Rehab Exercises for a Broken Tibia or Fibula

A broken leg can significantly impact your ability to perform daily tasks — most inconveniently, walking. Rehab is often performed through physical therapy for a broken tibia or fibula to restore range of motion, strength, and functional mobility.

Here’s a deeper dive into the rehab timeline for these injuries, as well as a few popular exercises for a lasting recovery.

Anatomy of the Lower Leg

The lower leg houses two long bones, according to the Cleveland Clinic. The ‌tibia‌ is your large shinbone and runs on the inside of the lower leg. The ‌fibula‌ is a smaller bone that runs along the outside of the lower leg. The ends of these two bones form the bony bumps on either side of your ankle.

The tibia is the lower leg bone that supports most of your body weight, according to the Cleveland Clinic. According to Medscape, tibia fractures are the most common long bone injuries in the body. However, because the tibia and fibula are connected by strong tissue, fibula fractures can occur with trauma to the tibia.

Recovery Starts With Immobilization (and Maybe Surgery)

Fractures of the tibia or fibula ‌require a period of immobilization to allow the bone to heal, says the Cleveland Clinic. This can be accomplished with a cast or removable brace, depending on the severity of your injury. The length of immobilization also depends on your injury, but is usually a few weeks, says the Cleveland Clinic.

In some cases, such as the bone breaking into multiple pieces, or if the bones can't be manually realigned, surgery may be required. According to the American Academy of Orthopaedic Surgeons (AAOS), this procedure, known as ‌open reduction internal fixation, involves the placement of plates and screws to keep the bone in the correct position. Sometimes fractures are externally fixated with temporary pins or other fixation devices that are removed once the bone heals.

Your Rehabilitation Timeline

There is currently no standard treatment for a broken tibia, according to a 2021 analysis published in Physical Therapy. Additionally, as stated, your rehabilitation timeline depends heavily on the nature of your injury.

Rehab typically begins with range-of-motion exercises for your toes, ankle, and knee, as well as strengthening exercises for your uninjured leg, core, and upper body to prepare you for weight-bearing exercises and gait training down the road. You may also be advised to complete non-weight-bearing strengthening exercises of the hip and knee muscles on your injured side.

After that, you'll likely progress to partial weight-bearing of a specific percentage of your body weight, then eventually full weight-bearing. Resuming normal walking after a broken tibia or fibula can take four to six months, depending on your specific injury, according to the Cleveland Clinic.

Range-of-Motion and Non-Weight-Bearing Exercises

Early rehabilitation typically involves range-of-motion exercises, like ankle circles, and strengthening exercises, such as leg lifts, on both the injured and unaffected sides of the body.

Reducing Ankle Stiffness

‌‌Active range-of-motion exercises‌‌ of the ankle to reduce stiffness begin after your cast is removed. Active movement also helps to decrease swelling. Perform exercises two to three times per day.

How to do it:‌ Sit in a chair or on the edge of a table with your leg off the floor. Perform ankle circles both clockwise and counterclockwise 10 times in each direction.

Point your toes down to the floor; then stretch them toward the ceiling 10 times. Draw the alphabet in the air with your big toe, moving your ankle as far as possible in each direction, without pain.

Ankle Strengthening

‌‌Strengthening exercises‌‌ for your ankle begin in a seated, or non-weight-bearing, position. A resistance band can be added to range-of-motion activities to strengthen your muscles as part of your tibia fracture physiotherapy exercises.

How to do it:‌ Sit with your leg out straight. Loop a resistance band around the ball of your foot. Hold the ends of the band in one hand or tie it to a secure object, such as a table leg.

Adjust the band as needed to perform resistance exercises in four directions — pointing your toes down, pulling your foot up toward your head, turning your foot inward, and rotating your foot outward. Repeat 10 times in each direction, working up to three sets in a row. As the exercises become easier, use a band with increased resistance.

