PT'S GUIDE TO PELVIC FRACTURES

A pelvic fracture is a break in 1 or more bones in the pelvis. It is sometimes referred to as a "hip fracture" or "broken hip" because it occurs in the bones that make up the hip area. A pelvic fracture causes difficulty walking or standing. It can also cause abdominal pain, bleeding from pelvic cavities, and difficulty urinating. Pelvic fractures in the United States are relatively rare, making up 0.3% to 6% of all fractures. Pelvic fractures are most common in people 15-28 years of age. In people younger than 35, males suffer a higher incidence of pelvic fractures than females. In people older than 35, females suffer pelvic fractures more often than males.

What is a Pelvic Fracture (Hip Fracture)?

A pelvic fracture is a crack or break in one or more of the pelvic bones, which are located at the base of the spine. The pelvis is often referred to as part of the hip. (When you "put your hands on your hips," your hands are actually resting on your pelvic bones.)

A pelvic fracture can result from a low-impact or high-impact event.

Low-impact pelvic fractures most commonly occur in 2 age groups: adolescents and the elderly. Adolescents typically experience fractures of the tips of 1 of the pelvic bones, resulting from an athletic injury (football, hockey, skiing) or an activity such as jogging. Pelvic fractures also can occur after minor falls in people with osteoporosis or even occur spontaneously when bones are weak. The elderly frequently suffer fractures of the thicker part of the pelvic bones. These "pelvic ring fractures" result from falling onto the side of the hip. These falls can be caused by balance problems, vision problems, medication side effects, general frailty, or unintended obstacles such as pets underfoot, slippery floors, or rumpled rugs. Low-impact pelvic fractures often are mild fractures, and they may heal with several weeks of rest. Physical therapy is very helpful in restoring strength and balance in these cases.

High-impact pelvic fractures most commonly result from major incidents such as a motor vehicle accidents, a pedestrian being struck by a vehicle, or a fall from a high place. These pelvic fractures can be life-threatening, require emergency room care, surgery, and extensive physical therapy rehabilitation.

How Can a Physical Therapist Help?

Pelvic fracture recovery often involves surgery or long periods of bed rest. In the case of athletes, avoidance of sport activities is recommended until pain has resolved. During these periods of rest, which are usually weeks to months, a person often loses strength, flexibility, endurance, and balance abilities.

Physical therapists can help you recover from a pelvic fracture by improving your:

• Pain level
• Hip, spine, and leg motion
• Strength
• Flexibility
• Speed of healing
• Speed of return to activity and sport

When you are cleared by your physician to begin physical therapy, your physical therapist will design a specific treatment program to speed your recovery, including exercises and treatments you should do at home. This program will help you return to your normal life and activities and reach your recovery goals.

The First 24-48 Hours

Your physical therapist may help you learn to use crutches so you can move around your home without walking on the leg of the injured side. This will more commonly apply to low-impact pelvic fractures, as in athletes. More severe pelvic fractures will require a wheelchair, in which your physical therapist can instruct your safe usage.

Reduce Pain

Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and special hands-on techniques called manual therapy that gently move your muscles and joints.

Your physical therapist will choose specific activities and treatments to help restore normal movement in the leg and hip. These might start with passive motions that he or she applies to your leg and hip joint, and progress to active exercises and stretches that you perform yourself. Treatment can involve hands-on manual therapy techniques called "trigger point release" and "soft tissue mobilization," as well as specific stretches to muscles that might be abnormally tight.

Improve Strength

Certain exercises will benefit your healing at each stage of recovery, and your physical therapist will choose and teach you an individualized exercise program that will restore your strength, power, and agility. These exercises may be performed using free weights, stretch bands, weight-lifting equipment, and cardio exercise machines such as treadmills and stationary bicycles. For pelvic fractures, muscles of the hip and core are often targeted by the strength exercises.

