Osteomyelitis

Overview of Osteomyelitis

This condition is an inflammation of bony tissues secondary to an infection. Chronic osteomyelitis can lead to surgical removal of connective tissues and amputations. Chronic infections and surgical procedures can also lead to limited joint and tissue mobility. The tibia and femur are most susceptible to osteomyelitis after a traumatic injury. Clients will benefit from the potential effects of exercise to enhance their immune system and to mediate the effects of stress and depression. Clients will have limited activities due to the effects of the infections and complications, leading to deconditioning.¹ Inflammation of bony tissues is painful and limits the client's ability to initiate movement.

Comorbidities to Consider

• Conditions that may compromise the immune system in these clients include diabetes mellitus, spinal cord injury, alcoholism, and malnutrition.

Client Examination

Keys to Examination of Clients

• Review reports of laboratory tests and cultures taken of infected tissues to determine the type and extent of the infection.

• Radiographs and computed tomography scans of the affected area can provide information about the extent of bony tissue damage.

• Patients with limited mobility can be assessed for their level of independence with transfers and ambulation.

Recommended Baseline Testing of Fitness Levels

• Assessments of endurance, strength, and mobility need to be designed to meet the current abilities of the client.²

• Clients unable to ambulate can use an upper body ergometer or an endurance test using a wheelchair to provide information about their exercise tolerance.³

Exercise Prescription

Type: Cycling, arm ergometry, weight training

Intensity: Low to moderate intensities

Duration: 10–20 minutes

Frequency: Three to five times per week

Getting Started

Treatment programs for osteomyelitis can become complex and will require ongoing monitoring of vital signs, pain from the affected area, and assessments of wound healing. Prevention of movement dysfunctions will require ongoing monitoring of movement, strength, and weight-bearing tolerance. Clients with limited lower extremity weight bearing can perform arm ergometry or use a wheelchair.¹ Repetitive movements using hand weights or pulleys allow for a variety of movements with concentric and eccentric muscle contractions. Clients with infectious processes may not be able to move the extremity due to discomfort. Aseptic techniques are very important when treating a client with a history of osteomyelitis.

Clients benefit from endurance activities progressed to 40% to 65% of predicted maximum heart rate for 30 to 40 minutes. Clients using an arm ergometer can use ratings of perceived exertion to control their exercise intentsity.⁴ Intense exercise activities need to be avoided for these clients as these may produce muscle soreness and may affect the immune system negatively. Resistive exercises ...