15 Tibia Fracture Recovery Exercises After ORIF Surgery (By Phase)

A tibia fracture is a frustrating injury because the tibia is such an important bone in supporting your body weight and allowing you to perform your everyday activities. More specifically, a tibial plateau fracture, which is the common fracture of the tibia is more serious than a typical broken leg and will often require surgery.

These 15 tibia fracture recovery exercises after ORIF (open reduction internal fixation) surgery will improve your knee range of motion, knee strength, walking, and overall mobility.

What Is A Tibial Plateau Fracture?

A tibial plateau fracture is when the tibial plateau or the flat surface on top of the tibia (shin bone) that articulates with the femur (long bone or thigh bone) is fractured. There are 5 types of tibial plateau fractures which we will be discussing.

The tibial plateau plays an important role in the function of the knee including the ability for the knee to sustain forces and bear weight.

Tibia Fracture Recovery Timeline

Typically you will begin to walk normally without crutches or an assistive device around 12 weeks (3 months) but it can take up to 6-12 months to return to “normal” including return to sports.

Your surgeon will be able to provide you with the best information on the guidelines and precautions for your specific surgery. This is a general outline based on most tibial plateau fracture protocols. 

• Phase 1 (0-6 weeks)
  • Non-weight bearing and in a knee immobilizer brace
  • For the first 2 weeks you will typically not exceed 90 degrees of knee flexion
  • Stop using brace around 6 weeks
• Phase 2 (6-12 weeks)
  • Toe touch weight bearing 
  • Regain full knee range of motion
• Phase 3 (12 weeks-6 months)
  • Full weight bearing and normalize gait pattern without assistive device 
• Phase 4 (6-12 months)
  • Return to sport and focus on sport specific activities 

What Exercise Should You Avoid With a Tibial Plateau Fracture?

The type of exercises you should avoid after tibial plateau fracture will depend on the stage of recovery you are in, however overall you should avoid all exercises that place excessive stress on the leg such as jumping, squat jumps and running and any exercises that cause severe pain. These jumping and running exercises should only be performed towards the end of recovery.

You should avoid any weight bearing activities for the first 6 weeks. This means you should not be placing any weight on your affected leg. You also should not be bending your knee more than 90 degrees in the first 2 weeks.

In addition to these precautions it is important to not rush your recovery and do not perform high intensity exercises early on in your recovery. Your bone needs time to heal fully. 

Physical Therapy Exercises

Physical therapy exercises are a crucial part to the recovery process of a tibial plateau fracture. For the first few weeks after surgery the exercises will be fairly basic due to your surgeon’s precautions and the early stages of your recovery. These physical therapy exercises are categorized by phase of recovery and include pictures of each exercise. They include:

• Phase 1
  • Heel Slides
  • Quad Sets
  • SLR Flexion
  • SLR. Abduction
  • SLR Adduction
  • SLR Extension
• Phase 2
  • Stationary Bike
  • Hip Flexor Stretch
  • Clamshells
  • Bridge
  • Dead Bug
• Phase 3
  • Sit To Stand
  • Step Ups
  • Heel Raises
  • Terminal Knee Extension

Phase 1 Exercises For Tibial Plateau Fracture

The knee will be very stiff after surgery so it is important to perform range of motion exercises or ROM exercises to regain the knee mobility in phase 1 after surgery. Phase 1 of tibia fracture recovery focuses on improving range of motion within the precautions and achieving quad activation. These range of motion exercises include 1. Heel Slides, and Quad Sets 3. SLR Flexion 4. SLR Abduction 5. SLR Adduction 6. SLR Extension.

If you have the strength, you can perform the straight leg raise in 4 directions, flexion, abduction, adduction and extension in phase 1, however you may need to wait until phase 2 if you are unable to lift your leg.

1. Heel Slides

• Heel slides are a great exercise to improve the mobility of the knee joint.
• Start by lying on your back with your affected leg straight and use a strap, sheet or towel to slowly help bend your knee by sliding your foot towards your butt.
  • Since the knee is stiff it is normal for this exercise to be uncomfortable, however you should not be experiencing severe pain with the exercise.
• Work in your tolerable range and be sure to adhere to the weight bearing precautions your doctor gave you.
  • This is typically 90 degrees of flexion for the first 6 weeks.

