Advice for my friend--any PTs??

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?

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.

Thanks, Knott.

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

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