Ab. No. 158 Lack of Rural Rehab: A Case Report of Chronic Stiffness Post Tibia Fracture

Abstract

Introduction: Even after 7 decades, referral depends on acceptance of physiotherapy as an independent profession. Even if prescribed, rural rehabilitation is not always executed with regular follow up.Neither documentation of rural physiotherapist-population ratio requirements, nor regulatory body to standardize rehabilitation level is available. Only 3% Anganwadi workers were informed about physiotherapy, though Maharashtra has 214 PHCs with wellness room for physiotherapy/yoga. Regain quality of life, return to employment, which was lacking a year after proximal tibial fracture, due to lack of referral to post-operative physiotherapy in Maharashtra’s Mangaon taluka. Methods: A 41-year-old patient with right undisplaced lateral tibial condyle fracture complained of limited knee range, stiffness, pain on standing, prolonged sitting, stairclimbing, reduced walking speed, loss of job as a coal miner. He was explained that restricted flexion was due to internal bony fragments, which caused fear of end range flexion, and was advised to undergo a revision surgery inspite of poor expected outcome. 4-week protocol included strengthening for quadriceps, hamstrings, hip abductors, flexors, calf, stretching, weight bearing exercises. Home exercises were regularly progressed. Adjuncts used were dry cupping, IASTM, dry needling. Result: Range increased from 10°-86° to 0°-112°, extensor lag, antalgic gait was corrected, thigh girth increased by 1.5 cm. Pain reduced while climbing stairs (4/10 to 0/10), standing after prolonged sitting (6/10 to 4/10), and walking (1/10 to 0/10). Squatting, cross leg sitting with minimal pain, return to work as a full-time coal miner was achieved. Revision surgery and disability were prevented. Conclusion: Rural early rehabilitative protocol could have prevented 1 year of unemployment, pain, stiffness. Implications: Highlights need for streamlined referral system to match evidence that recommends early ROM and weight bearing. Stimulate public –private partnerships for creating the role of physiotherapy assistant/technician at the existent PHCs. Facilitate followed-up tele-rehabilitation for rural physiotherapy.