Exercises after a Pelvic Fracture

Introduction

The pelvis is a ring of bones made up of different parts which connect your spine to your legs. It joins to your sacrum (tail bone) at the back and meets at the front at your pubic bones.

When you walk or sit, your pelvis supports your upper body.

It also acts like a bowl that protects important internal organs, for instance your bladder, bowel and reproductive organs and other structures like blood vessels and nerves.

Often you will need an operation to fix a broken pelvis but sometimes if the fracture is stable and still in a good position, surgery can be avoided. You will need x-rays or scans so that the doctors can decide on the type of fracture that you have and the best way to treat it.

Depending on the fracture and/or fixation your consultant will decide if you need to keep your weight off one or both legs. This is known as being non-weight bearing.

With some injuries patients may have a sitting restriction: in other words, they are only allowed to sit up to a certain angle. However, this does not mean they will have to stay in bed once their fracture is fixed. We will teach you how to transfer into wheelchairs and onto toilets.

Different ways of fixing a fractured pelvis:

• plates and screws onto the bone
• external fixator, a metal frame that is on the outside of your body, this still holds the broken bones in place
• internal fixator, a metal frame on the inside of your body
• rest and gradual movement using an appropriate walking aid – this is called conservative management and involves no operation

Exercises to do after your surgery

It is important to exercise whilst you are not as active as normal. This keeps your muscles strong and your joints moving. This is especially important if you are non-weight bearing.

Your physiotherapist will show you how to do your exercises and tell you how many to do and how often. Once you have been shown, you do not need to wait for the physiotherapist to be there to do your exercises.

If you do your exercises regularly, you will have the best possible result after the fracture/surgery. It will also help you feel in control and that you are helping yourself get better for the future.

Pelvic Floor Exercises

Your pelvic floor muscles are deep inside your pelvis and act like a sling of muscles. The pelvic floor muscles act together with the deep abdominal muscles to support the spine, pelvis and pelvic organs.

They are also important for bowel and bladder control, which can be affected after a fractured pelvis.

You may have had strong pelvic floor muscles before your accident but they can be switched off after a pelvic fracture and surgery can also disrupt them.

For men:

Sit or lie with your knees slightly bent and slightly apart, feet on floor or bed. If sitting, sit up straight with your shoulders back.

Imagine you are trying to pull your penis inside you and lift up your scrotum using your internal muscles. Tighten around your back passage at the same time. You should feel a sensation of something lifting up inside.

This exercise is not squeezing your big bottom muscles together.

Long contractions:

Three times a day, do up to 10 long contractions of up to 10 seconds pulling the muscles up with a gentle, half-way lift and hold whilst still breathing. Relax fully between each contraction.

(You may not be able to hold for long to begin with or do many repetitions e.g. if you can hold for 5 seconds and repeat 6 times, then start your programme by doing long squeezes of 5 seconds 6 times before you do your short squeezes.)

Short contractions:

Three times a day, do up to 10 short contractions pulling the muscles up strongly for one second and then letting go completely.

(You may not be able to do 10 to begin with e.g. if you can do 5, then you will do 5 short squeezes after your long squeezes 3 times a day.)

Try to contract your pelvic floor muscles before coughing, sneezing, lifting, pushing, pulling, standing up or yawning.

For women

Sit or lie with your knees slightly bent and slightly apart, feet on floor or bed. If sitting, sit up straight with your shoulders back.

Imagine you are trying to stop yourself passing wind from your back passage, tightening and closing your vagina and trying to stop a urine flow mid-stream. Your spine should stay still. Squeeze and lift the muscles.

Long contractions:

Three times a day, do up to 10 long contractions of up to 10 seconds pulling the muscles up with a gentle, half-way lift and hold whilst still breathing. Relax fully between each contraction.

(You may not be able to hold for long to begin with or do many repetitions e.g. if you can hold for 5 seconds and repeat 6 times, then start your programme by doing long squeezes of 5 seconds 6 times before you do your short squeezes.)

Short contractions:

Three times a day, do up to 10 short contractions pulling the muscles up strongly for one second and then letting go completely.

(You may not be able to do 10 to begin with e.g. if you can do 5, then you will do 5 short squeezes after your long squeezes 3 times a day.)

Try to contract your pelvic floor muscles before coughing, sneezing, lifting, pushing, pulling, standing up or yawning.

Click here for a useful video explaining women’s pelvic floor exercises.

The exercises will get easier as the days go by as the muscles come back to life and get stronger. Try to make them a part of everyday life.

Click here for a link to a useful app guiding women and men through pelvic floor exercises (opens in a new tab).

Other exercises

1. Ankle pumps (in a sitting or lying position)

Bend your ankles up and down or in a circular motion. Pull your feet up towards you and then point your toes downwards:

This helps with your blood circulation and stops your ankles becoming stiff. This is especially important if you are not allowed to put weight on your leg(s) as your ankles will not have your body weight on them to keep them flexible.

We may also give you some stretchy band or a bed sheet (if required), so you can stretch your ankles using your arms.

Repeat 20 times every hour, on both sides.

2. Hip and knee bends: (in a lying position) (For acetabulum/hip socket fractures start this in two to three weeks.)

Lying on the bed. Breathe in, breathe out, and engage your deep abdominal muscles and pelvic floor. Breathe in and on your out-breath, gently slide one heel away from you, keeping the heel in contact with the floor. Breathe in, and on out-breath gently draw your heel back to the starting position.

Keep your pelvis perfectly level and stable throughout the movement. Only go as far as is comfortable. You may find it easier on one side than the other.

Repeat 10 times, four times a day (to begin with) and increase the number of times if it becomes too easy. Do both sides but one leg at a time.

