01/08/2025
Physiotherapy Management for Fracture Basics
๐ฆด A Comprehensive Guide for Clinicians & Students
๐๐ง๐๐๐ฉ๐ช๐ง๐๐จโdefined as a break or disruption in the continuity of a boneโare among the most common injuries treated in orthopaedic and trauma care. While orthopedic management focuses on stabilization and healing, physiotherapy plays a pivotal role in restoring mobility, function, strength, and independence post-injury.
This article outlines the generalized physiotherapy approach to fracture management across different healing phases.
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๐งฉ ๐๐๐๐๐๐ฉ๐๐ซ๐๐จ of Physiotherapy in Fracture Management
1) Prevent joint stiffness and muscle atrophy
2) Reduce pain and swelling
3) Maintain joint range of motion (ROM)
4) Improve circulation and reduce complications
5) Restore normal movement patterns
6) Promote bone healing (without stressing the fracture site)
7) Improve strength and function
8) Assist safe return to ADLs and functional independence
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โณ ๐๐ฉ๐๐๐๐จ of Fracture Healing and Corresponding Physiotherapy Management
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A. Immobilization Phase (Inflammatory Phase โ 0 to 6 weeks approx.)
๐ก During this phase, the bone is immobilized via cast, splint, external or internal fixation.
๐ฏ Goals:
-Protect the fracture site
-Manage pain and swelling
-Maintain function in adjacent joints
-Prevent secondary complications (e.g., DVT, pressure sores, stiffness)
๐ง ๐๐๐ฎ๐จ๐๐ค๐ฉ๐๐๐ง๐๐ฅ๐ฎ ๐๐ช๐๐๐๐ก๐๐ฃ๐๐จ
1) Education & Protection
-Educate the patient about the importance of immobilization
-Non-weight bearing or partial weight bearing instructions (as prescribed)
-Pain & Swelling Management
-Cryotherapy (ice packs)
-Elevation
-Compression if appropriate
2) Circulatory Exercises
-Ankle pumps
-Toe curls
-Deep breathing exercises to prevent hypostatic pneumonia
3) Isometric Exercises
-Static quadriceps, gluteal, or arm muscle contractions depending on the limb involved
-These maintain muscle bulk and promote circulation
4) ROM for Adjacent Joints
-Active/active-assisted ROM for non-immobilized joints (e.g., shoulder and elbow if wrist is in cast)
5) Positioning
-Proper limb positioning to prevent contractures
-Use of pillows and splints if necessary
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B. Mobilization Phase (Reparative Phase โ 6 to 12 weeks approx.)
๐ก The fracture begins to unite. Mobilization of the affected joint can begin gradually under medical clearance.
๐ฏ Goals:
-Restore joint mobility
-Gradually reintroduce muscle activity
-Begin functional use of the limb
-Avoid overstressing the healing bone
๐ง Physiotherapy Guidelines:
1) Gradual Mobilization
-Gentle active-assisted to active ROM exercises
-Joint mobilization grades IโII (if pain persists, under guidance)
2) Progressive Strengthening
-Isometric โ isotonic exercises
-Use of therabands or light weights under supervision
3) Soft Tissue Management
-Gentle stretching of shortened muscles
-Myofascial release if needed
4) Scar Management
-If surgical incision is present: scar mobilization to prevent adhesions
5) Pain Relief Modalities
-TENS, Ultrasound (non-thermal), IFT, as clinically indicated
6) Functional Training
-Begin closed-chain activities (sit-to-stand, mini squats for lower limb)
-Gait training with assistive device if needed
7) Monitoring Healing
-Clinical signs (pain, swelling, function)
-Ensure patient compliance to orthopaedic advice
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C. Consolidation & Functional Recovery Phase (Remodelling Phase โ 3 months onwards)
๐ก Bone healing is typically complete or nearly complete. Focus shifts toward functional independence and high-level activities.
