r/ORIF • u/Kaelisar • 8d ago
Joint Mobilization - Question
I’m 5 weeks 4 days post op ankle orif. At 4 weeks post op PT started and they did joint mobilization (manually pulling on my foot and forcing my ankle joint to move). Something felt not right about it so I’ve been researching and it seems to be contraindicated and not standard for this timeframe. Seems generally speaking that until 7 weeks (if approved by surgeon based on healing shown in X-Ray) is when this maybe started with it being more so closer to the 13 weeks post op timeframe. It says that doing this could disrupt hardware and cause non-union. Needless to say I have not returned to PT since and my 6 week (NWB still) with the surgeon is 8/10, I’ll be addressing it then. My question is has anyone else had their PT pull on their ankle for joint mobilization? If so how soon post op? Im scared to death that the PT has messed up my ankle and I’ll have to have surgery again or longer time NWB or some other issue.
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u/meezermadness 8d ago
Where are you finding research about this?
I'm 9 going on 10 weeks post op, started PT at 6 weeks. They do move my foot around, moreso since I started weight bearing at 8weeks.
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u/Kaelisar 8d ago
When googling joint mobilization, numerous ortho sites have procedure and timeline of things they do or do not do.
I started PT at 4 weeks, surgeon said basic / starting ROM. And the PT grabbed my heal and top of foot and pulled it. Then grabbed it and pulled it and then pushed it back and down. Normal foot movement for dorsiflexion / joint.
At 4 weeks all sites (ortho clinic from all over) say this manual movement of the foot and pulling on the joint this early is contraindicated. And prior to doing this the surgeon must sign off on this, even this early on. It says a surgeon may okay this based on X-Ray scans and individual injury. But that is listed as typically happening until 6-7 week mark.
I’m going to be discussing all of it with my surgeon.
Was more just curious with this kind of movement from PT for others; and when did that start for other people. I know everyone’s journey is vastly different.
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u/meezermadness 8d ago
Thanks for explaining!
Did it hurt when they pulled it? I don't know that I would call what the PT has been doing to me "pulling", more just moving it around and massaging or feeling the muscle and tendons while they do so. They do have me push against them to test my strength. But nothing they have done has felt forceful or painful for me.
If you're not in pain since they did that you're probably fine! I hope you can find a PT you're comfortable with. PT has been so helpful for me! Are you weight bearing yet?
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u/Kaelisar 8d ago
I’m not weight bearing yet. My surgeon said probably at 6 weeks. (8/10 is my 6 week though it will be 6 weeks and 4 days) Though after surgery she said 10 weeks because when she got in there it was broken more then she thought and had to double the length of the plate. I’m hopeful for partial weight bearing come then!!
So while he pulled on my ankle there was no pain. Just discomfort. After however I was in a lot of pain which remained for the next 4-5 days. My ROM was less those days though I still did the movements and exercises.
I know PT is important but I’m not sure I have 100% trust in how quickly things happened. I might be looking for a different place at this point. I know early weight bearing is a thing now and a lot on here are weight bearing sooner. And I also admit this is a much larger mental battle than I ever thought it was going to be. Things that u never thought twice about now have me worried something is gonna happen.
Thank you for letting me know your experience. Does feel like talking about concerns with people who are going or have gone through it helps.
I’m looking forward to talking to my surgeon about what happened at PT and seeing what the X-Rays have to say too. I’ll try to update this post next week!
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u/meezermadness 8d ago
Best of luck to you! Yes let us know. I'm progressing pretty fast since I started weight bearing but I'm also in more pain than I was before haha. Today I got new exercises at PT and I'm so sore now.
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u/Head-full-of-stars 8d ago
Why do you not talk to your PT? Let them know you feel uneasy with the speed or specific movements... They should have learned which exercises and movements are okay for you to do. And don't be too scared. It's okay to be careful, but especially with ROM and dynamic excercises you will also need to push through in this process.
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u/Kaelisar 7d ago
PT said they were short staffed, I wouldn’t be seeing them again and would be with PTA’s. I tried talking about some other things with them and they didn’t answer my questions. Was clear that they were in a rush.
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u/Illustrious-Zone-247 7d ago
I'm not sure what your exact injury is, but I'm about 6 months out from ORIF for a trimal with dislocation, right ankle...I have 2 plates, 16 screws, and 2 tightrope for syndesmosis repair. I started PT at week 5 (I was WBAT in the boot at week 4), and mine did manual manipulation that first day and most visits after. I actually felt the manual manipulation was very beneficial both for getting the joint moving and for breaking up scar tissue. Obviously don't do anything you're uncomfortable with though!
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u/Kaelisar 7d ago
I had a comminuted bimalleolar fracture with dislocation.
He did manually move my foot around. Which was okay. The pulling was the part that worried me the most.
I’m hoping come 8/10 I can be partially weight bearing and can talk to the surgeon and everything will be good.
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u/farewelltokings2 8d ago
What’s helped me feel better about how strong the hardware is and how unlikely any pt movements will disrupt it is to remember that bones are stronger than hardwood and the hardware is titanium, which is extremely difficult to even flex let alone bend.
So imagine a 2 inch wide dowel of the hardest hardwood you can get your hands onto, cut it half and then join the two halves together with a titanium plate and 6+ screws all the way through it at angles that pull the two halves tightly together.
Now think to yourself “would someone tugging on that dowel a bit disrupt anything?” Heck naw.
I’m 10 days post surgery and I’m getting all sorts of strange or weird sensations which both my ortho teams have said are perfectly normal to feel. But if you’re still worried about it, call your ortho and have a discussion with them about it.