When can stretching be initiated after a sacral fracture?

Timing of Stretching After Sacral Fracture

Stretching should be initiated 6 weeks after a sacral fracture, following confirmation of adequate healing, and only after weight-bearing has been gradually introduced under medical supervision. 1

Classification and Treatment Considerations

The timing for stretching after a sacral fracture depends on several factors:

1. Fracture Type and Stability:

   • Stable fractures (APC-I, LC-I): Can be managed non-operatively with earlier rehabilitation 1
   • Unstable fractures (APC-II/III, LC-II/III, VS, CM): Require surgical fixation and delayed rehabilitation 1

2. Treatment Method:

   • Conservative management: Typically requires 6-8 weeks of limited weight-bearing 1
   • Surgical fixation: May allow earlier mobilization depending on fixation type
   • Spinopelvic fixation: May permit earlier weight-bearing in vertically unstable fractures 1, 2

Rehabilitation Timeline

Phase 1: Acute Phase (0-2 weeks)

• Focus on pain management and prevention of complications
• Positioning and splinting to preserve joint mobility 1
• Active finger motion exercises to prevent stiffness 1
• Passive mobilization for patients unable to move spontaneously 1

Phase 2: Early Mobilization (2-6 weeks)

• Gradual introduction of weight-bearing based on fracture stability and fixation method
• Patients with spinopelvic fixation may begin earlier weight-bearing 2
• Active or passive mobilization should be instituted early to prevent muscle atrophy 1

Phase 3: Stretching and Progressive Exercise (6+ weeks)

• Begin gentle stretching at 6 weeks if radiographic evidence shows adequate healing
• Start with low-intensity exercises and gradually progress
• Follow FITT-PRO approach (Frequency, Intensity, Type, Time, and Progression) 1

Stretching Protocol (After 6 Weeks)

1. Initial Stretching (6-8 weeks):

   • Hold static stretches for 10-30 seconds
   • 3-4 repetitions for each stretch with 30-60 seconds rest between stretches
   • Focus on major muscle groups affected by immobilization
   • Perform 2-3 times per week 1

2. Progressive Stretching (8-12 weeks):

   • Gradually increase duration and intensity
   • Progress from static poses to dynamic movements
   • Reduce reliance on balance support 1

Cautions and Considerations

• Pain monitoring: Stop stretching if sharp or severe pain occurs
• Neurological symptoms: Approximately 35% of patients with sacral fractures have neurological deficits that may persist 3, requiring modified stretching approaches
• Chronic pain risk: While only 7% of patients develop chronic low back pain after sacral fractures 3, proper rehabilitation is essential to minimize this risk
• Osteoporotic fractures: Patients with sacral insufficiency fractures require more cautious progression, as these fractures may take longer to heal 4, 5
• Concurrent injuries: Modify stretching protocol if there are associated pelvic ring injuries 6

Warning Signs to Stop Stretching

• Increased pain lasting more than 24 hours after stretching
• New onset of neurological symptoms (numbness, tingling, weakness)
• Visible deformity or instability at the fracture site
• Audible or palpable clicking during movement

By following this progressive approach to rehabilitation after sacral fracture, patients can safely regain mobility while minimizing the risk of complications or re-injury.