Healing a fracture doesn't stop when the cast is removed, it truly begins then. Rehabilitation is where structure meets strength. It helps restore movement, flexibility, and confidence, ensuring that the healed bone functions as naturally as it did before injury. Without proper rehabilitation, joints stiffen, muscles weaken, and even a perfectly healed bone can limit movement. This stage bridges medical treatment with complete recovery, helping you regain independence and mobility safely.

Goals of Rehabilitation

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Restoring joint flexibility and range of motion

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Preventing stiffness and muscle shortening

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Rebuilding muscle strength and endurance

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Enhancing balance, coordination, and posture

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Boosting circulation and blood flow for faster recovery

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Supporting mental and physical confidence after injury

Learn About Phases of Fracture Healing

Phases of Rehabilitation

1

Early Phase (0–6 Weeks) Protection & Circulation

During this phase, the bone is still stabilising, so the focus is on movement without strain.

  • Finger or toe movement to maintain circulation
  • Isometric contractions (tighten muscles without moving joints)
  • Elevation and cold compresses to reduce swelling
  • Breathing and relaxation drills to improve blood flow
Physiotherapist's role: Teach safe positioning, posture, and home care techniques to prevent stiffness and swelling.
2

Intermediate Phase (6–12 Weeks) Controlled Motion

As bone union begins, controlled motion becomes safe and beneficial.

  • Active and assisted joint movements to restore flexibility
  • Warm compresses to loosen soft tissues
  • Hydrotherapy for smoother, low-impact motion
  • Electrical stimulation (TENS/NMES) to re-engage weak muscles
Physiotherapist's role: Gradually increase joint range and monitor pain levels for safe progress.
3

Advanced Phase (3–6 Months and Beyond) Strength & Function

Once bone strength returns, the goal shifts to rebuilding function, endurance, and stability.

  • Strengthening with light resistance or bands
  • Balance and coordination drills
  • Gait retraining to correct walking patterns
  • Massage or manual therapy to enhance flexibility
  • Functional training for daily chores, posture, and confidence
Physiotherapist's role: Restore natural movement and guide safe load-bearing transitions.

Physiotherapy After a Fracture – What to Expect and When to Begin

Fracture Type Approximate Start Time Early Focus
Non-surgical (cast only) Within 1–2 weeks (unaffected joints); active PT after cast removal Gentle range-of-motion, circulation maintenance
Post-surgical (plates, rods, screws) 2–3 weeks post-surgery Controlled movement and scar mobility
Complex or multiple fractures 4–6 weeks or as advised Pain relief, swelling reduction, gradual muscle activation

Stage-by-Stage Physiotherapy Plan

1

Immobilisation Stage (0 – 6 weeks)

Focus: Preserve circulation and prevent stiffness.

  • Gentle finger, toe, or limb movement
  • Isometric muscle contractions
  • Elevation and icing to control inflammation
  • Breathing and relaxation exercises
Physiotherapist's role: Demonstrate safe home positions and ergonomic limb support.
2

Early Mobilisation (6 – 12 weeks)

Focus: Restore flexibility and reduce stiffness.

  • Assisted and active joint motion
  • Warm compresses to relax tissue before exercise
  • Hydrotherapy or low-impact pool movement
  • Electrical stimulation for weak muscles
Physiotherapist's role: Supervise motion limits and monitor pain response.
3

Strengthening (12 – 20 weeks)

Focus: Rebuild strength, endurance, and stability.

  • Light resistance training with bands or small weights
  • Coordination and balance exercises
  • Gait training and postural correction
  • Massage and stretching to improve tissue flexibility
Physiotherapist's role: Ensure correct alignment and prevent compensatory strain.
4

Functional Rehabilitation (5 – 9 months)

Focus: Return to daily activity with confidence.

  • Progressive weight-bearing under medical guidance
  • Proprioception and coordination drills
  • Low-impact cardio such as cycling or swimming
  • Activity-specific retraining (work, household, or sport)
Physiotherapist's role: Assess endurance and safe bone loading for long-term recovery.

Why Consistency Matters

Joint Stiffness

Reduced mobility and flexibility

Muscle Imbalance

Weakness and improper movement patterns

Chronic Pain

Persistent discomfort and swelling

Delayed Recovery

Incomplete return to normal function

Even 20 minutes of daily guided activity can greatly improve circulation, muscle memory, and functional confidence.

Returning to Daily Activities

Fracture Location Average Recovery Time
Fingers and toes 3–6 weeks
Wrist 6–8 weeks
Ankle 6–10 weeks
Clavicle (collarbone) 6–8 weeks
Ribs 4–12 weeks
Arm (humerus, radius, ulna) 6–10 weeks
Leg (femur, tibia, fibula) 10–16 weeks
Hip 10–12 weeks (can extend to 2–6 months for elderly)
Pelvis 8–12 weeks
Spine (vertebrae) 6–12 weeks

Tips for a Safe and Sustainable Return

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Resume activities gradually

Start with light movements and short durations, increasing intensity slowly

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Prioritise posture and ergonomics

Avoid additional strain, especially for wrist and spine fractures

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Use support aids as directed

Crutches, slings, braces until balance and strength improve

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Incorporate stretching and strengthening

Support muscles and tendons throughout recovery

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Avoid overexertion

Swelling or pain lasting more than 24 hours means you should scale back

Frequently Asked Questions

Why is my joint stiff after cast removal? +

Immobilisation limits blood flow and shortens soft tissue. This makes joints feel stiff once movement resumes. Guided stretching, gradual mobilisation, and physiotherapy restore elasticity and reduce discomfort over time.

When should physiotherapy start after a fracture? +

Physiotherapy usually starts soon after immobilisation or surgery — sometimes while the cast is still on. Early movement of nearby joints maintains circulation and muscle tone. Active movement begins only once X-rays confirm safe bone union.

What exercises are safe during recovery? +

Safe exercises are those prescribed by your physiotherapist. Initially, focus on gentle, pain-free movement and stretching. Later, progress to resistance and balance training. Avoid heavy weights or jerky motions until medically cleared.

Is pain during rehabilitation normal? +

Mild discomfort is expected as muscles awaken and joints adjust, but sharp or increasing pain isn't. Persistent pain can indicate strain or inflammation — inform your physiotherapist immediately so they can modify your program safely.

How do I know if I'm overdoing it? +

Excess fatigue, swelling, or pain lasting over 24 hours means you should reduce intensity. Rehabilitation should challenge you, not exhaust you. Consistent progress, not force - builds stronger, safer recovery.