Dorsiflexor, plantar flexor workout in a leg immobilized with ilizarov

[mageshanand]

Hello guys,

I got a patient who had RTA around a year back, he had tibial non union at around mid shaft, he is currently in Ilizarov lengthening program for the past 4 months now.

My problem is this, he has very weak dorsiflexor and plantar flexor, grade 1 (both).

How can I train it, I was wondering if I can give electrical stimulation in a modified way, by placing electrodes, one at the lumbar region at around L5/S1 and the other at his feet, there by following the sciatic nerve path, I would stimulate all the muscles supplied by the nerve, which would include DF and PF, ankle.

But electrical stimulation is contraindicated in case of metallic implants, now that too external fixator, will this modified electrode placement make a difference or is this also contraindicated?

please help me, even if you have other ideas please share it with me, Thanks

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[physiobob]

Grade 1 sounds rather scarey. Has he had and EMG studies to the area to locate the reason for the gross weakness? This would be important to isolate the problem before directing a treatment approach.

[sdkashif]

The complications with ilizarov method are muscles weakness, joint stiffness and sometimes nerve palsies as nerves are stretched by this procedure, so there is chance of neurapraxia of nerves due to traction applied to them.

As muscles are weak and of grade 1 strength, so try to re educatiing them with low frequecy currents like faradic current or IDC in case of nerve palsies. There is no complication of burn with low frequency current, so you may apply them safely even if the distraction fixator is attached to the limb. The problem of burn occurs only with high frequency currrents like short wave diathermy and microwave diathermy as they produce heating effect, so any metal in contact with high frequency currents may heat up and results in burn. The only problem with low frequncy currents is the unnecessary sensory stimulation of prickling or irritating sensory feeling which patient experiences.

Work on the joint stiffness with range of motion exercises and mobilization techniques. Strengthen the muscles with electrical muscles stimulation while re education the movement. Do the gait training of patient for being bed ridden.

[mageshanand]

well thanks for the reply guys, no EMG or such studies were done so far for him, i was learning this intersting text on the effect of TENS on non union bones, fron Therapeutic modalities by Chad Starkey.... i was contemplating on hitting two targets with elec stim, pls give me your opinions.....

thanks again for your replies

[physiobob]

..i was learning this intersting text on the effect of TENS on non union bones...

You should take a look at studies on electromagnetic therapy on bone union. It is used a lot to help speed fracture healing in professional athletes. Not sure of the vaildity of it but they were using it at the NSW Academy of Sport when I used to hang out down there

[sdkashif]

Have a look over some useful information resources.

Evidence based practice Transcutaneous electrical nerve stimulation (TENS)

Effectiveness and Comfort of Transcutaneous Electrical Nerve Stimulation

Modality References Electrical Stimulation

Modalities References TENS

Electrical Stimulation And Wound Healing References

Electrical Stimulation for Wound Healing: A Review of Evidence From In Vitro Studies,...

Electrical Stimulation for Wound Healing: A Review of Evidence From In Vitro Studies, Animal Experiments, and Clinical Trials

Treatment of chronic wounds by means of electric and electromagnetic fields part 1 literature review

Treatment of chronic wounds by means of electric and electromagnetic fields
Part 2 Value of FES parameters for pressure sore treatment

Stimulation of Osteogenesis

[mageshanand]

Thanks again guys, i will look in to this aspect soon