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Burst Fracture

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What is a Burst Fracture?

A burst fracture is an injury in which the vertebra is crushed in all directions. A vertebra is a series of small bones that together form the primary bone of the spine. This injury is caused by a high-energy axial load which could result from:

  • Accidents
  • Falling from a great height
  • Seizures

Note: A compression fracture is an injury in which the vertebra is crushed only on the front (anterior) side of the spine.

Typically burst fractures are much more severe than compression fractures because:

  • In a burst fracture, both the anterior (front) and posterior (back) walls break.
  • Burst fractures can cause neurological problems as well.

Alert: The neurological problems from burst fractures can result in paralysis. Its symptoms may become severe immediately or develop gradually; hence burst fracture is considered a significant injury.

Typically, burst fractures occur in the 1st vertebra of the lower back (L1 vertebra).

What are the Causes of Burst Fracture?

As commonly seen, road accidents and sudden falls are the most common causes of burst fractures. However, a medical condition like osteoporosis can also lead to a burst fracture.

What are the Symptoms of Burst Fracture?

If, after an accident, trauma, or a medical condition like osteoporosis, you experience the following symptoms, then it is highly likely that you may be having a burst fracture:

  • Urinary incontinence: loss of bladder control
  • Difficulty in performing everyday tasks: simple activities cause mild or intense back pain
  • Debilitation: Weakness, tingling sensation, and/or numbness

What are the Self-Care Tips for Recovering Fast After Burst Fracture Surgery?

  • Exercise: Only gentle and slow walking to improve blood circulation.
  • Meditation: Excellent for pain management as it makes you calm.
  • Medication: Only take the medicines prescribed by your healthcare provider based on the nature of your surgery.
  • Hydration: Staying hydrated and drinking the right amount of water will:
    • Save you from cramps
    • Keep your energy levels up
  • Rest: Don’t engage in any physical activity until you are ready mentally and physically. Consult your doctor to know when you can gradually get back to your daily activities.
  • Stop Smoking.
  • Cough and Sneeze Carefully: The incision made during the surgery is delicate until you fully recover. It can open up with something as simple as sneezing or coughing. So before you are about to sneeze, gently apply some pressure on the incision or the wound. You can use the force either with your hand or with something soft like a pillow.

How is a Burst Fracture Diagnosed?

The following medical imaging procedures commonly make the diagnosis of burst fracture:

  • X-ray
  • CT scan
  • MRI

What is the Treatment of Burst Fracture?

A burst fracture is a significant injury and hence requires immediate medical attention so that:

  • Any further damage to your spinal cord is prevented.
  • Existing damage is contained to limit the effect on your spinal cord.

Based on the severity of your burst fracture, your healthcare provider may recommend:

  • Operative treatments: such as instrumented intervertebral fusion with or without spinal decompression.
  • Non-operative treatments: such as physiotherapy or the use of a brace, cast, bed rest, and analgesics.

When Can You Start Physiotherapy?

Typically, your healthcare provider will allow you to start physiotherapy 7 to 10 weeks after the braces have been removed. Initially, your physiotherapist will only recommend gentle walking while using walking aids. After 10 weeks, your physiotherapy instructors will include exercises for improving balance and strength. This will help you in avoiding compression or save you from falling down.

How Do You Treat a Burst Fracture with Physiotherapy?

Physical therapy can help you in regaining the strength in:

  • Upper extremity: everything in the upper body, including shoulders, hands, arms, and deltoids.
  • Lower extremity: everything between hip to toes.

The main physical therapy exercises that your physiotherapist will recommend to you include:

Breathing Exercises:

Breathing exercises help you in strengthening your breathing muscles by blowing through a mouthpiece against resistance.

  • Diaphragmatic Breathing:
    • Sit down or lie on your back.
    • Place a hand under your breastbone.
    • Breathe in through the nose slowly. As you breathe in, your diaphragm contracts and the distance between your hand and belly increases.

Warm-up:

Gentle and slow body movements before the main exercises or any activity. These will warm up your muscles and joints and prepare your heart for the upcoming move.

Walk:

Take a simple walk. Record how much you can walk before you become breathless. Gradually increase the distance. While walking, don’t go too far, or else you might have difficulty breathing while walking back to the starting point.