3. Leg slides (hip abduction) (For acetabulum/hip socket fractures start this in two to three weeks.)

Lying on the bed. Breathe in, breath out and engage your deep abdominal muscles and pelvic floor. Breathe in and on your out-breath, move your leg out to the side. Breathe in and then on your out-breath move your leg back to the middle. Keep your knee straight and your toes pointing straight up to the ceiling.

Repeat 10 times, four times a day (to begin with) and increase the number of times if it becomes too easy. Do both sides but one leg at a time.

4. Thigh muscle exercise (static quads)

Lying on the bed with your legs flat, push your knee down onto the bed as straight as it will go.

Keep it pushed down for 10 seconds.

Repeat 10 times, four times a day (to begin with) and increase the number of times if it becomes too easy. Do one leg at a time.

Tip: If it helps imagine something underneath your knee at the back, for instance a rubber ball, and think about squashing it flat.

5. Buttock clenches (Static Glutes)

Squeeze your buttock muscles together.

You can do this exercise anywhere, lying, sitting or standing. Your legs won’t move but you may find that you rise up and sink down a little as your muscles contract.

Hold the squeeze for 10 seconds.

Repeat 10 times, four times a day (to begin with) and increase the number of times if it becomes too easy.

6. Abdominal exercises

Lie on your back with both knees slightly bent with a pillow under knees and feet on the bed slightly apart. Tighten your lower tummy muscles and gently flatten the small (lower part) of your back onto the bed. At the same time gently draw your tummy button towards your spine.

Hold for 5-10 seconds: repeat 10 times.

Gradually increase the length of time you can hold the contraction.

7. Tabletop

Engage your deep abdominal muscles and pelvic floor. Breathe in and on your out-breath lift one leg up to tabletop position and hold. Breathe in and on your out-breath, lower the same leg back to the starting position. Remember not to let your lower back arch too much when lowering your leg back down.

Repeat 10 times on each leg.

Progression: Engage your deep abdominal muscles and pelvic floor. Breathe in and on your out-breath, lift one leg up to tabletop and hold. Breathe in and on your out-breath, lift your other leg up to tabletop. Lower each leg back to the starting position, one at a time.

7. Single knee fallout

Start with both feet flat on floor and your knees bent. Breathe in, breathe out, and engage your deep abdominal muscles and pelvic floor. Breathe in and on your out-breath let 1 leg fall out to the side whilst keeping the other still. Breathe in and on your out-breath bring the leg back to the starting position.

Keep your pelvis stable and perfectly level throughout the movement. Your tummy should not dome. If it does, place your fingers on your pelvis and concentrate on drawing your lower tummy in and wide.

Release the pelvic floor and abdominal muscles before repeating the exercise.

Progression: Breathe in and on your out-breath, lift 1 leg to tabletop. Breathe in and on your out-breath let this leg fall out to the side. Breathe in and on your out-breath return this leg to tabletop before returning to the start position. Keep your pelvis stable and perfectly level throughout the movement.

Repeat 10 times for each leg.

8. Clam

Perform this in side-lying with neutral spine. Breathe in, breathe out, and engage your deep abdominal muscles and pelvic floor.

Without allowing the pelvis to roll back at all (imagine you are balancing a full glass of water on your uppermost hip), gently open your legs at the knees, keeping ankles together.

Progression: Perform this in side-lying with neutral spine. Breathe in, breathe out, and engage deep abdominal muscles and pelvic floor. Lift feet off the floor whilst keeping your knees and ankles together. Without allowing the pelvis to roll back, gently open your legs at the knees, keeping ankles together.

9. Chair exercises

Once you can sit in a chair or wheelchair comfortably:

Pull your foot up towards you, tighten your thigh muscle to straighten your knee and lift your foot up off the floor. Hold this position for 10 seconds

Repeat 10 times, four times a day (to begin with) and increase the number of times if it becomes too easy. Do both legs but one leg at a time.

Chronic pain

Your pain may persist i.e. become chronic, although everything has healed up and there is no obvious reason for its cause. Nevertheless, the pain is real and can be managed by you. For further advice please speak to your GP.

Home situation

To ensure that you are able to go home safely we will discuss your home situation, asking questions such as are there stairs and front door steps, are there people at home with you, is your furniture suitable, do you have a downstairs toilet? Sometimes adaptations may need to be made, such as sleeping downstairs for a time or staying in one room. Home adaptations should be made as soon as possible to ensure your easy and effective safe discharge from hospital and reduce delays.

An occupational therapist will come and discuss all these issues with you and talk to you about any equipment you may need. They will also work on functional goals, for instance, daily tasks that you need to achieve.

Wheelchairs

We can give you a list of wheelchair providers should you need to source a wheelchair.

The Red Cross provide many wheelchairs to our patients and they ask for a donation depending on your circumstances. We suggest that your friends or relatives organise this as soon as possible to prevent delays in you going home.

Walking aids

The physiotherapy team will give you any walking equipment that you need such as crutches or frames. They will also show you how to use them and how to manage the stairs with them if appropriate.

Once you have finished using them please return them to Addenbrooke’s Hospital or Boots the Chemists in Cambridge, (Petty Cury, Newmarket Road or the Grafton Centre) Saffron Walden, St Neots, Ely, Haverhill, St Ives, Royston.

Or The Princess of Wales Hospital, Ely, or the Park and Ride sites in Cambridge.

Contacts

If you have any concerns following discharge from hospital, the in-patient physiotherapy team can be contacted on 01223 216104.

Information

Please be aware that this handout is to be used as a guide. If you find these exercises painful please seek advice from your physiotherapist or doctor.

This information has been compiled by the physiotherapy team at Addenbrooke’s Hospital. You may receive this information during an appointment with a physiotherapist, from your clinic or ward, or via the physiotherapy section of our website (opens in a new tab).