Q: How soon should PT/rehab after a hip fracture that didn’t require surgery start? (It was a fracture in the actual hip, not the femur) Could you give me a general idea or a reference as to what that should consist of?
I am concerned about a friend. She’s in her mid 60s and was entirely sedentary until several months ago when she decided to join an local gym and do water aerobics. She did that and water walking for a few hours a week and was feeling really good. Something is wrong with a knee (I’m unclear as to what) so water exercise seemed a good way to go. (I tried unsuccessfully to talk her into some kind of weight training) Then Covid hit and she went back to sedentary level of activity.
A few weeks ago, she rolled out of bed and had a hip fracture. It did not require surgery. I asked her if she was doing PT and she said the doctor didn’t say anything about it. She was sent home with crutches and told to rest.
I tried to research this on the internet but most articles are about rehab after hip surgery, which apparently starts in the hospital. So I’m confused about why rehab for a lesser fracture wouldn’t start for a number of weeks.
I am just afraid of sarcopenia and more frailty. She’s a really dear friend.
It is difficult to comment on this without more details pertaining to the case.
Did they give her any specific weight bearing instructions or limitations? If not, she should already be doing PT – and if so, she should have follow up scheduled to re-assess these limitations and clear her for the next stage of rehab.
I agree with your concerns. If none of this happened at all, this is very problematic and she should inquire directly about limitations vs. clearance for PT, and/or pursue a second opinion on the matter.
I checked in last night and she’d gone back to the doctor (bone trauma specialist) for a follow up visit last week. He said the bone is healing well but not totally healed (It was the greater trochanter—I had misunderstood her before) and she’s now allowed a few steps of weight bearing.
Here’s the part where I want to say thank you so much for your mission not just to educate the weightlifting community about science, but the medical community about strength-training. My ds had sent me your sarcopenia lecture maybe a year ago and I’ve learned so much from continuing to read/listen to more of BBM’s material.
So thank you! Because this happened:
Doc to friend: Would you like a referral to PT?
Friend: No, I don’t want to possibly be exposed to Covid.
Doc: Ok, I can print you off some exercises. (Adding nothing about why it’s critical to her recovery that she DO the muscle-strengthening. )
Since he 1) made PT a matter of whether she wanted it or not and 2) didn’t emphasis why the exercises were important, she assumed they were discretionary and had never looked at them. This is a week since she got them and about 4 weeks since the fracture.
(So again, thank you so much to BBM. You guys have quite the mission cut out for you!)
We have been friends for decades, so I flat out said, " You could end up in a nursing home if you don’t work to maintain your muscle mass right now" which shocked her. She agreed to find the papers and start the exercises.But why the heck didn’t the doctor tell her how crucial her strength is? I’m going to follow up with her today and also send her your sarcopenia tweetorial.
Am I correct that a hip fracture in that situation (rolling out of bed onto a carpeted floor) almost certainly means a person has osteoporosis?
Thank you so much for your help! And for your mission!
It is unfortunate that the exercises were framed to her in that way (yet another example of how our language can be so important with patients), and am glad that she is motivated to start doing them. I definitely agree that strengthening - particularly of the hip musculature - is the key to staying out of hospitals and nursing homes/long-term care facilities.
If she rolled out of bed, this could likely be classified as a “fragility fracture” and would raise concern for osteoporosis, which I would recommend she get evaluated for. With a combination of exercise, dietary interventions, and potentially medications, she could substantially improve her bone density and reduce the risk of further (potentially catastrophic) fractures in the future.