After an injury or operation, your surgeon will provide guidelines on when and how you can start weight-bearing. This is an essential part of your rehabilitation after an injury or surgery. Skipping this time, or putting any more weight through your leg than recommended can be very detrimental to your recovery.
Your physiotherapist will show you how to get around without using your injured leg. When necessary, you will be given aids like crutches, a cane or a walker to assist you.
Usually, rehabilitation begins with minimal movement and protection of the injured limb. At this point you may be completely non-weight-bearing. As the bone or ligaments start to heal, you can begin to increase the weight you put through your leg.
This guide to weight-bearing during rehabilitation is designed to give you an idea of what you should and should not do during these periods. You should however always follow the advice of your physiotheapist.
You may also be referred to the occupational therapists for help in the home.
What should I be doing during non-weight-bearing?
- Keep your leg elevated to reduce swelling, and if necessary use occasional icing. These two can be discussed with your physiotherapist.
- Exercises for the rest of your leg & your body.
- Your physio can show you exercises to maintain your general fitness while unable to weight beat.
- Other joints in the injured leg need to be kept moving to stay flexible. The muscles will also need to be exercised to maintain their strength and elasticity.
Full weight-bearing is prescribed when your bones or ligaments are too weak to take any strain at all. Walking using the injured limb risks re-injury. This means that you cannot lean on your injured leg even when it is in a plaster.
In order to avoid putting any weight through your leg, it is best to avoid lowering your foot to the ground at all. Only in special cases will patients be allowed to touch their foot to the ground during weight-bearing – this is called ‘touch’ weight-bearing and is used when non-weight-bearing is too difficult.
Your physiotherapist will provide you with:
- Gait aids – this is usually crutches, however other aids may be used.
- Instructions on how to negotiate stairs, perform turns, ascend and descend slopes and any other necessary maneuvres.
At this point, your foot or ankle is probably immobilized in a plaster cast. A cast covering your ankle will not take your weight – even if you have a cast you should not put any weight on your foot.
When is full NWB used?
Full non-weight-bearing is required after serious knee, hip, ankle or foot injuries. It is also used after some surgeries.
Occasionally, moderately severe ligament injuries affecting joints in the leg require a few weeks of non-weight-bearing despite not requiring surgery.
What are the risks of weight-bearing too early?
The most serious risk is re-injury of the bone or ligament that was damaged.
Transition from Full Non-Weight-Bearing
The first time you put weight on your foot you will probably feel sore, weak and/or unstable. This will be especially noticeable when you’ve been non-weight-bearing for a prolonged period of time, ie weeks. This is a normal consequnce of disuse, and it is important you begin weight-bearing and movements as soon as it is safe to do so.
Most people find that they repaidly regain strength in their leg as they continue with rehabilitation and gradually increase their weight-bearing. It is however, a difficult period, and your physiotherapist will provide encouragement and support as you start to take your weight. They will also teach you exercises to improve the feeling and strength in your joints.
What are the risks of full non-weight-bearing for too long?
Your body is designed to move and carry your weight, so prolonged periods of non-weight-bearing will alter the strength of your bones and muscles. Some changes include:
- Ligaments can become less elastic
- Muscles can shorten and become weaker
- Loss of proprioception can increase the risk of losing balance.
- Softening of bone (osteoporosis) leading to increased risk of fractures.
After an injury or operation, your surgeon or physiotherapist may ask you to be partial weight bearing. This form of non-weight-bearing is also frequently used as a transition phase between full non-weight-bearing and weight-bearing as tolerated.
The term ‘partial weight bearing’ refers to walking with gait aids, like crutches, but using the injured leg as a balance or support – as part of the walking system. You will still need to use gait aids like crutches or walking frames during this period.
Technically, physical therapists and surgeons refer to partial weight-bearing as up to but not exceeding 50% of your weight. This means that even when putting weight on your foot you should feel most of your weight supported by the crutches or walker.
How do I know how much weight I’m putting through my leg?
Your physiotherapist will help you with this. Some will suggest using bathroom scales to ‘practice’ feeling partial weight-bearing.
Can I limp?
No, you should not walk unaided at all. Limping still requires putting 100% of your weight through your injured foot, albeit for a short period of time. This is still dangerous to the healing tissues in your leg.
You can ‘hop’, using handrails or furniture to support your weight, but limping unaided should be avoided.
Weight bearing as tolerated is usually the last step in rehabilitation. It is essentially a green light to put as much of your weight through your leg as you wish.
At this point, you may still be using walking aids like a cane, but should not be using frames or crutches all the time.
What should I do if I have pain?
You should expect some degree of discomfort when beginning to weight-bear. To help relieve this you can take over-the-counter pain relief or talk to your surgeon.
Pain that increases, or sudden sharp pain may indicate re-injury in your joint. If this occurs, make sure you inform your surgeon and physiotherapist at your next session.
If you need help before your next appointment, see your local doctor or visit the Emergency Department.
Can I drive while non-weight-bearing?
This depends on whether you have an automatic car and whether it is your right or left leg that is injured. Before you can be cleared to drive, you may need to be able to perform an emergency stop.
Your insurance company will have some information on what they require before they consider you safe to drive.
Is there anything I should tell my doctors?
If you are risk of blood clots (for example, on the oral contraceptive pill or have a family history of blood clots) you may need extra medications.
If you have a cast in place, tell your doctors if you notice signs of cast irritation, including:
- Change in the colour of the toes, or pins and needles in the foot.
- Excessive pain
References
Atkinson, K, Coutts, F., Hassenkamp, A, ‘Physiotherapy in Orthopaedics: A Problem Solving Approach’, 2nd Ed.,Elsevier Churchill Livingstone, London, 2005.
Brotzman, S. B., Manske, R. C, ‘Clinical Orthopaedic Rehabilitation’, 3rd Ed.,Elsevier Mosby, Philadelphia, USA, 2011.
Warre, ‘Training procedures and biofeedback methods to achieve controlled partial weight bearing: an assessment’, Archives of physical medicine and rehabilitation [0003-9993] Warren yr:1975 vol:56 iss:10 pg:449 -455
