What are the most important exercises after a tibial (tibia) and fibular (fibula) fracture?

Most Important Exercises After Tibia and Fibula Fracture

A graduated walk-run progression with short-duration running periods initially (30-60 seconds) interspersed with walking is the most important exercise approach after a tibial and fibular fracture, focusing on pain-free movement and progressive loading. 1

Initial Recovery Phase

• Before introducing running-related loads, ensure the patient is pain-free with ambulation and activities of daily living for at least 10-14 days 1
• Begin with pain-free walking exercises, progressing to 30-45 minutes of continuous walking 1
• Resolution of bony tenderness is crucial before advancing to more demanding exercises, especially for high-risk tibial fractures 1
• Assess lower extremity functional movements before introducing running-related loads 1

Progressive Exercise Protocol

Walk-Run Progression

• Start with short 30-60 second running increments interspersed with 60-second walking periods 1
• Perform these exercises on alternate days to allow bone cells to regain mechanosensitivity (98% returns after 24 hours of rest) 1
• Begin at a slower pace than pre-injury running speed 1
• Monitor for pain during and after exercise - if pain occurs, rest until symptoms resolve, then resume at a lower level 1

Surface Considerations

• Initially use a treadmill or more compliant surface for running exercises 1
• Avoid hard surfaces and uneven terrain during early recovery 1
• Progress to level surfaces before introducing hills 1
• Vary terrain only once back to normal training 1

Load Progression

• Progress distance before increasing speed - build to 50% of pre-injury distance level before introducing speed work 1
• Increase running distance gradually, with many studies suggesting the "10% rule" as a guideline (though this lacks strong empirical validation) 1
• Monitor for pain during and after exercise as the primary guide for progression 1

Strength Training Components

• Incorporate strengthening exercises for local muscles including calf and tibialis anterior 1
• Add proximal strength training for core and pelvic muscles 1
• Progress to plyometric strengthening and running drills once the patient can sprint or squat 1.5 times their body weight 1
• Address muscle flexibility, particularly in the calf and hamstring 1

Special Considerations

• Female patients may benefit from a slower progression due to higher tibial bone stresses across running speeds compared to males 1
• High-risk tibial fractures (such as anterior tibial cortex) require slower overall progression and delayed integration of speedwork 1
• Modify rehabilitation according to injury severity, with slower progression for higher-grade bone stress injuries 1
• Single leg hop (SLH) test can be used to assess readiness for return to running, as it's strongly correlated with functional progression 1

Weight-Bearing Considerations

• Recent evidence suggests earlier weight-bearing protocols may be beneficial after tibial plateau fractures, with similar outcomes and complication rates compared to traditional delayed weight-bearing 2
• Immediate post-operative weight bearing does not appear to affect fixation or cause articular collapse after surgical stabilization of tibial plateau fractures 3
• Early range of motion exercises should be encouraged as soon as possible after surgical procedures 4