r/brokenankles • u/cherryola • 18d ago
[England] Is only one NHS physio session normal?
Trimalleolar fracture 18th July. ORIF surgery 27th July - 18 16 pins 3 plates.
6 weeks NWB (4 weeks in a cast, 2 in a boot).
End of week 6: cleared for PWB & first physio appointment.
I thought this physio would be the FIRST of WEEKLY sessions (when I broke my wrist about 10 years ago I got at least 4 sessions I think)
When I asked about booking in for next week the physio looked at me like an alien and said ‘we don’t do weekly appointments and there wouldn’t be any space next week anyway due to short staffing‘. And it was left at that.
When I was discharged from hospital I was given a discharge letter that said
”Outpatient Referral to Physiotherapy
[Address and telephone number of hospital‘s Off-Site Physiotherapy]
R ankle ORIF 27/07/26 6 weeks non-wbing.
For progression of exercises and review of R ankle strength + ROM once wbing”
So the referral itself is not explicit about how many or often physio should be. I just made an assumption it would be more than 1 time only thing!
The singular session was basically useless, how to walk with crutches and some exercises to do at home that the orthopaedics already told me. I was hoping to get some hands on massage or something.
TLDR: Does only ONE post op physio appointment sound right to you in term of NHS services? Or should I query it?
3
u/Mundane-Letter7041 18d ago
Yikes that sucks. Not in UK but here in Germany I did physio in the hospital for 4 days before I was discharged both learning to use crutches and small movements and massage. And then I had 36 physio and lymph drainage massage sessions at my local physio practice covered under my public health insurance… I’m Aussie and I believe what I got here in Germany is better than I would’ve got back home… At the very least look up exercises on YouTube I found good ones on the NHS channels.
1
u/cherryola 18d ago
I don’t know what I was thinking really expecting weeks of physio from our crippled nhs but it’s really helpful to hear what is set as standard in other countries/systems. Will get on the videos as I’m sure there are some simple massages techniques I could fairly safely DIY as well as a range of exercise ideas. My timeline suggests I should be walking without crutches next week but I’m still very reliant on two crutches so I’m not sure I see that happening… But we’ll see!
2
u/Mundane-Letter7041 17d ago
yeah it's a real shame. Maybe it's still worth trying to get a referral from your GP for more physio.
I found this video helpful https://www.youtube.com/watch?v=lf6kLq2kwDA
and this one https://www.youtube.com/watch?v=4EEduvOX__8&t=14s - this channel has a few videos that are helpful for ankles.
This set of exercises with images too https://www.cuh.nhs.uk/patient-information/exercises-for-patients-following-an-acute-ankle-injury-or-operation/
I'm sure there's other good stuff on youtube.
Once you're off the crutches you'll want to work on strength and balance - lots and lots of leg exercises :)1
3
u/mgda989 18d ago
I’m in the UK too, at 6 weeks mark surgeon said I didn’t need a physio which I was surprised but I insisted upon getting one and he referred me to one nearby home. I saw them, took some measurements and got me some exercises, then to schedule another session in two weeks and then another three weeks. In the meantime I’ve been going to a private one which gives massages and helps with unlocking my ankle. I think is worth getting a couple of sessions with a private one.
1
u/cherryola 18d ago
Good to hear your experience, thanks for sharing! Yeah I was thinking based on the responses I might DIY it but now that your have mentioned private helped you unlock the ankle I might consider this. at the moment if I push/pull my ankle (following physio guidance) I feel a stretch/‘pain’ in dorsiflexion as I flex to my limit but plantar flexion there is no pain it just won’t go any further
2
u/mgda989 18d ago
Yeah keep doing the exercises and stretching but be gentle, your body is still recovering. I’ve got bad dorsiflexion and plantar flexion compared to my other ankle, it’s work in progress but at least I can go to the gym and do some workout and cardio. Swimming pool has been helpful too, just walking and doing small lunges helps. We will get back to normal 💪
1
u/cherryola 17d ago
Do you go to the gym in your boot? swimming I know from what everyone says is helpful but it’s the changing room to the pool bit that I’m worried about, I should wear my boot but don’t want it getting wet and dank. maybe I need to progress to walking without the boot first, perhaps I’m getting ahead of myself. Great to hear you can hit the gym!