Passive Leg Stretching

‌‌Passive range-of-motion‌‌ ‌‌exercises‌‌ are often first performed by your therapist, then can be taught to you as part of your home exercise program.

How to do it:‌ Sit with your leg straight out in front of you. Loop a towel or belt around the ball of your foot and hold one end in each hand. Gently pull the towel to stretch your toes toward your head. Stop when you feel a pulling sensation in the back of your calf. Hold for 20 to 30 seconds; then relax.

Repeat three times. Do not stretch to the point of pain — this can cause further damage to your healing bone.

Strengthening Your Hip and Knee

‌Straight leg raises strengthen the muscles around your hip and knee.

How to do it:‌ Lying on your back, bend your uninjured knee and place your foot on the floor. Straighten your knee on the injured side and lift the leg toward the ceiling — to the height of the bent knee. Slowly lower the leg. Repeat 10 times, working up to three sets in a row.

Training Your Toes

‌‌Toe-strengthening exercises‌‌ help improve walking after a broken tibia or fibula by targeting the smaller muscles in your foot.

How to do it:‌ Sit in a chair with your feet on the floor. Place marbles on the floor next to your feet. Using your toes, grab each marble individually and place it in a cup. Repeat this activity for several minutes.

Alternatively, lay a towel flat on the floor and scrunch it up with your toes. Next, with your foot flat on the floor, lift your toes and hold for two to three seconds. Relax and repeat 10 times.

Full-Weight-Bearing Exercises

As stated above, it can take several months for you to walk after a broken tibia or fibula. Speak with your doctor or physical therapist about when it’s best for you to begin full-weight-bearing exercises.

Regaining Your Balance

Balance activities begin once you’re able to put full weight on your leg and are safely walking after a broken tibia or fibula. These exercises, sometimes called proprioception activities, teach your leg how to help you maintain your balance again, according to the Cleveland Clinic.

Receptors in your muscles, tendons, and ligaments provide feedback to your brain when you’re standing to help maintain your balance, says the Cleveland Clinic. These receptors are off-duty when your broken leg is immobilized and need to be reawakened.

Weight-shifting exercises ‌allow you to regain balance with the assistance of your uninjured leg.

How to do it:‌ Stand with your feet hip-width apart. Shift your weight to the injured leg and hold for 10 to 20 seconds. Repeat three times. As your balance improves, lift up on the toes of your uninjured leg. Work up to standing on only the injured leg, with the opposite knee bent. At first, you’ll likely need to put your arms out to your sides or hold onto a stable surface such as a wall.

Once you’re able to balance on one leg, practice this activity with your eyes closed or while standing on an uneven surface such as a pillow.

Cardio Conditioning Activities

Because you will most likely lose muscle strength in the injured area, exercises during the healing process can be helpful, according to the AAOS. Once your balance is adequate, ‌conditioning exercises‌ are added to your rehab routine to improve your tolerance of activity. These activities might include use of a stationary bike or treadmill.

Your specific timeline for resuming activities in physical therapy for a broken tibia or fibula will depend on several factors, including the extent of your injury, prior level of fitness, and physical requirements of your job or sport.

Plyometric Training Exercises

Plyometric training, or jumping activities, are performed to increase speed and power, according to Harvard Health. These activities place a high amount of stress on your legs and are often last to be added to your rehab exercises.

‌Plyometrics can include box jumps, broad jumps, squat jumps, clapping push-ups, and jumping rope. Progress with these exercises slowly under the supervision of your physical therapist to help prevent excess soreness and risk of reinjury.

What to Do if Pain Increases

Although some discomfort is expected while performing rehab exercises, notify your physical therapist right away if you experience sharp pain or increased pain and swelling following your exercise session.

In rare cases, a condition called complex regional pain syndrome can occur after a fracture in the leg. Symptoms include sensitivity to light touch, cold insensitivity, color changes in the skin, and decreased range of motion, according to the Mayo Clinic.