Cycling Accident – Fractured hip

This is a case study of a 50 year old male who was knocked off his bike and fractured his acetabulum (the socket part of the hip).

He was training for a triathlon when a car clipped his rear wheel and sent him up in the air. He landed on the pavement with the outside of the hip taking the full force of the impact. X-ray revealed that the Femoral head (ball) had smashed into the acetabulum (socket) and fractured it. He remained in hospital for 5 weeks with traction to help allow the fracture to heal as best possible.

He then had to use crutches without taking any weight through the injured side for 5 weeks. Then followed by a period of partially taking weight through the leg still using the crutches. This is when he visited first visited the practice……….

 

Initial Assessment

-Significant muscle wastage through the entire leg

-Tender to touch through the inside and front of the hip.

-The whole hip joint was extremely tight and limited to about 50% of normal range in all directions

-Nerve mobility through the leg was also limited to about 50% of the other side

 

Manual therapy techniques used (hands on stuff)

-Soft tissue mobilisation (using my elbows, thumbs, forearms, fingers, and knuckles!)

-Trigger point release work

-Instrument Assisted Soft Tissue Mobilisation (picture?). The tool helps break down soft tissue restrictions and scar tissue

-Joint mobilisations

-Pelvic muscle energy techniques (to help bring the pelvis into equal alignment)

 

Home advice

Dietary advice – the patient would normally burn off lots of calories when training so it was importance to reduce his calorific intake to ensure he did not gain weight and put further stress through the hip joint

Vitamin D supplementation – important for healthy bones

Avoid prolonged sitting – The patient had a desk based job so took regular breaks from sitting to ensure he maximised the gains he was getting from the flexibility exercises.

 

Rehabilitation

-Gait re-education (helping the patient walk again without crutches)

-Swimming pool rehab programme (using the buoyancy of the water to offload the hip initially)

-Cycling, cross trainer and eventually rowing

-Progressive lower limb strengthening programme

-Foam rolling, tennis, hockey and golf ball soft tissue release work

-Progressive flexibility programme

-Nerve gliding techniques (to help allow the nerves to pass through and between muscles easier)

-Jumping and hopping drills

-Gradual return to running programme

 

Outcome

He is currently training (without stabilisers!) for his first sprint triathlon since the accident. It was a very long process (just over 1 year) but a fantastic feat following such a nasty injury and many doubting his ability to ever be able to run again. We will continue to address any residual tightness that the patient is unable to relieve with the techniques we have taught him. We like to educate patients so they are able to self-manage as soon is safely possible.

Marc Evans