After doing a history and and exam, and checking what's available on the
file (!) like X-rays, I usually take an aproach somewhere on this continuum:
1 Non weight bearing = obvious!
2 Feather weight bearing - this is walking on eggshells, more for for
movements than for weight bearing.
3 Partial weight bearing with a goal of progression to full weight bearing
as tolerated. Patient is asked to place foot of injured side on a weigh
scale, and then apply pressure as they feel comfortable. a person who has no
contraindication to full weight bearing minor sprains or strains, may be
spared most of this, as their progression will return anyway, If we have a
more significant injury, bone, ORIF, tendon rupture, or neuro involvement I
ask for hindfoot, then forefoot pressure, and get them familiar with the
pressure. If all is well, I usually suggest they start with 20-25% of body
weight and then then I ensure they ambulate with crutches properly. I write
the numbers down and should they be having a course of treatment, then I
will use this pressure/number technique to guide/document progression. if
they have a dozen screws put in 6" of bone, or just had the screws out of
same bone, or have been in a cast for a lengthy time, we take a slower
approach dictated by healing and consultants goals, but really it's just a
comfort, (ROM, strength, stability) issue that will progress naturally. In
all cases i suggest a progression to 50, and 75% WB; it's the pace that
may vary.
In the cases where tarzan may need be reminded to take it easy or a piglet
needs a little re-assurance, and I find the objective information helps
folks relate their sensation to the degree of weight bearing. The more
reasoned patients don't seem to need too much more. Aagain I don't bother
with this detail with an injury with no contra-indication to FWB.
Your post asks do we have any evidence to support this practice. A couple
of ways to look at this. does it make healing optimal or sub-optimal, I
can't say. It is my understanding that axial compression across a fracture
helps bone repair, so why limit this unnecessarily unless the weght bearing
de-stabilises the thing. Surgeons generally advise in this regard. Tendon
grafts and neuro damage appear different - we try to stimulate repair but
not exceed a threshold, ie rupture or what ever.
Does this treatment approach provide objective data on which to help base
adjunctive treatment, make return to work, or sport recommendations, or
with which to defend a treatment program in court, I would have to say I am
more comfortable with an objecvtive measure than by guessing!
my 02.
Ian
----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, January 06, 2001 8:13 AM
Subject: Partial weight bearing
> A student was talking to me the other day about partial weight bearing. As
a
> consequence of our discussion the following issues arose, and I would be
> interested to hear your views. If you are aware of any research in the
area
> I would also be interested as the student has not (so far) managed to find
> anything relevant.
>
> It appears that some therapists give quite specific instructions about how
> much weight should be taken through a limb when a patient is partial
weight
> bearing. For example the patient should only take 50% of body weight. But
do
> we have any evidence to support this level of precision?
>
> Is there any research into how strong (perhaps as a percentage of original
> 'strength') a bone is in the later stages of healing (union and
> consolidation)?
>
> Does anyone know of any evidence that patients are able to weight bear to
a
> specified level or is it rather a nonsense to tell a patient to take 50%
of
> his/her weight?
>
> Just out of curiosity I wonder what sort of instructions clinical
> colleagues give when trying to convey the concept of partial weight
bearing
> to a patient. Obviously some use a percentage of body weight, others
appear
> to suggest to patients that there is a tomato or an egg under the sole of
> the foot and it should not be squashed!
>
> Marion Trew
> University of Brighton
> UK
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