› Forums › Knee › Correcting chronic Internal tibial rotation

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    • 03/23/2020 at 11:55 am #130974
      AvatarJamie Irving
      Participant

        Hey peeps,

        I had a compound fracture of the tib and fib 20 years ago that required IM rod and 9 screws. I had the rod and screws removed last year and noticed improvements in ankle ROM and general joint ‘stiffness’ as gone. That said, I really struggle to get ‘knee’s out’ and feet straight when squatting. My ankle dorsi is acceptable however internally rotating the ankle is poor (especially when compared to the right side) and the body automatically compensates with the hip internally rotating. This causes a valgus knee at the midpoint of a pistol and range is very limited when simply twisting when standing straight (hip flexion between 0 and 90). However, bottom of a pistol is fine.

        1 surgeon advised that the tibial internal rotation can’t be corrected as it’s now permanently structural, i.e. the bone has healed with a very slight tibial internal rotation (visible with straight legs), whereas another therapist advised that can correct it. When i spend 2 mins mobilising it the position improves, however it’s never permanent. My question is, is the surgeon potentially incorrect and the joint is possible to correct with mobilisations, and i suspect hip strengthening, or do i simply need to accept the fact that the bone has healed and it can’t be improved without further surgery?

        Also i have a very small part of the of the skin graft seeming attached to the bone. Is this possible to restore the sliding surface over time?

        Thanks again

      • 03/25/2020 at 7:41 pm #133218
        Michael AlzheimerMichael Alzheimer
        Moderator

          Hey Jamie,

          If you are seeing temporary changes that’s a good sign there is potential for long term improvement in your ROM. Temporary changes can become permanent with consistency and strengthening in the new ROM. Certainly would not opt for further surgery.

          The sliding surfaces should be able to be restored over time and that tacked down skin could be a player in your limitations. Allowing the skin to move independently of the muscles and tissues and vice versa is key. Some IASTM works well for this. Do you have a voodoo band or voodoo x band? If not I recommend getting one. Wrapping the area and performing squats and other movements that are restricted can have a big impact on restoring the movement and sliding surfaces. Addressing up down stream of where you see the problem is an important aspect as well.

          Cheers,
          Mike

        • 03/28/2020 at 4:04 pm #136467
          AvatarJamie Irving
          Participant

            Hey Michael,

            Yeah I have 2 voodoo band and have been using them either daily or every second day depending how sore my joints feel from the previous days mobilisations and have recently starting doing exactly what you said as the majority of my warm up. Lol, Voodoo feels awful, although pain before pleasure. It’s having a short hangover BEFORE a good night out on the booze!

            My balance is not optimal and i’ve been advised that i have hip stabilizers, which is obvious. I’m generally doing around 40 mins TRS mobilisations, 10 for warm up and more mob’s in strength rest periods 5-7 days. Additionally a morning routine of traditional stretches, isometrics and isolated eccentrics for 15 mins with no rest periods between sets, as per the physio’s instructions. My hips and calves always seems sore even after 1 days rest and good soft tissue sessions with ball and theragun. Could this be too much volume?

          • 03/30/2020 at 6:13 pm #137675
            Michael AlzheimerMichael Alzheimer
            Moderator

              Hey Jamie,

              Spending 40 mins on TRS mobilizations is too much volume. You can definitely over-treat an area which could be why your joints continue to feel sore. We advocate more around 10-15 min for mobility work per day. Pick 2-3 prescriptions and do them consistently for 10 min a day and see if that helps you progress. As Kelly always says, don’t be heroic be consistent.

              Cheers,
              Mike

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