Straight Leg Raise (SLR):

  • Lie down on your back and keep your legs straight on the ground.
  • Raise one leg by a few inches while keeping the other leg on the ground.
  • Hold this position for 5 seconds and then gradually bring your leg down to the beginning position.
  • Repeat the same with the other leg.
  • Repeat this exercise for 5 sets.

Ankle Pump Up:

  • You can do this exercise in any position – sitting, standing, or lying.
  • Take any position and try to pull the toe of one leg upwards as if you are trying to touch your shin with your toes.
  • Hold this position for 10 seconds and then repeat for the next leg.
  • Try to do 5 sets of this exercise.

Ankle Pump Down:

  • Point the foot and the toes of one leg in the downward direction.
  • After you have stretched as much as you can, hold the position for 10 seconds and then release.
  • Repeat the same for the other leg.
  • Do at least 5 sets of this exercise.

Strengthening Exercises After Six Months of Treatment for Burst Fracture:

Quadriceps Isometrics:

  • Sit on the floor and stretch your legs.
  • Place a rolled-up towel or a pillow under one knee.
  • Press the towel or the pillow as if trying to straighten your knee.
  • Pull the toes and foot in your direction.
  • You will feel a stretch in the calf muscles.
  • Hold this position for 15 seconds and then relax for 15 seconds.
  • Do 10 sets of this exercise for both legs.

Leg Extension:

  • Sit in an upright position on a chair and look straight ahead.
  • Your feet should be flat on the floor and hip-width apart.
  • Contract your thigh muscles.
  • Raise one leg as high as possible while keeping your buttocks on the chair.
  • Lower the leg and repeat the same for the other leg.
  • Try to do 3 sets of 10 repetitions for each leg.

Alternating Side Lunge Exercise:

  • Stand upright.
  • Keep your feet hip-width apart.
  • Step out with one leg and bend the knee.
  • Keep the other leg straight and stretched out.
  • Push your hips back.
  • Hold the stretched-out position for 30 seconds.
  • Return to the starting position and repeat the same with the other leg.
  • Do 2 to 3 sets of this exercise.

Alternating Forward Lunge Exercise:

  • Stand up straight and keep your feet hip-width apart.
  • Step forward with one leg.
  • Gradually bring your body down until your knee is bent at an angle of 90 degrees.
  • Hold this position for 30 seconds.
  • Return to the starting position and repeat the same with the other leg.
  • Try to do 2 to 3 sets of this exercise.

Strengthen Inner Thighs:

  • Lie on your back on a mat.
  • Put a ball between your knees.
  • Squeeze the ball for 10 seconds.
  • Do at least 10 repetitions of this exercise.

Hip Abduction:

  • Lie down on your side.
  • Keep your legs straight.
  • Gradually raise the top leg to 45 degrees while keeping your knee straight.
  • Hold this position for 5 to 6 seconds.
  • Slowly bring your leg down.
  • Lie down on the opposite side and repeat the same for the other leg.

Hip Adduction:

  • Lie down on your right side.
  • Both your legs should be straight.
  • Bend your left leg and cross it over your knee of your right leg.
  • Raise your right leg slightly by about 6” to 10” off the floor.
  • Hold this position for 5 to 6 seconds.
  • Gradually bring your leg down.
  • Switch to the opposite side and repeat the same for the other leg.

Arm Across the Chest:

  • Hold one arm above the elbow with the opposite hand.
  • Pull that arm across your chest.
  • You will feel a stretch in your shoulder.
  • Hold this position for 20 seconds.
  • Repeat the same steps for the other arm.

Triceps Muscle Stretch:

  • Stand in an upright position with your back straight.
  • Keep your feet shoulder-width apart.
  • Bring your hand up and bend the elbow at 90 degrees.
  • With the other hand, grab the bent elbow and gently pull it towards the opposite shoulder.
  • When you reach a comfortable stretch, hold the position for 10 seconds.
  • Return to the starting position.
  • Repeat the same steps for the other arm.

High-to-Low Rows:

  • Place a resistance band above your shoulder in such a way that the band stays steady.
  • Kneel on the knee that is on the side of the injured arm.
  • Stretch your arms and hold the band.
  • Keep your back straight and pull your elbows towards your body.
  • Repeat this exercise for 3 sets.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254755

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930335

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418977

Dr. Garima Singh
Physiotherapist
BPT and DPTR.