Fracture Recovery With Physiotherapy: From Cast Off to Full Function

Fracture Recovery With Physiotherapy: The Complete Rehabilitation Guide

A fracture — whether from a road accident, fall, sports injury, or fragility break — heals in approximately 6–12 weeks for most bones. But the fracture healing is only half the story. Rebuilding the muscle strength, joint mobility, and functional capacity lost during immobilization requires a structured physiotherapy programme.

Why Physiotherapy Is Essential After a Fracture

During immobilization (cast, brace, or splint):

• Muscle atrophy: Immobilized muscles lose strength at 1–3% per day — after 6 weeks in a cast, quadriceps strength can be 40–50% below normal
• Joint contracture: The capsule, ligaments, and tendons shorten through collagen remodeling in the resting position
• Cartilage degeneration: Without compressive loading, joint cartilage loses its nutritive synovial fluid circulation
• Oedema/swelling: Post-fracture haematoma and inflammatory swelling impair tissue healing and movement

Phase 1: While Immobilized (During Cast Period)

Physiotherapy during casting is often overlooked — but it is the most cost-effective investment in the recovery.

What is safe during casting:

• Isometric contractions through the cast (tighten muscles without moving the joint)
• Exercises for all uninvolved joints — elevate and exercise the rest of the limb
• Oedema management — elevation, gentle active movement of digits
• TENS for pain relief (leads placed proximal and distal to cast)
• General fitness maintenance — aerobic exercise with uninvolved limbs

Phase 2: Cast Removal (Week 1–4 Post-Immobilization)

The immediate goals after cast removal are reducing stiffness and restoring range of motion.

Key interventions:

• Warm water soaking: 15 minutes before each session — heat increases tissue extensibility for better gains
• Gentle active range of motion: Working through available range without forcing
• Scar mobilization: If surgical incision is present — prevents adhesion to underlying tissue
• Lymphatic drainage massage: Reduces post-cast swelling
• Joint mobilization: Grade I–II mobilizations to stimulate synovial fluid and reduce mechanoreceptor pain inhibition

Phase 3: Strengthening (Week 4–12 Post-Fracture)

Once radiological evidence of consolidation is confirmed:

• Progressive resistance training: Begin with isometrics → isotonics → eccentric loading
• Closed kinetic chain exercises: For lower limb fractures — squats, step-ups (protected weight-bearing initially)
• Proprioception retraining: Balance board, single-leg activities (ankle/foot fractures)
• Functional activity practice: Task-specific training for return to work or sport

Common Fracture Sites and Specific Rehabilitation

Wrist (Distal Radius / Colles' Fracture)

Most common fracture in adults. After 6 weeks of immobilization, wrist extension is typically severely limited. Prioritize: forearm rotation (pronation/supination), wrist flexion/extension, grip strength (1–20 kg progression).

Ankle Fracture (Bimalleolar / Weber)

Non-weight-bearing for 6 weeks typically. After cast removal: ankle dorsiflexion is critically important for normal gait. Single-leg calf raises, balance training, and gait retraining are the rehabilitation pillars.

Hip Fracture (Proximal Femur — Elderly)

The most serious common fracture — associated with 30% 1-year mortality in elderly patients. Physiotherapy begins Day 1 post-surgery (ORIF or hip replacement). Goals: early mobilization, fall prevention, return to independent community ambulation.

Femur Shaft Fracture

Usually requires intramedullary nailing surgery. Physiotherapy starts with non-weight-bearing crutch walking, progresses to full weight-bearing at 6–8 weeks. Quadriceps rebuilding is the primary rehabilitation focus.