Physiotherapy is an organized process designed to restore a patient’s mobility, strength, and function after a bone fracture. While initial treatment focuses on immobilizing the bone to allow healing, the extended inactivity causes muscle weakness, joint stiffness, and impaired coordination. Rehabilitation aims to counteract these negative effects, ensuring the bone heals strongly and surrounding soft tissues regain their pre-injury function. Timely intervention is important for preventing long-term complications and regaining the capacity to perform daily activities.
The Critical Role of Pre-Clearance Movement
Movement is encouraged almost immediately, provided it does not stress the fracture site. This early phase, called pre-clearance movement, focuses on maintaining the health of the limb during immobilization. These initial, low-impact activities are designed to prevent adverse effects of prolonged rest, such as muscle atrophy and poor circulation.
A primary technique is isometric exercise, involving tensing a muscle without changing its length or moving the adjacent joint. For a leg fracture, a patient might perform quadriceps sets by tightening the thigh muscle while the leg remains straight in a cast, maintaining muscle mass without stressing the healing bone. Gentle ankle pumps or finger clenching also promote blood flow, reducing the risk of blood clots and swelling.
Patients are also encouraged to perform a full range of motion exercises on all joints not directly immobilized by the cast or fixation device. For instance, a person with a broken forearm should frequently move their shoulder and elbow to prevent stiffness in those adjacent joints. This proactive movement helps to maintain overall mobility and prepares the entire limb for the more intensive rehabilitation phase that follows once the fracture is stable.
Determining the Optimal Start Window
The precise timing for starting active physiotherapy is highly individualized and is determined solely by the orthopedic surgeon based on objective medical criteria. The decision to progress beyond pre-clearance movement hinges on whether the fracture site possesses sufficient mechanical stability to tolerate controlled stress. This stability is influenced by several factors, including the complexity of the break, the bone’s location, and the method of fixation.
A simple, non-displaced fracture immobilized in a cast may be ready for gentle motion sooner than a complex fracture requiring internal fixation. For a lower limb fracture, the ability to bear weight is the most significant milestone, granted only after the surgeon confirms adequate bone healing. Radiographic evidence, such as callus formation bridging the fracture gap, signals that the biological healing process is advanced enough to begin active rehabilitation.
The start window for active movement can vary widely, often ranging from four to twelve weeks, depending on the bone, age, and health. For fractures in highly vascular areas, like the wrist, controlled passive range of motion might begin as early as four to six weeks. Conversely, a major weight-bearing bone, such as the femur, may require three months or more before significant loading is permitted. The transition to active therapy is always a medical clearance, ensuring the bone is protected from re-injury during rehabilitation.
Goals and Techniques of Active Rehabilitation
Once the orthopedic surgeon gives clearance, the focus of physiotherapy shifts to active rehabilitation, a structured effort to reverse the effects of immobilization. The immediate goal is to restore the full range of motion in the joint that was previously held immobile. A therapist may use manual techniques, such as joint mobilization and passive stretching, to gently increase flexibility before the patient begins active-assisted and then fully active flexibility exercises.
Following the regaining of mobility, the next priority is rebuilding muscle strength. This phase involves progressive resistance training, starting with very light resistance using body weight or resistance bands, and gradually advancing to weights or specialized equipment. Exercises are tailored to the limb, such as calf raises for an ankle fracture or bicep curls for an arm fracture, with intensity managed to stimulate muscle growth without stressing the healing bone.
The final component of this phase focuses on improving function and proprioception, the body’s sense of its position in space. For lower-body injuries, this includes gait training to eliminate limping and balance exercises to restore coordination and reduce the risk of future falls. For upper-body injuries, functional tasks involve fine motor control and grip strength exercises, ensuring the patient can safely return to daily activities such as cooking, writing, or driving.
Recognizing Signs of Overexertion or Delay
Patients must closely monitor their body’s response to rehabilitation demands to avoid setbacks. Signs that the routine is too aggressive include sharp pain during or immediately after exercise, or pain that persists for more than 24 hours. Increased swelling, throbbing, warmth, or redness around the affected joint after a session suggests the tissues are reacting poorly to the stress and that intensity needs to be reduced.
Avoiding the temptation to delay or skip physical therapy once immobilization is over is equally important. Postponing active rehabilitation can lead to chronic joint stiffness, known as contracture, which can become permanent and severely limit function. Prolonged inactivity also accelerates muscle atrophy, making strength recovery much longer and more difficult.
Skipping sessions also increases the risk of chronic pain, as the body may adopt compensatory movement patterns to avoid using the weak or stiff limb. This can place abnormal strain on other joints, leading to new aches and imbalances in the hip, back, or opposite limb. Consistent, managed effort is necessary to ensure the fracture heals fully and the patient reclaims their previous level of function.