Improve Balance

The hip area contains many muscles that are vital for balance and steadiness when walking or performing any activity. Your physical therapist will teach you effective exercises to restore strength and endurance to these muscles so that you can regain your balance.

Speed Recovery Time

Your physical therapist is trained and experienced in choosing the treatments and exercises to help you heal, get back to your normal life, and reach your goals faster than you might be able to on your own.

Return to Activities

Your physical therapist will collaborate with you to decide on your recovery goals, including return to work and sport. Your treatment program will be designed to help you reach these goals in the safest, fastest, and most effective way possible. Your physical therapist will use hands-on therapy and teach you exercises and work re-training activities. Athletes will be taught sport-specific techniques and drills to help achieve sports-specific goals.

Prevent Future Problems

Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your hip, upper leg, and core to help prevent future problems, such as fatigue and walking difficulty. This program may include strength and flexibility exercises for the hip, thigh, and core muscles. Your physical therapist will also review with you and your family ways to prevent falls in your home. These fall-prevention strategies may include clearing the floors of loose obstacles (throw rugs, mats), using sticky mats or chairs in the shower, preventing pets from walking near your feet, and using non-slippery house shoes, as well as installing grab bars or rails for the shower, toilet, and stairs.

If Surgery Is Necessary

If surgery is required, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the speediest manner possible after surgery.

Can this Injury or Condition be Prevented?

Pelvic fracture can be prevented by:

• Warming up before starting any sport or heavy physical activity. Your warm-up should include stretches taught to you by your physical therapist, including stretches for the muscles on the front, side, and back of the hip.
• Increasing the intensity of an activity or sport gradually, not suddenly. Avoid pushing yourself too hard, too fast, too soon.
• Following a reasonable and safe nutritional plan. Nutritional factors can contribute to osteoporosis, which can put you at higher risk of pelvic fracture.
• Maintaining good balance skills. Balance problems can increase the risk of falling and thus increase the risk of incurring a pelvic fracture. Physical therapy can help maintain and improve balance ability, which can help prevent falls.
• Driving safely to avoid motor vehicle accidents.
• Clearing your house of obstacles that you could trip over, and eliminating slippery walking surfaces.

5 WAYS TO PREPARE YOUR BODY FOR PREGNANCY

Ensure that your body is ready to carry a baby by addressing before pregnancy any pain or problems associated with posture or weakness. Here are some physical therapist tips for helping to prepare your body for pregnancy and to guard against musculoskeletal pain and dysfunction during and after it.

1. Strengthen your pelvic muscles. To strengthen your muscles, use pelvic floor contractions (commonly referred to as Kegels), which involve gently squeezing the sphincter muscles (rather than the buttocks and thighs). These tightening exercises help prevent leakage when a woman sneezes, coughs, etc, and also can help reduce pelvic pain during pregnancy. However, many women do Kegels incorrectly (perhaps because muscles are too tight and need to be relaxed before strengthening). Doing Kegels incorrectly can worsen conditions such as incontinence, pelvic pain, and even low back pain. This is why it is important to consult a women’s health physical therapist before beginning an exercise program. Physical therapists who specialize in women’s health can instruct women in how to perform these exercises safely and correctly.

2. Prepare for "baby belly" by focusing on your core. Core exercises can help prevent diastasis recti —abdominal muscle separation. As your belly grows, the abdominal muscles that run vertically along either side of the belly button can be forced apart, like a zipper opening. If these abdominal muscles separate from each other too much, the result can be low back pain, pelvic pain, or other injuries as your body tries to compensate for its weaker core. This also can result in the postpregnancy "pooch" many women find undesirable.

Some exercises, such as sit ups, increase the likelihood of developing diastasis recti, incontinence, and back pain during and after pregnancy. It is important, therefore, to work with your physical therapist on the right exercise strategy for establishing a strong core.

3. Take a breath! Learning proper breathing and relaxation techniques from your physical therapist will help prepare your body and mind for a healthy pregnancy. It is important to learn to properly exhale before performing any exercise. With proper technique, your core and pelvic floor muscles will contract automatically, and this will lead to optimal stability and injury protection.