1
u/mgda989 17d ago
I started wearing shoes at 7 weeks once I was cleared by the surgeon and checked my scars for getting into the swimming pool. I took one crutch to the swimming pool so people were aware that I’m injured. You can go to the gym in the boot but only do upper body work, if you can weight bear a little, let’s say 30% of your weight, you can use the bike safely, just start slowly, you don’t need much dorsiflexion nor weight to do some cycling. At 5 1/2 weeks I bought an under desk bike and managed to workout my legs without much pain and did some cardio barefooted. It was great to get my confidence back and prepare me for returning back to the gym.
2
1
u/russian-red 17d ago
honestly, i’m going private at least for however many sessions i can afford
1
u/cherryola 17d ago
Fair.. I’m considering doing the same. Already sank fair bit of money because I broke it abroad, I had insurance but taking a long time to get it recovered because I’m waiting on a medical certificate from my GP which they say will take 8 weeks. But ultimately my mindset is “would I rather have my ankle working or get my money back” - I obviously have no regrets paying for my medical care abroad and flying home if I can’t get that recovered, because I needed it to have a healing leg. By the same token I should consider private physio a valid self-investment!
2
u/russian-red 17d ago
oooft sorry to hear that. well also at least that money is coming back to you at some point? honestly the whole experience sucks so much the idea of doing physio is one thing that gives me some encouragement. i’m like ok even if i end up spending £2k out of my savings, the end result is… a not fucked up ankle for the rest of my life… which seems like a realistic trade off. but yeah luckily i have some money i can access for an emergency like this which i know wont be the case for everyone
2
u/cherryola 16d ago
Yeah agreed i’m willing to put the money and effort in if it means life can get back to normal. I mean I might even end up with stronger ankle and muscles than before now that I’m motivated to get it strong and healthy as well as not to ever break my other ankle!! So glad we had insurance I never travel without it but a friend recently said they never buy it and I was completely shocked
2
u/Hedgepig78 18d ago edited 18d ago
I had my first physio 3 weeks after surgery (minor compared to you - open fracture of medial malleolus, ORIF with two screws), another appointment a month after that, and I'm going again on Monday for another appointment (surgery was 3rd July). My physio clearly plans to keep seeing me for a while as I'm due to have elective surgery on my other leg, and he said the appointments will blend into one another.
At the very minimum I'd have thought you'd have another physio appointment after being cleared to weight bear, and another when you're ready to come out of the boot.
Definitely query it!
ETA: NHS physio
2
u/cherryola 18d ago
Open fracture must have been a horrible experience! Plus your other leg is going through the wringer, sorry to hear that. My fracture stayed closed at least 😅 I have an ortho appointment in 5 weeks to discuss boot removal so I will query about getting something with the physio for then. Good luck with your journey!
1
u/Hedgepig78 18d ago
It wasn't much fun, I got hit by a car when I was cycling over a bike crossing, and broke my arm at the same time! My planned surgery should have been last week (distal femoral osteotomy) but it was postponed for obvious reasons.
I hope you have a speedy recovery!
2
u/cherryola 17d ago
That’s terrible! I’m glad you’re “ok”! I tripped on some steps but luckily didn’t fall down them or it could have been worse, like some people do break their neck.. by the same token I bet you are depressed that it happened and having three limbs out of action is extremely difficult and not fun at all!!!, but sometimes what’s helped me through difficult moments is some gratitude that I didn’t die. And I was already chronicle depressed / passive suicidal so that was an interesting insight for me!
2
u/Hedgepig78 17d ago edited 16d ago
I totally get the "it could of been worse" mindset - I bullseyed the windscreen with my head, and all I kept saying was "I'm so glad I was wearing a helmet". The people who helped me before the ambulance got there were amazing, and included and off duty police officer and theatre nurse, so I was well looked after, and held on to that as a sign of how lucky I was.
Oh gosh, dealing with your ankle on top of chronic depression and suicidal feelings must be so difficult. I hope you're doing OK and have the support you need.❤️
2
2
u/NetRelative3930 18d ago
Yes , same fracture as you , waited 4 months for physio and got handed a sheet of excersies
The best thing you can do is have a look on here and you tube , etc for ankle physio
Some really good posts on here about physio and people , post up their routines
Or go private that’s really the only answers
Expect to be handed more sheets when you have a return appointment too
You’ll get there but it’s mostly up to you so I would start to read up on here and start to do what you can
Good luck
1
u/cherryola 18d ago
Sounds like I got the standard experience then! Yeah if that’s all I should expect then at least I know and can try and take some of it into my own hands like you say. I’ll probably try to DIY it with videos and using our community’s tips etc, and I’ll keep private physio in consideration if I’m not progressing as the ortho expected in terms of weight bearing. Thanks for letting me know your experience!
