Real talk, I still haven’t been directly referred to physio by my surgeon. In the beginning, pre-op, they told me I would be able to start physio pretty soon after surgery, but never gave details. This is one of the more infuriating parts of this recovery. The surgeon I saw and his team have not given me much information about my recovery. I don’t really know where I should be compared to where I am now, and they aren’t the best at teaching you the physical skills you need.
That said, just because I haven’t officially been sent for physio doesn’t mean I haven’t had a whole lot of treatment over the last 6 weeks (including the week between the fracture and surgery). Over the course of 6 weeks, I’ve had somewhere around 30 treatments which is not hugely realistic for everyone, but if you can manage it, it helps monumentally with the pain and is increasing range of motion. As soon as you can manage, get to a physio. The longer you wait, the harder it is to make progress, so getting your first treatment in the first few weeks will give you a leg up. If you’re seeing the right therapist, there are even things that can be done before your cast comes off to help with long-term pain management and hypersensitivity control.
At Endeavour, we do a whole lot of neurofunctional acupuncture. This has been a hugely powerful tool for me over the course of this process. In the beginning we used acupuncture to calm the nervous system in general which reduces pain. Fun fact, the endorphins acupuncture releases are the same as the ones simulated by opiods, so you can swap out at least some of your painkillers for acupuncture with no side effects or risk of addiction.
Once I was out of the splint and into The Boot we were able to start targeting the local area, slowly getting closer and closer to the surgical site and the fracture site.
Now, we’re able to get relatively close with the needles, and are able to stimulate the muscles in the calf through the contractions, which helps minimize atrophy as well as returning regular function to the ankle. Even though this still is a little painful and the contractions are still a little uncomfortable my ankle is starting to behave a little more like a normal ankle (one that’s in need of some serious physio, but still). At 5 weeks post-op, I’ll definitely take it.
On top of the acupuncture, we are able to get the ankle moving with some manual techniques. These are a little more tricky than the acupuncture in a lot of ways. There is more prolonged pain (during treatment, not after treatment) and often require movement. We’ve also used some cupping (not fire cupping) to help reduce the swelling in the ankle, which long-term helps reduce pain and improve movement.
There is a degree of anxiety for me around movement of the joint. Even though I am cleared for movement and it is safe, I feel a little anxious about the movement and the associated discomfort. Not knowing exactly how much is too much in terms of pain makes movement harder. This is one of the reasons I fell discouraged by the system in at least some hospitals. The team at Sunnybrook has not provided detailed information and training that would allow for a safer and faster recovery. Relying on the help of physios is fine for me because I have access to them and know that it’s a necessary step at this point, but having not been directly referred yet, I know that most people in my situation do not have the knowledge to keep their recovery on track and as efficient as it can be. If the surgical team in the fracture clinic don’t have the resources to provide sufficient information, that’s fine, but they need to inform their patients, at the very least, of their options when it comes to post op and post fracture recovery.