Can you Walk With a Broken Pelvis? (PT’Tips + What Studies Say)

What do general recommendations say about walking after a pelvic fracture?

An Italian research team 🇮🇹 recently delved into the issue of resuming walking after a pelvic fracture (Murena 2021).

Here’s what they found:

✅ Arguments FOR

Resuming walking right away after a pelvic fracture can be beneficial because it:

• Reduces the risk of complications associated with prolonged bed rest or semi-seated positions (constipation, phlebitis, muscle loss, etc.).
• Can induce micro-movements between fracture fragments, promoting bone healing.
• May lead to a faster functional recovery, quicker return to work and recreational activities.
• Patients often do not adhere to non-walking instructions, and few complications are observed from earlier-than-recommended resumption of walking.

❌ Arguments AGAINST

However, there are theoretical disadvantages to resuming walking right away:

• Walking may exert too much stress on the fractured area and ligaments, increasing the risk of poor consolidation and healing.

So, what’s the conclusion?

The Italian team read and analyzed 44 studies that looked at whether people recovered better by walking or not walking immediately after a pelvic fracture. Here are their findings:

Despite biomechanical data, few clinical evidences can be found to support early weight bearing in pelvic and especially acetabular fractures treatment.

The promising results of some clinical experiences, however, should direct further studies to clearly define the indications and limits of early weight bearing in these injuries.

Recognizing intrinsic lesion stability and bone and fixation technique quality, together with patient age and compliance, should be the mainstay for post-operative management choice.

Murena et al. 2021

In simpler terms:

• In theory, it makes sense to think that one recovers better by walking right after a pelvic fracture,
• but there’s still limited data to prove that immediate walking leads to better recovery.
• To determine if walking is recommended, factors like fracture stability, bone quality, and age must be considered.

This applies to all types of pelvic fractures, including iliac wing, ischio-pubic or ilio-pubic branches, pubic symphysis, obturator frame, and acetabulum.

How can you know if, in YOUR case, you can walk (and when)?

Typically, the healthcare professional who diagnosed your pelvic fracture (doctor or surgeon) should have provided clear information.

This information is usually conveyed verbally and documented in your medical records or hospital reports, including emergency room or surgery reports.

As a physiotherapist, I often see two types of patients:

“Younger” patients: They are often prohibited from walking for 10 to 12 weeks (2 to 3 months) and then gradually resume walking with a progressive increase in load (25% more each week).

They may go to a rehabilitation center, especially if they live alone. Sitting positions are often restricted, and they can be semi-seated at a maximum trunk inclination of around 30 to 60 degrees.

Walking is usually allowed after a follow-up X-ray several weeks after the initial one. These are often patients with complex, displaced, and unstable pelvic fractures.

Even if you are strictly bedridden, there are exercises you can do to maintain muscle strength, joint mobility, and cardiovascular health, such as adapted muscle strengthening and arm cycling.

Patients over 65/70 years old: They are often allowed to start walking in the first few days after the fracture to reduce the risk of complications associated with prolonged bed rest, which is more critical in this age group.

These are usually people with less severe, simpler, and less displaced fractures, as the trauma was less severe.

Clinical study data increasingly suggest that healthcare professionals’ recommendations may be overly conservative.

If the instructions you’ve received seem too restrictive to you, discuss it with your physiotherapist, doctor, or surgeon. Ask for their rationale for applying such strict guidelines in your case and inquire about the potential risks of slightly deviating from them or being more flexible.

How to walk with a broken pelvis if walking is allowed?

If walking is permitted, you don’t need any special precautions.

Walk as you normally would, as long as the pain is tolerable.

Often, you may require a walking frame, crutches, or a walker to reduce pressure and discomfort.

Find the walking style that suits you best.

In the video below, I’ll show you different ways to walk with crutches and gradually transition away from them.

There’s no maximum walking distance to adhere to. In fact, it’s a great idea to try and walk a bit more every day, depending on how you feel.

Physical therapists in rehabilitation centers, at home, or in private practices are there to help you gradually regain normal walking!

How to resume walking after a period of bed rest?

You’ve been bedridden or without weight-bearing for several weeks or even months?

Here are some tips for resuming walking, although generally, you’ll be supervised by a physiotherapist for at least a few sessions.

Getting up for the first time

If you’ve been lying down for a long time, the idea is to gently reacquaint your body with two things:

• Being upright.
• Moving around.

These are two different things, and you may have lost some of your abilities in these two areas after prolonged bed rest.

That’s why, in rehabilitation centers, they sometimes use “standing tables.” You lie on a table, and it’s gradually raised.

This prevents a rapid drop in blood pressure and allows control of the amount of weight placed on each leg by using scales on the feet.

Another option (and it’s my favorite) is to simply sit for a few minutes at first. Then, with sturdy support, gradually stand up, with someone nearby to intervene in case you feel a bit dizzy from standing up again for the first time.

Once you’ve passed this initial step, you should normally have fewer difficulties standing up, and you’ll take fewer precautions as the days go by.

Resuming walking with support

You’ll typically have specific instructions on this, such as increasing by +20kg or 20% of body weight per week, etc.

In practice, you can also adjust based on how you feel, following the rule of gradual progression.

I recommend using crutches or a walker, at least for the first few days. Then, release one crutch, and eventually walk without any support.

You can increase the distances you walk as the days go by. Start on flat surfaces, then move to inclines and declines. Also, try climbing stairs, which engage your muscles and heart differently.

If you experience pain the night after or the day after, readjust: do a bit less the next day, then gradually increase the frequency or intensity in the following days.

How long does it take to walk normally after a pelvic fracture?

It’s challenging to answer this question without knowing your specific circumstances. Even healthcare professionals who are following your case may find it difficult to provide an exact prognosis because many factors come into play.

First, the more active and free of particular difficulties you were before breaking your pelvis, the better your chances of recovering your previous walking abilities quickly.

When I say ‘quickly,’ what do I mean? If I look at all the patients I’ve rehabilitated after a pelvic fracture, I’d say:

• If you’ve been bedridden for several weeks, you can regain ‘normal,’ pre-injury walking without crutches or limping in a matter of weeks after taking your first steps, and sometimes, it might take a few months.
• If you haven’t been bedridden, the quickest may take 3-4 weeks, while others may need 2-6 months.

You typically return to walking normally after a pelvic fracture within a few weeks to several months after taking your first steps.