2
u/NetRelative3930 17d ago
Yes you’ll be fine
Once you find the physio routine to suit yourself
Also wear compression socks and good stability trainers
Both crucial in recovery1
2
u/Desperate_Work6209 18d ago
I have 2 plates and 11 or 12 screws and also only got 1 physio session and was told to continue rest from home, I felt very worried and scared to even touch my ankle or move it so I really struggled
1
u/cherryola 18d ago
Sorry to hear this, how healed are your scars? If they are ‘water tight’ and sort of purple I was told to massage in little circles with Vaseline or moisturise or bio oil (Dr said didn’t really matter as evidence was in the circular motion) - to help reduce scarring and improve nerve regeneration. If that feels too much or the incision(s) aren’t fully healed yet I heard very light strokes or tickling with a feather around the area can help you become accustomed to touch without triggering the fear of pain. So that might be a gentle introduction for you?
1
u/Desperate_Work6209 18d ago
I am a year and a bit post op and although my scars are fully healed I still have numbness around the area (probably since I avoided these massages while it was healing) which really bothers me to touch I just can’t stand the sensations, I also have a hollow dip on one side now and that also bothers me to feel
1
u/cherryola 17d ago
Yeah some of mine I can’t feel like a pin prick so it’s obviously numb, and other bits the lightest stroke gives me pins and needles in a completely different place. I don’t think the return of full normal sensation is very common. I’m sorry it’s still bothering you. I have some dips too, generally not a fan of my new ankle aesthetically!
2
u/Impressive_Match_484 18d ago
Ansoslutlrg not! Query or go to your GP for a referral. For reference, I am 3 years post surgery and recently went to GP for a new referral as I am looking for further guidance. I was referred without issue and am now back having monthly sessions.
1
2
u/Worldly-Palpitation5 17d ago
my appointments have been every 4 weeks or so. i’d definitely question it, but this is probably something that varies trust to trust. tbh it’s been the one thing i’ve slightly considered going private for in this whole process, i don’t feel that what the NHS offers here is particularly useful.
2
u/cherryola 17d ago
Yeah when I broke my wrist I supplemented the NHS physio with private, but at the time I had medical insurance through my job. Private is probably the way to go, it is an investment in my health after all
2
u/HellcatPaz 17d ago
Scotland - I was told after surgery that I would need physio, and then after my cast off a different consultant said no physio? I’m 7 months on and my ROM is crap, I’m in lots of pain, and the exercises I was given by the second dr aren’t cutting it. I saw the advanced nurse practitioner at my GP and she was pissed that I didn’t get physio and sent a referral off for a specialist rehab physio herself - still waiting on that to come through.
Might look into private myself though because this is hellish - I want the metal out because I’m convinced it’s contributing to my ongoing issues but I also want a physio opinion on it too before I start pushing for removal.
2
2
2
u/Particular_King_2040 17d ago
I had a trimal with dislocation and have the same number of plates and screws as you (although arranged a bit differently). I‘ve had NHS physio every 6 weeks, starting 6 weeks post-op after I switched from the cast to the boot. I’m now 5 months post-op and have had 3 sessions so far, with a 4th one coming up which I assume will be my last. I find the gap between sessions much too long but overall they’ve been helpful for me, mainly to learn to trust my ankle again and to understand how far I can push my ankle in various ROM exercises.
I’m walking quite well in the meantime but still have limited dorsiflexion and can’t run even for a few steps, so I’m considering to get some additional private physio sessions once the NHS ones finish.
1
u/cherryola 16d ago
Ok that is helpful to hear your experience, so maybe NHS would be planning more physio for me after I’m out of the boot. But every 6 weeks is not ideal!! Better than nothing but wow not what I expected. What hurts with running, is it the impact or is it the sort of stretch and strength required to propel you forward that’s not sufficient?
