Physical Therapy for Bone Fractures

Although breaking a bone isn’t rare, fractures are still a serious medical condition. A bone may break due to high-force impact or stress, or it may break from an otherwise trivial injury worsened by medical conditions that have weakened the bones.

Fractures are either considered closed, when the skin stays intact, or compound (sometimes called open), when the bone is exposed. There are three different types of fractures:

  • Type I is a "nondisplaced" fracture, where the bone has a break but is still in normal position.
  • Type II is a fracture where a fragment of bone has shifted.
  • Type III is the most serious type of fracture because there are multiple breaks of the bone.

The first two fractures usually are treated without surgery, but Type III generally requires surgery.

All fractures require treatment—for both proper bone healing and rehabilitation. Proper care is required to regain full use and range of motion.

How Physical Therapy Can Help

The type of therapy will, of course, differ based on the type of fracture. But in general, therapy begins when the cast is removed. Strengthening and aggressive range of motion exercises usually must wait until the bone has healed. The physical therapist:

  • Assesses the fracture to make sure the patient can return safely to previous home and work activities.
  • Works with the patient to regain fitness.
  • Helps the patient restore full movement and strength in a safe manner while healing occurs.
  • Guides the patient to a safe return to sports and other physical activities—a return too early after a fracture may increase the risk of another fracture.


Wrist and elbow fractures

Wrist fractures are the most common broken bone for those younger than 75 years old. They and elbow fractures can often occur when people stretch the arm straight out to catch themselves as they fall.

While the bone recovers, the patient’s arm or wrist will be placed in a cast or a sling. During that time, it will be important that the arm or wrist not get too stiff, weak, or swollen. Depending on the type of injury and the amount of activity allowed, a physical therapist may prescribe shoulder, elbow and finger exercises even while the patient is still in a cast or sling.

A therapist will also help the patient remain independent by teaching how to perform daily activities — such as dressing, working on a computer and housekeeping—even while wearing a cast or a sling. Once a patient can move the arm freely without pain, the therapist may begin adding activities, such as using the arm for dressing, grooming and housekeeping.

So the rest of the body remains in shape, most people with fractures continue to exercise. Physical therapists can help adapt exercise programs to maintain overall strength and fitness without interfering with the healing of the fracture.

After the cast or sling is removed, the area that was injured will likely be stiff and weak.

Physical therapists prescribe several types of exercises. Early on, the therapist can help with "passive range-of-motion" exercises. Soon patients can begin to exercise without weights. Once the bone is well healed, patients may use weights and resistance bands.

A physical therapist may also use manual therapy to enable joints and muscles to move more freely with less pain. Finally, a therapist can help retrain muscles to react quickly to protect from another fall.

Hip fractures

Hip fractures are the most common breaks for patients older than 75. Usually these require surgery.

Research has shown that the sooner physical therapy starts after hip surgery, the quicker and more complete the recovery. The course of therapy will differ based on the type of fracture, but generally a therapist will help the patient begin using crutches and putting weight on their hip within one to four weeks after surgery.

The therapist closely monitors progress and moves the patient to full weight bearing once pain has subsided.

Although the hip has been injured, it is also important that patients maintain cardiovascular fitness throughout their recovery. A therapist may provide exercises to keep the patient healthy while the hip continues to heal.

Ankle fractures

Physical therapy is very important after an ankle fracture. It will often include activities to increase movement at the ankle and other joints during or after the period of immobilization.

The physical therapist attends to pain relief and help a patient learn to walk safely using crutches or a walker.

Eventually, a patient will begin strengthening exercises. It may take several months for the muscles around the ankle to grow strong enough to allow walking without a limp and a return to regular activities. Later, the physical therapist adds activities to include building of the muscles around the knee, the hip, ankle, and lower trunk so the patient is fully prepared to return to normal activity.