4. Begin a regular fitness routine. Exercise will help reduce the amount of cortisol (stress hormone) in your body and will boost your muscle and cardiovascular strength—strength you'll need to carry that extra baby weight. Once you become pregnant, consider engaging in relatively low-impact activities, such as swimming, walking on even surfaces, biking, or using an elliptical machine. Runners should be aware that loosening of their ligaments may make them more susceptible to knee and ankle injuries. Also, when the muscles and ligaments that support a woman's pelvic organs weaken, the repetitive jarring of running can cause these organs to descend. This is known as pelvic organ prolapse. Physical therapists strongly recommend that, to prevent this condition, women wear undergarments that offer pelvic floor support, or compression shorts that support the pelvic floor, both during and after pregnancy.

5. Practice good posture. Poor posture can have a major effect on every part of your body, particularly with regard to pain during pregnancy. A physical therapist can evaluate your posture and suggest muscle-strengthening exercises and lifestyle education (such as not sitting at a desk for long periods, and carrying grocery bags properly). Establishing healthy posture habits—pre-baby—will better prepare your body for the extra weight of pregnancy and lessen your chances of low back and pelvic pain.

Acknowledgement: Marianne Ryan, PT, OCS

RECOVERING FROM CHILDBIRTH - IS YOUR BODY HEALING PROPERLY?

Using MRI, researchers suggest that, after childbirth, up to 15% of women sustain pelvic injuries that don’t heal.

The researchers, from the University of Michigan, also note that women can take 8 months or longer to heal from pelvic injuries sustained during childbirth, and in some cases the Kegel exercises commonly prescribed don’t work at all, according to a media release from the university.

“If an athlete sustained a similar injury in the field, she’d be in an MRI machine in an instant,” says Janis Miller, PhD, RN, APRN, FAAN, associate professor at the U-M School of Nursing.

“We have this thing where we tell women, ‘Well, you’re 6 weeks postpartum and now we don’t need to see you—you’ll be fine.’ But not all women feel fine after 6 weeks nor are ready to go back to work, and they aren’t crazy,” she adds in the release.

Miller and a team of midwives, radiologists, and obstetricians studied a group of pregnant women at high risk for pelvic muscle tears, and used MRI to diagnose injury and track healing time, the release explains.

Medical experts previously thought that postpartum pelvic injuries were primarily nerve-to-muscle related.

However, the images in Miller’s study showed that one-quarter of the women studied had fluid in their pubic bone marrow or sustained fractures similar to a sports-related stress fracture, and two-thirds showed excess fluid in the muscle, which indicates injury similar to a severe muscle strain. Forty-one percent sustained pelvic muscle tears, with the muscle detaching partially or fully from the pubic bone, the release continues.

Miller stresses in the release that the study group was selected for high-risk factors of muscle tear, and isn’t representative of the population of expectant mothers. Most injuries, including all fractures, healed by the eight-month return visit time.

What Miller hopes is that this study helps to derail the one-size-fits-all approach to treating postpartum injuries—Kegel exercises are the most commonly prescribed—so that women can stop blaming themselves if problems linger.

“We’re not saying that every woman who gives birth needs an MRI, nor that women should not do Kegel exercises. A key point is that if a woman is sensing that she has delayed recovery or unusual symptoms of discomfort or feels she just can’t Kegel anymore, she should see a specialist,” Miller stresses in the release.

Here at Champion Performance and Physical Therapy, specialist Molly Sauder, PT focuses her treatment on coccygeal pain and pelvic floor, and Janice M. Bode, PT specializes in Women's Health.  If you are unsure your body is healing properly 6 weeks after giving birth, talk to your doctor about coming to see a specialist like Molly or Janice. We'll do our best to get you feeling back to normal!

[Source(s): University of Michigan, Science Daily]