After surgery to repair an ankle fracture, physical therapy exercise is usually prescribed; however, no randomized, controlled studies have evaluated the effectiveness of a rehabilitation program after removing the post-operative cast. A prospective, randomized, controlled trial (RCT) was published by researchers in Sweden to evaluate a standardized, but individually-suited training program supervised by a physiotherapist.
05 patients were randomly assigned to a control group or physical therapy group after an average of 6 weeks in a plaster cast. The control group received usual care: advice and self-directed exercise. While 76% of subjects in the control group also attended physical therapy sessions on their own, their exercises were not the standardized program of the experimental group.
The physical therapy program began 1 week after cast removal and lasted 12 weeks, with 2 sessions per week. Patients also performed exercises at home between physical therapy visits. The neuromuscular training program consisted of range of motion (ROM) exercises, strengthening, balance training, and closed-kinetic chain exercises. Patients used Thera-Band resistance bands for ankle strengthening exercises as well as wobble board and mini-trampoline exercises for balance training. View the protocol here.
After 12 weeks, the physical therapy group showed improved results compared to the control group in patients under 40 years old. The physical therapy group had significant improvements in subjective function and muscle strength, but not in other measures of physical function. There was no significant difference in radiologic outcomes at 12 months post. The lack of significance in several variables may be explained by the fact that 76% of the control group also received physical therapy. Interestingly, older patients (greater than 40 years old) did not benefit as much as younger patients; its possible that older patients need more time for rehabilitation and recovery following ankle fracture.
In conclusion, Thera-Band resistance bands and balance boards are effective for rehabilitation following surgery for ankle fracture.
REFERENCE: Nilsson GM, Jonsson K, Ekdahl CS, Eneroth M.Effects of a training program after surgically treated ankle fracture: a prospective randomised controlled trial. BMC Musculoskelet Disord. 2009 Sep 25;10:118.
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