You can buy a stretch strap with loops on Amazon

2. Quad Sets

• Start by lying down on your back and focus on squeezing tightening your thigh or quadriceps muscles and pushing your knee down into the surface below you.
• If you need an extra tactile cue you can place a small towel beneath your knee or ankle and try to push your knee down into the towel.
  • The placement of the towel will depend on what works best for you.

3. Straight Leg Raise Flexion

• All of these straight leg raises should be performed with your brace on.
• Start by lying on your back with your good leg bent and your affected leg straight.
• Now tighten your quad muscle and lift your leg up to the level of your opposite knee.

4. Straight Leg Raise Abduction

• Start by lying on your side with your good leg bent and your affected leg straight.
• Now lift your affected leg up.
• Try not to roll your hips backward as you are performing the motion.

5. Straight Leg Raise Adduction

• Start by lying on your affected side with your affected leg straight and your good leg bent over your leg.
• Now lift your bottom leg up off the ground.

6. Straight Leg Raise Extension

• Start by lying on your stomach with your legs straight.
• Now lift your leg off the ground.
• Be sure to not pull with your back too much.
• This is a glute exercise and you should feel your butt muscle groups working.

Phase 2 Of Tibial Fracture Recovery Exercises

Phase 2 of tibial fracture recovery is focused on achieving full knee range of motion past 90 degrees in phase 1. You will continue to perform the same exercises in phase 1, however you can now progress the previous range of motion and SLR exercises and perform new exercises. These new exercises include 7. Starionary Bike 8. Quad Stretch 9. Clamshells 10. Bridge.

7. Stationary Bike

• A stationary bike is a great way to improve knee mobility.
• Start by sitting on a bike with a high seat.
• If you do not have the knee mobility to push the bike pedal in a full circle start with half circles forward/backward.

8. Quad Stretch

• The starting position for this exercise is lying on your back with your affected leg hanging off of the side of a table or bed.
• Slowly allow your knee to bend.
• If you want a stronger stretch you can use a to towel or strap around your ankle to gently pull your foot closer to your butt.

9. Clamshells

• Start by lying on your side with both legs bent.
• Now lift your top knee up while keeping your feet stacked on top of each other.
• For added difficulty you can place a resistance band around your knees as seen in the second picture.

10. Bridge

• Start by lying on your back with your knees bent.
• Now squeeze your butt and lift your hips and butt off the floor.
• You should feel your butt muscles working NOT your back.

11. Dead Bug

• This is a great core strengthening exercise.
• If you are performing this exercise with your brace and do not have full flexion you can perform a modified version of this exercise with your affected leg straight.
• Start by lying on your back with both legs bent and both arms straight and pointing to the ceiling.
• Now tighten your abdominal muscles and slowly reach your leg and opposite arm out.
• Bring them back to starting position and then reach out the opposite arm/leg

Phase 3 of Tibia Fracture Recovery Exercises

By phase 3 you should have full knee range of motion and begin focusing on normalizing your gait and placing full weight bearing on your affected leg. These exercises include 12. Sit To Stand 13. Step Ups 14. Heel Raises 15. Terminal Knee Extension.

12. Sit To Stand

• Start by sitting with your feet hip width apart and then lean forward and stand up.
• Try to not to use your arms when standing up.

13. Step Up

• Step up onto a step with your affected leg.
• Start with a step with a low height and slowly progress to a higher step.
  • If needed start by holding onto a railing and slowly progress to stepping up unsupported when safe.
• As a progress you can step up with your affected leg and then drive your opposite leg up in front of you as shown in the picture.
• Don’t have access to a step? Here are 15 Effective Alternative Exercises For Step Ups.

14. Heel Raises

• Stand next to a wall or supportive surface and push up onto your toes and then slowly lower yourself back down to the ground.

