A clavicle fracture, or broken collarbone, is an injury to the long bone connecting the shoulder to the rib cage. This fracture often results from a direct blow to the shoulder or a fall onto an outstretched arm, which can cause significant pain and limit arm movement. While immobilization in a sling is the typical initial treatment, safe and strategic activity is necessary to prevent muscle loss and joint stiffness during recovery. It is necessary to receive clearance from a healthcare provider before attempting any exercise to ensure the fracture is stable and ready for movement.
Maintaining Fitness in Unaffected Areas
Maintaining cardiovascular fitness and muscle mass in uninjured areas is a practical goal during initial recovery. Low-impact aerobic activities are ideal because they elevate the heart rate without jarring the healing clavicle. A stationary or recumbent bike allows for a workout while the injured arm remains securely in the sling. Walking on a flat surface or a treadmill is also acceptable, provided the pace does not cause any bouncing or vibration that could irritate the fracture site.
The lower body can be exercised safely using movements that do not require gripping or bracing with the injured arm. Squats, lunges, and leg presses are effective for maintaining strength in the glutes, quadriceps, and hamstrings. Core stability work can also be performed, such as planks supported by the elbows or forearms, or leg raises, ensuring the movement avoids rotational stress on the torso. The injured arm must remain completely immobilized in the sling during these activities to prevent unexpected movement.
Early Passive and Assisted Movement
Once initial pain subsides, usually within the first one to three weeks, a physician may clear the patient for gentle movements designed to prevent joint stiffness. These initial exercises focus on maintaining range of motion in the shoulder, elbow, wrist, and fingers, not on building strength. The goal is to move the joints passively, meaning the muscles surrounding the fracture site are not actively contracting to lift the limb.
A common exercise at this stage is the pendulum swing, where the patient leans forward, allowing the injured arm to hang freely, using torso momentum to create small, passive circles. The patient should be relaxed and let gravity, rather than muscle effort, move the arm. Other early movements involve gentle range of motion for the elbow and wrist, such as bending and straightening the elbow or rotating the forearm, which can be done without stressing the clavicle. Hand and finger exercises, like making a fist and opening the hand or squeezing a soft ball, are also encouraged to maintain dexterity and grip strength, as the hand often stiffens from prolonged sling use.
Rebuilding Strength and Full Mobility
The transition to active rehabilitation, starting around four to six weeks post-injury and confirmed by an X-ray showing initial bone healing, focuses on gradually restoring muscle strength and full range of motion. This phase begins with isometric exercises, involving contracting a muscle without changing its length or moving the joint. A patient might gently push the elbow of the injured arm against a door frame or wall, holding the contraction for a few seconds to reactivate the surrounding shoulder muscles.
As tolerance improves, the rehabilitation progresses to active range-of-motion exercises, such as wall crawls, where the fingers of the injured hand walk up a wall to gradually increase the height of the arm lift. The next step involves using light resistance to rebuild strength, often with resistance bands for gentle external and internal rotation of the shoulder. These rotational movements are performed with the elbow bent to 90 degrees and tucked close to the side to isolate the rotator cuff muscles. Resistance should start with the lightest possible tension and only be introduced after achieving full, pain-free active movement, with all progressions guided by a physical therapist or physician.
Movements That Must Be Avoided
Certain movements and activities present a high risk of re-injury or delayed healing and must be avoided during the entire recovery period. Lifting any object that weighs more than a few pounds, such as a full gallon of milk or even a heavy book, can place excessive strain on the healing bone fragments. The healthcare provider will specify a weight limit, often restricted to one or two pounds in the early weeks.
High-impact activities, including running, jumping, or contact sports, are contraindicated because the sudden force or jolt can displace the fracture fragments. Movements that involve reaching across the body, known as adduction, should also be limited as they can put direct stress on the clavicle. Patients should avoid sudden, uncontrolled movements or quick jerks of the arm. Driving should not resume until they have full, pain-free range of motion and medical clearance, especially if the injured arm is dominant.