Logan Steele
Weight-bearing is any activity that involves carrying body weight on at least one lower extremity. It is an important aspect of recovery for patients on the orthopedic floor. Extensor muscles, on the other hand, are muscles that increase the angle between members of a limb, resulting in movements like straightening the elbow or bending the wrist backward. Given the relationship between weight-bearing and the skeletal system, as well as the role of extensor muscles in limb movement, it is important to understand if and how extensor muscles are weight-bearing.
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What You'll Learn
Extensor tendons and their role in weight-bearing
Weight-bearing exercises are an important part of recovery after orthopedic surgery. They help improve endurance, balance, coordination, and overall health. Extensor tendons, which connect muscles to bones, play a crucial role in weight-bearing. These tendons are like strong, flexible ropes that help extend and straighten body parts such as fingers, toes, and the front of the foot.
Extensor tendons are found in both the hands and feet. In the hands, they assist in extending and straightening the fingers, while in the feet, they enable the lifting of the toes and the front of the foot off the ground. This action is essential for walking and maintaining balance. The extensor tendons in the hands and feet are susceptible to tendinitis, an inflammation caused by repetitive motions or overuse. Tendinitis can cause pain and difficulty in moving the affected body parts.
The role of extensor tendons in weight-bearing becomes evident in various therapeutic contexts. For instance, functional weight-bearing mobilization is beneficial for healing after an Achilles tendon rupture. Similarly, weight-bearing exercises are recommended after orthopedic surgery to aid in recovery. The amount of weight-bearing prescribed depends on the type of surgery and the patient's progress. Crutches or ambulatory devices may be used to assist patients in bearing weight safely.
In the case of wrist injuries, extensor tendon impingement can occur, as seen in gymnasts due to the transformation of the upper extremity into a weight-bearing entity. This can cause chronic wrist conditions like distal radial epiphysitis, commonly known as "gymnast wrist." Therapeutic interventions and rehabilitation protocols are crucial for managing these injuries and facilitating a return to full sports participation.
Additionally, weight-bearing exercises are beneficial for bone healing and can be modified to suit an individual's needs. Low-intensity weight-bearing exercises are advantageous, especially after orthopedic surgery, to expedite recovery and reduce post-operative complications. However, weight-bearing may not be suitable for everyone, as those with rheumatoid arthritis affecting a weight-bearing joint may need to remain on pharmacotherapy to prevent further joint damage.
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Extensor muscles and their function in the hand and wrist
The human hand and wrist are complex parts of the body, with a range of bones, muscles, nerves, connective tissue, and blood vessels. The extensor muscles of the hand and wrist are located in the back of the forearm and have long tendons connecting them to bones in the hand. These muscles extend or open flat the joints in the hand and wrist, and straighten the fingers.
There are two groups of tendons in the hand and wrist: extensor and flexor tendons. Extensor tendons help to extend and straighten the fingers, hand, and wrist, while flexor tendons help to flex and curl the fingers, hand, and wrist. The extensor muscles of the hand include the abductor pollicis longus (APL), extensor pollicis brevis (EPB), and extensor pollicis longus (EPL). These muscles are responsible for thumb extension. The EPB and EPL tendons create the medial and lateral borders of the anatomic snuffbox, an area on the dorsal aspect of the wrist. The EPL tendon crosses obliquely with the tendons of the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB).
The ECRB and ECRL muscles act together with the extensor carpi ulnaris (ECU) muscle to achieve neutral wrist extension movements. The ECU inserts at the base of the 5th metacarpal to extend and adduct the wrist. The APL inserts into the base of the first metacarpal bone to abduct the thumb at the carpometacarpal joint and may also abduct the wrist. The EPB inserts into the base of the first phalanx of the thumb, helping to extend and abduct the thumb, while the EPL inserts onto the base of the distal phalanx of the thumb. The EPL also extends the distal phalanx of the thumb, using the dorsal tubercle on the radius as a fulcrum to assist the EPB.
The extensor digitorum communis (EDC) muscles are responsible for the extension of the second (index finger), third (long finger), fourth (ring finger), and fifth (small finger) digits. The index finger is accompanied by the extensor indicis (EI) muscle, which lies on its ulnar side. The extensor digiti minimi (EDM) muscle has a similar role in extending the little finger. The independent extension of the index finger is carried out by the extensor indicis proprius (EIP) muscle, while the independent extension of the small finger is accomplished by the EDM muscle. The EIP and EDM muscles are located in the fourth and fifth extensor compartments, respectively.
