Dorsiflexor, plantar flexor workout in a leg immobilized with ilizarov
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
Dorsiflexor, plantarflexor workout in a leg immobilized with ilizarov
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.
