Tibia Fracture and Nailing with Patellar Tendon Recovery

[Thanothan]

Hello,
I am a 25 y/o male, 245 lbs, at 6 feet tall.
Last June, I fell off a ladder at my job and broke my left tibia which resulted in a surgery the next day which went well with no complications. Fast forward to today, and I am able to lift perfectly fine with no pain. The only lasting problems are two fold: My left calf is noticeably smaller and weak because of atrophy and a load bearing issue in my patellar tendon.
The latter is where my real issue comes in.
In squatting and any other lower movement like it I have no issues in my patellar tendon. It is in running and jumping where the discomfort and inability arise. When running, there is noticeable stress on the patellar tendon but not enough to be considered painful. I was able to run a 5k, although slowly, with no pain. The reason it is slow is the same reason I have discomfort in jumping. Trying to run faster not only increases the discomfort levels, but my left leg cannot keep up with my right. It is as if my left knee's patellar tendon is too weak to bear the load needed to thrust off the foot and then land on it. The same goes for hopping on my left knee. I can barely, if at all, get my left foot off the ground if I try to hop. It mainly looks as if I am doing an awkward calf raise. After scouring the internet it does not seem like I have a normal case of patellar tendinopathy, and I am unsure what to do to strength my knee. As I said earlier I can squat and deadlift just fine, but I have not tried lunges or single legs. The only other time I feel the same stress is getting up off the couch, but other wise no pain or swelling.
Any advice or help would be appreciated.

[Matthew Rupiper, PT]

Hi Thanothan,

I was your age when I fractured my right tibia and underwent an ORIF. Like you I had considerable atrophy of my entire leg. My lower leg function was the last to return. Activities such as running and jumping took well over a year to return to full strength and power. Like you, if I tried plyometrics or running beyond my abilities, symptoms would occur. If I'm reading your post correctly you're 9ish months post op. At 9 months I was on the platform in an O-lifting meet but unable to sprint or perform a single leg jump without pain. The patellar tendon was sore for a while because that was the incision site (common in ACLs too). Hamstring work was uncomfortable because the screw was drilled in near my pes anserine (where semitendinosous/gracilis/sartorius attach). Calf work was sore because of the ankle screw.

To get back to "normal" took performing single leg work and comparing to my "well leg." Single leg knee extensions, calf raises, lunges, Bulgarians, various ham curls, etc.

Maybe that helps.

[Thanothan]

Matthew,

Thank you for the advice and sorry for the late reply, it has been a busy week.
This is incredibly relieving to have some advice on what to do moving forward. I wil say, I would have expected hamstring exercises to be something that would help, but I will take what I can get.

Now, I will say that I have no idea what to do with programming. So, moving forward(no pun intended), how would you go about programming these exercises into a routine? Right now I have been focused primarily on weight loss, as I gained a lot of weight since a brain injury in 2020 and have never been particularly in shape at all. This has been a goal of mine this year, to finally fit back into some suits of mine, not experience the boxer waist band flip, and to be healthy. As such, I have been running(slow) 5 days a week and splitting the beginner template into 4 days to save time. If I were to add this exercises in, would you recommend replacing squats and deadlifts with these, or adding them on top. Also, I feel like I would be getting way more lower body volume, and very little upper body stimulation by proportion. This feels like I would need to change some things. I really am open to any advice at all, as I just want to do whatever I can to be in shape, strong, lean, and healthy for the first time in my life and this leg problem is not helping haha.