Advice for my friend--any PTs??

[Crankin]

You may have heard me talk about my friend who broke his hip in a crash on 3/17. He asked my advice about this and I told him I would defer to some wise people on TE.
He has been a model patient; was on his trainer 2 weeks post surgery and religiously doing his exercises. At this point, he is driving, swimming, working. His ROM is not 100% and he has a limp. He asked his PT when he could begin riding outside, and the guy said no, no, no. So, he went back to the ortho doc, who took a new x ray; the doc cleared him to ride outside, building up slowly. Today he went for a 24 mile ride, with some small hills. He felt fine, and the only issue was getting his leg over the top tube, which he solved by leaning the bike. Tonight, he said he was going to "lie" to his PT, which I thought was silly. We talked about how maybe he should look for someone new. He likes the guy, who has been working him well, but the guy won't really state any reasons for not riding outside at this point. Brant has 5 weeks left on his PT prescription and will be able to get more. He's wondering if the ROM will come back on its own, or does he really need more PT? Or is there some type of special therapy that might help this along even more quickly?
This has been a rough 3.5 months for him. It's the first real medical issue he's had, at age 47. He was surprised at how great the ride went today and that he doesn't feel he has lost a ton of fitness.
Any thoughts?

[KnottedYet]

Usually PT defers to the ortho. After all, we work under their orders. Once the PT is informed of the ortho's decision to ok riding outside it really shouldn't be an issue at all.

PT is just a stepping stone to get people back to their usual activities. Once a patient is back to their usual stuff, I kind of go by a 90% rule: if they have 90% of their ROM, feel 90% improved over all, and have eagerly returned to activity; I kick 'em out the door!

At that point, they know as much about rehabbing their injury as I do and usually if that remaining 10% is going to come back, it is during full return to activity. Activity is better than PT at that point. They continue with their home exercises and I call them in a month. If they feel like things are even better a month later, I discharge their chart.

Hips can be funky, because the ORIF surgery and nature of the break can sometimes build in a limitation or two, but his ortho would have told him if he didn't expect full ROM.

[Crankin]

Thanks, Knott.
Hey, do you know that your PM mailbox is "full?"

[KnottedYet]

Yeah, I know... I couldn't keep up with it, so I just gave up on it.

[Trek420]

Yeah, your mailbox is full.

[NbyNW]

I'm not a PT but have personal experience with a similar injury --

Just wanted to add some thoughts on healing time and pain & ROM. It can take a LONG time to get back to pre-injury condition. I still sometimes limp if I am tired or not concentrating on how I am moving (my walking mechanics weren't great pre-injury, it's just something I am always working on).

I had to cut my PT short after only three weeks, because I couldn't pass up an opportunity to study abroad that year. I took my PT homework on the road and followed up with my PT after I got back. On the one hand, maybe it wasn't ideal to have that break in care, but on the other hand, having that elapsed time gave us some ideas as to what was working and what else we needed to focus on.

About two years after my injury, someone told me that where you are after a year is where you're going to be. Thank goodness I didn't get that memo!
At that point I was still in pain on a daily basis, still had something of an old-person shuffle when I first got out of bed in the morning, but I was still making progress! It took that long for me to be able to do some things that I had not been able to do since getting hurt; it has probably only been in the last year where I feel like I'm out of injury mode and more in daily maintenance mode.

For a while, to get on my bike I would stand on my good leg, lift the bad leg up, hug my knee to chest and guide my ankle over the top bar. For my first year I favored my folding bike with its low stepover.

The best thing for me to get my ROM back after I was done with PT, was to keep on moving. I had a desk job but tried to move around as much as possible. A good part of that is knowing when to work through some discomfort and when to ease off so as not to make things worse.

I had done a lot of pilates before my injury so I used that as my baseline for what I wanted to be able to do after my PT discharged me, in terms of strength and flexibility. I had an instructor who also had a PT background and she helped me to adapt exercises for my limited ROM and gave me exercises that would help improve my ROM.

This month is the 4th anniversary of my injury. It's been a 2-steps-forward-3-steps-back kind of year. I can do everything I was able to do before my injury with no restrictions. I have my pre-injury ROM but often feel clumsy when I am moving around. My mind-body awareness of the injury site is a daily thing. I don't go a day without thinking about it. Add that to brushing my teeth and cleaning my contact lenses: I need to stretch, massage and move in order to get through my day.

Lying to his PT is a bad idea. Having a frank discussion about expectations and goals would be a good one.

[Crankin]

Well, he went on another ride this morning, before going to the PT. He probably didn't get my email with Knott's advice until after the visit. He's out of town until the end of the week, and I am going away Friday, for the weekend, so I won't get updated until then. His wife, my friend, came by for a swim after work. From our discussion, I am pretty sure he will give the PT the boot. He can work with a trainer at the gym to do some of the stuff he's doing.
He's very rule bound, so even though my DH told him he needed to push the limits on this and do what he needs to (based on his own experience after getting stents), because sometimes we know our own bodies better than anyone, he sort of just did what he was told. I think that is over and getting on the bike did the trick to make him see this. We already have a ride planned for the 18th; 40 hilly miles up to NH.