๐ฏ Goals:
-Restore full ROM and strength
-Return to ADLs, work, and sport (if relevant)
-Maximize neuromuscular control and balance
๐ง Physiotherapy Guidelines:
1) Advanced Strengthening
-Resistance training (therabands, dumbbells, gym-based)
-Eccentric and concentric exercises
2) Proprioception & Balance Training
-Wobble board, balance pads
-Useful for ankle, knee, and wrist fractures
3) Endurance Training
-Cycling, walking, swimming (if allowed)
-Builds cardiovascular fitness and limb endurance
4) Functional & Task-Specific Training
-Squatting, stair climbing, reaching tasks
-Simulate patient-specific tasks (e.g., lifting for laborers)
5) Sport-specific or Work Hardening Programs
-For athletes and physically demanding jobs
-Focus on agility, speed, and coordination
6) Gait Correction & Biomechanical Alignment
-Especially after lower limb fractures
-Use of mirror feedback, video analysis if needed
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โ ๏ธ ๐๐๐ฃ๐๐ง๐๐ก ๐๐ช๐๐๐๐ก๐๐ฃ๐๐จ & ๐๐ง๐๐๐๐ช๐ฉ๐๐ค๐ฃ๐จ ๐๐ฃ ๐๐ง๐๐๐ฉ๐ช๐ง๐ ๐๐๐๐๐๐๐ก๐๐ฉ๐๐ฉ๐๐ค๐ฃ
-Always follow the orthopaedic surgeonโs protocol
-Avoid overloading the healing bone
-Respect pain and swelling as warning signs
-Watch for compartment syndrome, nerve injury signs, or DVT
-Monitor patientโs psychological status (fear of movement is common)
-Use functional goals to track progress (e.g., ability to walk 50m, lift 2kg, open a door)
-Modify exercises based on:
I) Type of fracture (stable vs unstable)
II) Location (upper vs lower limb)
III) Fixation method (internal vs external)
IV) Age and comorbidities
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๐ง ๐๐๐ ๐๐ก๐๐๐จ to Watch Out For
-Persistent or worsening pain beyond expected healing time
-Swelling or redness that increases with time
-Loss of sensation or motor control
-Sudden change in temperature or color of the limb
-Development of deformities
-Excessive callus formation or malunion/non-union signs
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๐ ๐๐ช๐ฉ๐๐ค๐ข๐ ๐๐๐๐จ๐ช๐ง๐๐จ ๐๐จ๐๐ ๐๐ฃ ๐๐ง๐๐๐ฉ๐ช๐ง๐ ๐๐๐๐๐
1) Visual Analogue Scale (VAS) for pain
2) Range of Motion (goniometric)
3) Manual Muscle Testing (MMT)
4) Functional Independence Measure (FIM)
5) Timed Up and Go Test (TUG)
6) DASH (Disabilities of Arm, Shoulder & Hand)
7) LEFS (Lower Extremity Functional Scale)
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๐งฐ ๐พ๐ค๐ข๐ข๐ค๐ฃ ๐ผ๐๐๐ช๐ฃ๐๐ฉ ๐๐๐๐ง๐๐ฅ๐๐๐จ ๐๐จ๐๐
1) TENS/IFT โ Pain control
2) Ultrasound โ Soft tissue healing
3) NMES/FES โ Muscle activation
4) Hydrotherapy โ Low-load strengthening
5) Kinesiology Taping โ Edema control, support
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๐ฃ ๐พ๐ค๐ฃ๐๐ก๐ช๐จ๐๐ค๐ฃ
Fracture rehabilitation is a multidimensional process requiring clinical judgment, functional goal setting, and patient-centered planning. A well-structured physiotherapy program ensures complete restoration of function, prevents long-term complications, and promotes faster reintegration into daily life.
> A good physiotherapist doesnโt just mobilize bonesโthey restore confidence, movement, and independence.
Al wahid physiotherapy center Burewala chungi number 5
03046834747
03126834747
