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Physical therapy for a tibia and fibula break

The tibia and fibula are the two bones of the lower leg. It’s unusual to break both bones, even in contact sports like football. It takes quite a bit of trauma to break both of them at the same time. The footage of the Washington Redskins quarterback, Alex Smith, breaking both of these bones is hard to watch. 
Anyone sustaining a double break like this would go directly to surgery. The severity of the break can vary, but there are some standard things that anyone who breaks these bones will go through. 


The biggest factor is that the tibia is a weight bearing bone. Just like a load-bearing wall in a house, the tibia is integral to our physical structure and without it we can’t stand up. Any time a bone is broken we have to remove pressure on that bone to allow it to heal. This contributes to the prolonged healing time and requires a period of about 6 weeks where no weight is put on that leg. Depending on the severity of the break and the complexity of the surgery that time could be even longer. This initial healing period is extremely difficult because not putting weight on the bone causes atrophy of the surrounding muscles.

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During the period of non-weight bearing recovery, rehabilitative procedures can be done to encourage healing. This is where having a great physical therapist with an extensive skillset, like ours at Rose Physical Therapy Group, is essential. Management of swelling and circulation, gentle working out of the other leg and upper body, maintenance of range of motion of the toes, ankle, knee and hip, are all important to the recovery process. These procedures are performed with great skill, and applying these skills in the right way can significantly decrease the time it takes to return to normal activity once the bone is healed.



Traditionally physical therapy is brought into the equation a little later in the healing process, after the bone has healed enough to begin putting weight on it. However, a skilled PT would recommend starting gentle therapies before that to maximize outcomes and improve tolerance to harder therapies later on.
The athlete will return to weight bearing activities after the bone has healed. Initially physical therapy will include gentle strengthening and stretching. Weight distribution onto the broken leg is performed in carefully selected stages, starting slowly and with light weight at first. 
As the strength of the bone and muscle builds, more activity is allowed. This is a time when staying in touch with the surgeon is important. At this stage the surgeon ensures that everything done in therapy is within the bounds of what the surgeon recommends based on the structural integrity of the Tibia. It also means pushing into new boundaries as healing allows. It’s not good to fall behind in the rehab schedule. 

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Once there is enough healing to go back to basic activities such as walking without crutches then the real work begins. This is the time when the muscles are weakest from disuse and the freshly healed bone is fragile. Strengthening and mobility begin in earnest and can be quite a lot of work. Workouts that previously would have felt easy will be quite difficult. With hard work and guidance from a physical therapist strength grows and athletic ability can be regained.
Over time the workouts go from unloaded exercises like leg raises, to loaded exercises like squats to impact exercises like jumping. It’s a slow journey. The job of the physical therapist is to assess form and to progress things in a safe way to make sure no further injury or re-injury occurs.

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A really great physical therapist will also incorporate care for scar tissue and tissue mobility. Once an exercise is mastered that exercise becomes part of a home exercise program so that the time spent in therapy is used for the things that cannot be done at home. We spend a lot of time and effort perfecting our skills and abilities, we do not need to spend time watching exercises. Therapy time is for therapy.
A broken bone is never fun. Breaking both the tibia and fibula together is devastating. Part of what makes Alex Smith’s recovery favorable is access to top quality care. Fortunately there are lots of resources, even for normal folks, to make recovery possible. At Rose Physical Therapy Group we offer one-on-one care, one-hour appointments and we accept insurance. But these things are just the framework for good physical therapy care.

Rose Physical Therapy is setup to make the best physical therapy accessible to you by giving our therapists enough time to treat you in an environment that is centered around medical care, convenient to downtown Washington, DC and Capitol Hill / Capitol Riverfront / Navy Yard on the Southeast side of the District. All of this framework is important, but it shouldn’t just be about the convenience of a clinic to your geographic location in the city, or your commute. The key to all of this is the extra expertise that every Rose therapist has, it’s the secret sauce that makes everything work. So whether you’re Alex Smith coming back to the NFL, or just trying to get rid of knee pain while you are running, the skill and passion of your physical therapist helping you to heal in the right environment is the key to a speedy recovery.

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