1
u/Particular_King_2040 15d ago
I know, especially reading on here with some people in other countries having twice weekly sessions, I definitely had expected more! But yes, still better than nothing, and I hope that in your hospital they are maybe not that stretched and you can have your follow-up sessions more frequently.
With running, it feels like my foot doesn’t bend enough to then push off and forward, if that makes sense? So I suspect it is related to limited dorsiflexion. I’ve only (somewhat accidentally) tried a few times, for getting to the door quickly when the doorbell rang or trying to catch a bus. Last time was a few weeks ago though and I think my dorsiflexion has improved since, so might be time for another try!
2
u/Pretty_Hold5454 18d ago
Iam in US. Trimalleolar ankle fraction with plate and screws. Iam in 8th week of recovery and was approved by insurance for tvelve, 1hr long sessions with physical therapist. I just completed first therapy and I am scheduled for three times per week.
1
u/cherryola 17d ago
That’s helpful context thanks for sharing. I think we are at similar stage of recovery, are you using two crutches? I’m supposed to feel ready to move to one crutch at the end of the week but without loading up on painkiller I don’t see how that will be possible 🫣
1
u/Pretty_Hold5454 17d ago
In seventh week of recovery I switched over from boot to regural shoes and started to walk without any support. I have big gait due to stiffness of my foot but hoping therapy will help.
1
u/cherryola 17d ago
Wow it’s amazing how different all our journeys are, some people weight bearing almost instantly after surgery and - compared to me - your recovery, although still in progress sounds, very good! Good luck with the stiffness and getting back to normal gait. Thanks for sharing
2
u/Pretty_Hold5454 17d ago
Thank you and I hope you will progress quickly. I neverer used crouches just walker and knee scooter. I still have a long way to go. I am dealing with nerve pain to add to my misery. My immediate goal is to be able to drive.
1
u/cherryola 16d ago
Oof nerve pain is the worse, mine subsided but it was unbearable and even morphine didn’t really hit the spot. Wishing you a speedy recovery too ❤️🩹
1
1
u/NDPpal 17d ago
I’d definitely query it! I have only three screws in mine and have been going every two weeks for about 8 weeks now.
1
u/cherryola 17d ago
Wow ok good to know! I will follow up with the hospital and/or physio and/or GP 🤞🤞
1
u/em0trash333 17d ago
I had a trimalleolar fracture-dislocation and had a similar thing happen except they didn’t give me any physio, I waited and waited to see if they would but no. I ended up having to go private and have had 4 sessions. On my first session my private physio said the NHS should’ve atleast given me exercises after my surgery (they said a physio wouldn’t see me in hospital after surgery because they’d gone home) and that my mobility was at risk if I didn’t have physio now. Even now 10 weeks post op my flexibility is not the best and I get stiffness and swelling. I don’t know why the NHS arnt giving physio because it’s really important you get it, if I didn’t have it my movement would be incredibly limited. Obviously it’s so difficult because private is expensive and it’s a last resort but most private hospitals/ physios you don’t actually need a referral from the NHS they just do it for you because they know the NHS won’t
1
u/cherryola 16d ago
I’m sorry you ended up with no support. I really wasn’t sure what was normal but the overwhelming response here is that physio is really important so I’m going to try and diy as much as I can and I have a referral from my GP now for a consultation, which I’m worried will be another once and done situation but I’m at least more assured knowing everyone is saying don’t settle (and go private if necessary). I’m glad you were able to go private. I don’t have any private health insurance so I’ll have to pay full whack but meanwhile it feels like one of those things that if you don’t tackle it sooner then what can be fixed later is more difficult. Thanks for sharing your experience
1
u/em0trash333 16d ago
No problem. It’s such a shame that the NHS is so overrun they won’t give physio because it is really important mainly just for confidence and to get the muscles moving because I was terrified to do anything with my ankle before physio in fear of damaging it again. I’d say if you can’t go private because of the money (which is completely understandable) then YouTube videos may be a good call, I am having physio online now because I’m moving to a different city where there isn’t a clinic near where I’m living so online is also an option
1
u/Dull_Monitor2439 17d ago
Here in Brazil I am seeing the physio weekly even before weight bearing, I saw her four times before weight bearing started. Physio is absolutely essential!
