Tiger Woods...What Exactly Did He Do?
As most of you probably know, Tiger Woods is out with a leg injury that he sustained from a car accident back in February. The statement that he and his people released said that he sustained comminuted open fractures of his upper and lower tibia and fibula and had to have a surgical release of the coverings of the muscles and tissues.
Comminuted fractures are fractures with two or more pieces or fragments, and open fractures mean that the fragments broke the skin. This presents problems because now the open wounds need to be cared for as well as the fractures, and there is a chance for infection. The surgical release to the coverings of the muscles and tissues sounds like he also suffered from acute compartment syndrome. This is a potentially life threatening condition that must be treated with a fasciotomy, which is what he had.
Compartment syndrome is when the pressure within the leg in this case builds to the point of blocking blood flow and nerve function. The lack of blood flow can permanently injure the muscles and other tissues. There are four compartments in the lower leg, each with different muscles and other contents, and each separated by fascia. Fascia is a non-stretchy covering that functions to keep everything in its place. Because it doesn’t stretch, if there is excess fluid or other build up, the internal pressure increases.
The rehabilitation for both of these are very different. Comminuted fractures can take several months to heal; compartment syndrome can take 4-6 weeks to heal. So how do you start rehab to ensure that both get better without worsening the other? The rehab for both of these injuries actually use the same techniques.
Compartment Syndrome rehab after surgery usually includes: range of motion exercises; muscle strengthening; manual therapy to manipulate muscles and joints; modalities such as ultrasound, iontophoresis, moist heat, cold therapy; and education on how to avoid this again in the future by changing footwear, adjusting training equipment or terrain of exercise, avoiding or adding exercises to your workout, learning proper cool down and rest time.
Healing comminuted fractures is a much more in depth process. You have to go through the inflammatory phase that lasts 1-2 weeks, the repair phase that lasts 2-3 weeks, and the remodeling phase that can last a couple months after the area is no longer painful and appears to be healed on x-rays.
Immediately after surgery for comminuted fractures (known as Open Reduction Internal Fixation), a brace must be worn to protect the area, and crutches will be used to prevent weight bearing. Physical therapy will be implemented in a couple of weeks to regain muscle control, range of motion, muscle strength, and more so that normal activity can eventually be resumed. The goal of the first 4 weeks is to reduce pain and inflammation and maintain range of motion and strength in both the unaffected and affected legs. Weeks 5-8 focuses on progressing range of motion and muscle strength and control, and gradual weight bearing exercises and gait training will be introduced. Weeks 9-12 focuses on further progression of range of motion, muscle strength and control, walking, balance, flexibility, and pain control. Activities will also be introduced to improve cardiovascular fitness and muscle endurance. Months 3-6 focuses on improving muscle strength and balance, as well as flexibility, as full range of motion should have been achieved. Cardiovascular exercises to increase independence will be a main focus.
For recovery from both of these injuries simultaneously, rehab for the Compartment Syndrome will simply be elongated to ensure no harm comes to the healing process of the fractures.
While it is a long process, full recovery is possible and probable. In fact, Tiger is expected to return to play by the end of this year.
If you’d like to know more about a player’s sports injury, email us and maybe you will see the answer in our next blog! If you have an injury of your own that you’d like to understand better, feel free to contact Cindy at BodyFit Physical Therapy for a free consultation.