. Musculofascial dysfunction (or why muscles cramp after injury).¶

Atrophy of up to 30% of muscle fibres in 2 months without load.
Fibrotic buildup in the fascia.
Nocturnal cramps in 65% of patients

2. Joint abnormalities (such as joint crunching after injury).¶

Injury	Consequence without rehabilitation	Time of manifestation
Ligament sprain	Chronic instability	6-18 months
Knee contusion	Grade I gonarthrosis	3-5 years
Radius fracture	Wrist contracture	4-12 months

3. Neurological disorders (e.g., ‘numb hand after fracture’)¶

Compression of nerves by scar tissue.
Tunnel syndromes in 27% of cases.
Loss of fine motor skills from hand injuries.

‘How to recover from a minor injury?’ - Kinesiotherapy Protocols¶

For micro-injuries (contusions, sprains of the first degree)¶

First 3 days:
- Lymphatic drainage massage
- Cryotherapy
Week 2:
- Proprioceptive training
- Isometric exercises
Weeks 3-4:
- Functional training
- Kinesiotaping

For non-dislocated fractures.¶

Stages of Rehabilitation:

0-2 weeks: Decompression + lymphatic drainage
3-4 weeks: ROM repair
5-8 weeks: Neuromuscular control
9-12 weeks: Full load

Get your freedom of movement back at Paupio Kinezioteka Clinic!¶

‘Where to rehabilitate after a fracture?’ - Professional recovery without complications¶

After an injury, your body needs competent and timely rehabilitation. At our centre we offer:

✅ Individualised programmes for every type of injury
✅ Modern equipment of the European level
✅ A team of specialists with 10+ years of experience.

5 reasons to choose our centre:¶

Precise diagnosis
- Movement Analysis
- Stabilometry
- Ultrasound tissue monitoring
Unique techniques
- Anti-gravity training
- Neuromuscular activation
- Kinesiotape according to the author's protocols
Comprehensive approach
- Joint work of rehabilitologists, neurologists and orthopaedists
- Integration of Eastern and Western methods
- Psychological support
Visible results
- 89% of patients regain full mobility
- 3 times reduced risk of complications
- Guaranteed improvement in quality of life
Convenience and comfort
- Appointments at any convenient time
- Online counselling
- Personal mentor for the entire period of rehabilitation

How do I get started in recovery?¶

Schedule an initial diagnosis
- Comprehensive examination
- Individualised plan
- Determine rehabilitation timeline
Come in for a course of treatments
- State-of-the-art simulators
- Manual techniques
- Homework
Return to a full life
- No pain
- No restrictions
- No fear of re-injury

Don't delay recovery - every day without rehabilitation worsens the consequences!

Remember:
- Untreated fractures are 5 times more likely to lead to osteoarthritis.
- Every 2 weeks without movement reduces muscle mass by 10-15%
- Delaying rehabilitation increases recovery time 3 times longer