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Weight-bearing exercises for osteoporosis patients
Weight-bearing exercises are important for osteoporosis patients as they help build and maintain bone density. These exercises can be high-impact or low-impact, and they include activities that involve moving against gravity while staying upright. Patients with osteoporosis should aim for about 50 moderate-impact exercises each week, which can include jumps, skips, jogs, or hops. It is also recommended to do 20 minutes of low-impact exercises on most days of the week to maintain bone health.
High-impact weight-bearing exercises help build bones and keep them strong, but those with osteoporosis who have broken a bone or are at risk of breaking one may need to avoid these types of exercises. Examples of high-impact weight-bearing exercises include:
- Running or jogging
- Jumping rope
- Tennis
- Dancing
Low-impact weight-bearing exercises can also help keep bones strong and are a safer alternative for those who cannot do high-impact exercises. These exercises include activities where you move your body, a weight, or some other resistance against gravity. Examples of low-impact weight-bearing exercises include:
- Walking
- Yoga
- Pilates
- Tai chi
It is important to note that certain positions in yoga and Pilates may not be safe for people with osteoporosis, such as forward bends which can increase the risk of breaking a bone in the spine. It is always recommended to consult a healthcare professional or physical therapist to determine which exercises are safe and appropriate for your individual needs.
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Post-operative weight-bearing progression
During the initial post-operative period, patients are often advised to adhere to non-weight-bearing guidelines, which means placing no weight on the operated leg. This restriction is crucial to allow for proper bone and tissue healing and to ensure the stability of any hardware placed during the surgical procedure. Assistive devices, such as crutches or a walker, become necessary for ambulation during this phase.
As the healing progresses, patients may advance to partial weight-bearing, where they can bear a limited amount of weight on the affected leg. This progression is typically initiated around 3 to 4 weeks after surgery, allowing for gradual adaptation and pain management. Physical therapists play a vital role in guiding patients through proper weight-bearing techniques and ensuring safe progression.
The rate of weight-bearing progression varies depending on the individual's recovery and pain management. Therapists monitor patients for increases in pain or swelling during this phase, adjusting the progression if necessary. Crutches or other assistive devices may be discontinued once the patient can ambulate without a limp, demonstrating sufficient strength and stability in the affected leg.
By the seventh to eighth week, the goal is to achieve full weight-bearing, where patients can bear their entire body weight on the operated leg. This progression is facilitated by controlled exercises, gradually increasing the load on the leg. Techniques such as deweighting devices on treadmills can assist in this process, aiding patients in regaining their mobility and independence.
In conclusion, post-operative weight-bearing progression is a carefully managed process that aims to balance healing, mobility, and pain management. Through a combination of weight-bearing restrictions, physical therapy, and gradual progression, patients can safely return to full weight-bearing status, promoting a successful recovery and improved quality of life.
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Non-weight-bearing and partial weight-bearing
Non-weight-bearing (NWB) means that no weight at all should be put on the affected limb. The leg must not touch the ground and must be fully supported at all times. Crutches, a walker, or a wheelchair may be necessary for mobility. Non-weight-bearing is usually prescribed for the first two weeks after surgery.
Touchdown or toe-touch weight-bearing is when only the toes can lightly touch the ground, just enough to maintain balance. The aim is not to bear weight but to help the patient keep their balance. This is allowed in the immediate postoperative period.
Partial weight-bearing (PWB) means that a fraction of the body's weight, typically between 20% and 50%, can be put on the affected limb. Crutches or a walker are usually required to offload weight. Partial weight-bearing is typically allowed from weeks 3 to 4 after surgery, as long as pain and swelling are controlled, and the patient can demonstrate a voluntary quadriceps contraction.
The progression from non-weight-bearing to partial weight-bearing and eventually to full weight-bearing can be facilitated by using techniques that gradually increase the load on the affected limb. Therapists should monitor patients for increases in pain or effusion during this process and reduce the progression if these iatrogenic effects arise.
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Frequently asked questions
Extensor muscles are muscles that increase the angle between members of a limb, as by straightening the elbow or knee or bending the wrist or spine backward. In the hand, these include the extensor carpi radialis brevis, extensor carpi radialis longus, and extensor carpi ulnaris, which extend the wrist; the extensor digitorum, which extends the fingers; and the extensor indicis, which acts upon the index finger. Extensors in the foot include the extensor digitorum longus and extensor digitorum brevis, which act on the toes.
Weight-bearing is any activity that a person performs on one or both feet. It requires carrying body weight on at least one lower extremity. It is an activity that the skeletal system does against gravity, adapting to the impact of muscles and body weight and becoming more stable and strong. Weight-bearing may be full or partial.
Extensor muscles are not exclusively weight-bearing. While extensor muscles in the lower limbs, such as the legs and feet, may be involved in weight-bearing activities, extensor muscles are also present in other body parts like the hands, arms, and back, which are not primarily associated with weight-bearing functions.
