There are times, however, when these “permanent” fixtures need to be removed, such as if they are causing pain, there is a severe infection, or the bone hasn’t healed as hoped.
If this happens, you will likely undergo a period of immobilization once the hardware is removed, leading to a loss of strength, flexibility, and mobility. To compensate for this, your orthopedic surgeon may recommend a structured program of physical therapy.
Baseline Evaluations
After fixation hardware has been removed, you will most likely be wearing a cast or removable immobilizer to help stabilize the healing bone. Any time that a limb is immobilized for a prolonged period of time, there will inevitably be some level of muscle atrophy (wasting) and/or the loss of range of motion of a joint.
If physical therapy is advised, you would undergo an evaluation to provide baseline measurements of some or all of the following:
Pain Strength Range of motion (ROM) Gait cycle and stride length Weight-bearing status (how much weight you can bear without pain or loss of stability) Functional mobility (the ability to move independently) Surgical scar tissue
These measurements help the physical therapist formulate a rehabilitation plan and measure improvement as you progress through recovery.
Treatment Options
The most common reason for hardware removal after a fracture is pain or the loss of mobility and ROM. Physical therapy would therefore likely focus on regaining ROM around the injured extremity using various physical therapy techniques.
Gait Training
If you have had hardware removed from a lower extremity like an ankle or knee, then you will most likely need a walker or crutches after your surgery. Your physical therapist can help progress from walking with two crutches to one crutch and finally to a cane. This is part of a rehabilitative effort know as gait training.
Gait training may also include side-stepping, stair-climbing, navigating obstacles, and retro walking (walking backward) to target different muscle groups and enhance mobility.
As you progress in your treatment, your physical therapist may incorporate exercise to aid with balance and proprioception (including a BAPS board). Jumping and plyometric (agility) training may be necessary if you are planning to return to high-level sports and athletics.
ROM and Strength Traning
If internal hardware was removed due to the restriction of ROM, there may be further loss of ROM once the limb is immobilized. To minimize the loss, the physical therapist may employ passive physical therapy exercises in which there is no weight-bearing. Depending on the injury, these may include:
Toe pointsAnkle pumpPassive knee flexion (bending)Hip abduction (pressing outward) or adduction (pressing inward)
After the cast or immobilizer is no longer needed, resistance training and weight-bearing exercises may be added, increasing in intensity and duration week on week. In addition to in-office exercises, your physical therapist will provide you a list of exercises to do at home.
Scar Mobility
After surgery, you will have a surgical scar where the surgeon cut through your skin and muscles to remove the hardware.
Manual techniques like myofascial release can aid with healing and help reduce the amount of scar tissue that develops. The excessive buildup of scar tissue can lead to tissue contraction and the formation of adhesions (in which tissues stick together).
Pain Management
After ORIF surgical removal, you may experience pain and swelling around the surgical site. Your physical therapist can use various treatments and modalities to help manage postoperative pain including:
Cryotherapy (cold therapy) Thermotherapy (heat therapy) Therapeutic ultrasound Transcutaneous electrical nerve stimulation (TENS)
In addition to physical therapy, your healthcare provider may provide you with medications to help control acute pain, ranging from over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to the short-term use of prescription opioids.
Duration of Physical Therapy
You can expect to start physical therapy a few weeks after your hardware removal surgery. ROM and strength gains can usually be made quickly, and within 4 to 6 weeks you should nearer to your preoperative level of function.
A Word From Verywell
Physical therapy after ORIF hardware removal can be extremely beneficial in restoring ROM, strength, agility, and endurance. By staying motivated and working hard with your physical therapist, you can increase your chances of returning to full functional mobility even in older adults.
