male with IMnail fixation to tibia with distal and prox 3rd fractures 12/52 ago. delayed rehab due to skin necrosis. Now green light surgeon. objective fwb with no crutches return to sport. Callus formation is very slow
He lacks knee extension and has tibfem pain on WB . Not the nail - directly over the incision through the Patella tendon.
1. can I mob the tib fem joint?
2. exs to avoid for strengthening. i am looking closed chain, cocontraction and balance through out the leg. Leg press, bike, hip work, stp ups, wt transfer work and stretching, proprioception. I am avoiding resisted knee extension as in on a cybex machine. I assume that is right.
Chances are i am not going to bother the fracture and that ultimately I am looking for co contraction/stability /wb loading with no shear forces to facilitate the # consolidation etc.

PLease comment. I am just returning to practice

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