This document, authored by Jared T. Lee, MD, outlines the rehabilitation plan following a Tibial Intramedullary Nailing procedure.
The protocol is divided into four phases:
- **Phase 1 (Weeks 0-2):** Focuses on reducing swelling and edema, minimizing pain, retarding muscle atrophy, and protecting the surgical repair. It includes non-weight bearing and a splint. Therapeutic exercises involve knee range of motion, wall slides, seated knee flexion/extension, patellar mobilizations, isometric quadriceps contractions, straight leg raises, clams, ball squeezes, hamstring sets, and stationary biking with the well leg.
- **Phase 2 (Weeks 2-6):** Transitions to a walker boot and partial weight-bearing (50% with crutches). Goals remain reducing swelling and pain, retarding muscle atrophy, protecting the repair, and restoring range of motion. Therapeutic exercises include continuing previous exercises, ankle pumps, passive and active ankle range of motion, rowing with the well leg, UBE, scar massage, dry needling, and IASTM as tolerated.
- **Phase 3 (Weeks 6-12):** Progresses to full weight-bearing in the boot and then a boot wean, eventually weight-bearing as tolerated without the boot. Focus is on full range of motion, minimal pain, increasing resistance exercises, restoring a normal gait pattern, and protecting graft fixation. Therapeutic exercises include continuing previous exercises, toe and heel raises, balance series, biking with both legs, aqua jogging, treadmill walking, elliptical trainer, rowing with both legs, and stair stepper.
- **Phase 4 (Weeks 12-16):** Emphasizes full weight-bearing, full range of motion, proper gait mechanics, improving lower extremity strength, neuromuscular control, proprioception restoration, power progression, and patient education. Exercises include progressing the strengthening program, double leg knee bends, double leg bridges, reverse lunges with static hold, balance squats, single leg deadlift, leg press, forward and backward running progression, dynamic balance exercises, cutting, crossover, carioca, plyometric exercises, and agility drills. Patients may return to activities like golf, hike, bike, snowshoe, skiing, basketball, tennis, football, and soccer with clearance at week 16.
The document also mentions specific strength indices (hamstring and quadriceps >90% compared to the contralateral limb) and a Y-Balance anterior reach measurement as criteria for discharge.
