A friend told me that people who come out of casts have to undergo physical therapy because the limb was “inactive” for the period in which it was in a cast. The inactivity causes the muscles/tendons/etc. to atrophy, so they undergo PT to strengthen them. Is this correct? I always thought PT had more to do with the injury itself than the period of inactivity after the injury.
Do people who wake up out of very long comas (over a year) require physical therapy? That is, if you stay immobile for a long period of time, but are well nourished, would your muscles still atrophy?
I’ve heard of muscular atrophy. Do tendons, ligaments, and bones all atrophy as well?
Finally, can bones and ligaments be strengthened by physical therapy just like muscles and tendons?
IANAPT but I’ll give it a shot anyhow til one shows up:
It depends in part on the injury, but yes, what your friend says is true. Actually, the PT in this case is probably for both the initial injury and to restore strength and flexibility in the limb.
Absolutely yes. In fact, it wouldn’t take as long as a year for this effect to be noticable.
I don’t know if tendons and ligaments atrophy - but they will become stiff and less flexible, and may also contract, contorting the limbs in to various useless shapes.
Bones will also atrophy, and typically do so with age even in people who are on their feet and moving around. If it gets bad enough we call it “osteoporosis”. Prolonged inactivity can have similar results. So can living in space, since in zero-g little or no force is being exerted on the bones.
As I said, I’m not so sure about the ligaments, although proper exercise/therapy will certainly make them more flexible.
Any weight-bearing exercise will promote stronger bones.
The need for PT following casting depends on other factors such as age, extent and location of injury, etc. For example, a 12 year old with a simple fracture and six week cast will see some atrophy, but will bounce back quickly without PT assistance.
I have not had any experience with people who have awakened from a coma, but would surmise that they would need PT if they were bedridden for any significant length of time and, of course, the cause of the coma may play a role.
I did have a young, healthy patient on complete bedrest (no bathroom priveledges) for 4 months who needed the assistance of a walker for a few days or week following the bedrest, and needed a few weeks or months to recover fully. Because she was basically a young an healthy person who was bedrested for a problem pregnancy, she did recover her strength pretty quickly. Had she been an elderly person, I don’t think she would have recoverd as quickly or as well.
I do know that muscle will atrophy and bone will become weak without use. The guideline we use is that muscle and bone loss will begin on the third day of complete bedrest. I don’t know that that rule is actually true, but we use it as a guide to decide if we want to order PT for the bedrested patient. PT will then visit the patient regularly and prescribe bedrest exercises using therabands (really big rubber bands) and other things. I’m not so sure about tendon, but it is probably true that they will become weak, too.
Again, I’m not sure about ligaments and tendons, but bones do need weight bearing and exercise to maintain strength. Because tendons and ligaments don’t have a great amount of blood flow as compared to muscle, perhaps they don’t change in temrs of loss and strength as quickly.