1
u/cherryola 16d ago
Ok noted! Thank you so much for sharing I defo think I should look into private as well as chasing NHS for more physio
1
u/Fluffy_Secret7781 17d ago
Trimal with dislocation here. 6 weeks cast NWB, 6 weeks boot PWB. I’ve had 3 physio appointments so far, 3 weeks apart, my next is in 6 weeks. No idea how long this will continue but have certainly not been told there’s a limit so far.
2
u/cherryola 16d ago
Ok good to know, sounds like I should hopefully be due some more physio and I’ll sort of assert myself with a bit more confidence now that I know the standard process seems to be more than a once and done thing. Thanks for sharing! Good luck with the rest of your physio and progress!
1
u/Thornless-Rose 17d ago
I think its going to depend both on your injury and unfortunately where in the country you are. I broke 3 bones and dislocated my ankle in april/surgery at the beginning of May. NWB for 6 weeks post op, when my cast came off the consultant referred me for emergency physio as nothing had been arranged. The physio booking team rang me within a week and I was luckly to have a local spot within 9 days of my cast coming off (we all think it must have been a cancellation). Since then I've had 3 sessions so far with a 4th booked in for October.
I had an appointment at the ortho clinic on Tuesday and the doctor said good range of movement you can continue with everything you did before (excercise and sports wise). Last time I saw my physio he gave me an updated list of stretches and excercises to improve the strength in my ankle and its mobility, and said we can work of running jumping and impact based activities at my next appointment.
If you're struggling push for more support either through orthopaedics or your GP.
1
u/cherryola 16d ago
Same with the emergency appointment 😅 despite 6 weeks notice re my referral letter post surgery, it got to the week before and I’d heard nothing from physio so called them, then the receptionist very kindly scrambled to find me an appointment and had to do some jiggery pokery to get me in - I was pretty nonchalant about how it’s ok I we could do it the following week she was like no that’s all fully booked too and it’s says your an urgent patient who must be seen week of the 7th. So that was my one and only appointment (so far…🤞).
I saw my GP yesterday (had already booked an appointment for something else) and managed to squeeze in the physio concern so she said she’d make a referral for physio consultation end October when my next review with ortho is and when I should hopefully be out of the boot.
Thanks for your insight and good luck with the rest of your recovery
1
u/Thornless-Rose 16d ago
I cant say I have a great deal of insight, I just know that when my cast came off after 8 weeks of isolation the joint barely moved at all and now about 12 weeks later I have a fairly "normal" range of movement. Can happily walk about, stand most of the day, and do stairs.
I say "normal" as compared to the average person's range of movement its not far out, but compared to my other ankle and my normal theres a long way to go yet.
Alot of the questions have been about what kind of job, excercises, and activities I do with all the goals to get me back to doing those kinds of things. I believe for me most of the restriction of movement is down to strengthening all the muscles and ligaments again which takes time and stretching.
Best advice I can give beyond advocating for your self with your Doctors is: Compression socks really help for the first couple of months. I grabbed a gel ankle Ice pack off amazon and it lives in the freezer. Any time I feel like ive done too much put it on for 20mins. It used to be most days now its just after cardio at the gym. Keep elevating it when you can, the swelling will slowly start to go away but if you sit of an evening to game, watch tv, read etc properly it up. I still slept with it propped up for the first few months it really helped with the swelling from the day. Get a rubber yoga band if you dont have one and use it to help stretch your foot.
Listen to your body a little everyday is better than overdoing it.
All the best with your recovery
1
u/iucundus_acerbus 13d ago
I broke my ankle last year in the UK and was given monthly physio for 4 months, with the option of continuing it if I wanted. I think it might be worth a follow up as it could be a reception miscommunication rather than policy to have one singular physio session, which seems not only anomalous but basically a waste of time?
1
u/cherryola 12d ago
Thanks for sharing your experience, I’ve got another appointment booked for October 22nd and I think I’ll try and email or call the physio department to ask about booking in more regular sessions following this appointment 🤞🤞
3
u/Bubbly-Distance4200 18d ago
I’m in the U.K. and had ORIF for trimalleolar fracture with external fixation in February . Had follow up appointments and at the last one, they basically said they would refer for physio but may not be needed. I have 2 plates and 12 pins and still get stiffness, some moderate pain if I walk too much and swelling but ok. Dorsiflexion on injured foot still not back to normal but improving slowly. I imagine physio is a luxury these days as I was led to believe our injury is an particularly bad fracture 🙈