15. Terminal Knee Extension

• This is an excellent exercise for quad activation.
• Stand with a resistance band around your affected knee.
• Start with your knee bent and then activate your quad muscle and push the back of your knee straight back into the band.
• The key with this exercise is to not move the band by swaying your hips forward/backward.

Is a Full Recovery Possible After a Tibial Plateau Fracture?

Yes, a full recovery is possible after a tibial plateau fracture, however the speed of your recovery will depend on the type of fracture you sustained, the surgery you underwent and the rehab that you did after surgery.

Starting physical therapy early and adhering to your surgeon’s precautions are the most important factors in speeding up your long term recovery.

Treatment of Tibial Plateau Fracture

The gold standard to treat a tibial plateau fracture is surgical intervention. Unlike other injuries where it is possible to avoid surgery, typically the best treatment is surgery after a tibial plateau fracture and physical therapy after surgery. The surgical procedure that is best to fix a tibial plateau fracture is called an open reduction internal fixation or ORIF surgery. 

If your injury was complicated by a dislocation or severe open fracture you may need an external fixation prior to ORIF surgery. This is when an external fixator device is placed on the bone, but outside the body and works to keep the fractured bone stabilized and in proper alignment. 

When Should I Start Physical Therapy After Tibia Fracture?

You should start physical therapy once your surgeon gives you clearance to do so. This is typically a couple of days after surgery. Your physical therapist will be able to work with you within your precautions.

For example in the first 6 weeks you will be non weight bearing so you will mostly be performing mat exercises under the supervision of a physical therapist. 

When Should I Start Weight Bearing After Tibia Fracture?

Your weight bearing status is determined by your surgeon, however you can typically start toe touch weight bearing at 6 weeks and full weight bearing at 12 weeks after surgery.

What To Expect With Surgery

• Significant swelling
  • Use ice and elevation for pain relief.
• Loss of function due to muscle atrophy and the use of crutches.
• Lots of physical therapy sessions.

Types Of Tibial Fractures

The type and complexity of your fracture will influence your recovery process. 

Proximal Tibial Fracture

• Proximal Tibial Epiphyseal Fracture
  • This fracture affects the growth plate of a bone and the top of the tibia or epiphysis
  • Typically needs surgery
• Proximal Tibial Metaphysical Fracture (Cozen’s Fracture)
  • This fracture affects the neck of the tibia or metaphysis of the bone
  • Typically treated with a cast nonoperatively

Tibial Shaft Fractures

• Nondisplaced
  • This fracture is considered one of the simple tibia fractures because there is a fracture but the bones remain aligned
  • Can typically be treated with a cast non operatively 
• Displaced, Noncomminuted
  • A fracture where the bone is broken into two or less bones but not aligned. 
• Displaced, comminuted
  • A fracture where the bone is broken into more than 2 bones and is not aligned. 

Tibial Plateau Fracture Types

The type of fracture sustained will impact the healing process.

Shcatzer Classifcation

• Type I
  • Split fracture of the lateral tibial plateau 
• Type II
  • Split depression of the lateral tibial plateau
• Type III
  • Central depression the lateral tibial plateau fracture
• Type IV
  • Split of the medial tibial plateau 
• Type V
  • Bicondylar tibial plateau fracture
• Type VI
  • Dissociation between metaphysis and diaphysis

Pain Location After Tibial Plateau Fracture

In a tibial plateau fracture, the pain is typically localized to the lower part of the knee or just below the knee cap. 

How Does a Tibial Plateau Fracture Occur? 

A tibial plateau fracture occurs when a strong force is placed on the lower leg when the leg is in a varus or valgus position.

The most common mechanisms of injury occur from a motor vehicle accident, or high velocity sports such as skiing.

Summary of Tibia Fracture Recovery Exercises

These tibia fracture recovery exercises are perfect for someone after ORIF surgery. These physical therapy exercises will improve knee strength, knee mobility, and most importantly, get you back to walking and all of the activities that you love.

If you are looking for more non weight bearing exercises during the early stages of rehab you can find 19 Easy Non Weight Bearing Leg Exercises For Full Body Workout here.