Fracture Rehabilitation

Support for movement, strength and recovery after a fracture

A fracture can affect much more than the bone itself. After a period in a cast, brace or sling, it is common for the surrounding joints and muscles to feel stiff, weak or difficult to use normally.

Fracture rehabilitation focuses on gradually restoring movement, rebuilding strength and helping you return to everyday activities once the injured area is ready for rehabilitation.

Treatment depends on the location of the fracture, how it was treated, your stage of healing and any instructions provided by your orthopaedic or fracture team.

What is fracture rehabilitation?

Fracture rehabilitation is physiotherapy provided during or after the healing process of a broken bone.

Some fractures are treated with a cast, boot, brace or sling, while others require surgery. The amount of movement and weight that can be placed through the injured area will depend on the fracture and how healing is progressing.

Rehabilitation may focus on:

• Restoring joint movement
• Rebuilding muscle strength
• Reducing stiffness
• Improving balance
• Returning to normal walking
• Improving use of an arm or hand
• Increasing confidence after injury
• Returning to work
• Returning to exercise or sport

The rehabilitation programme changes as healing progresses.

When fracture rehabilitation may help

Physiotherapy may be useful if you are experiencing:

• Stiffness after a cast or brace has been removed
• Reduced movement around the injured area
• Muscle weakness
• Difficulty walking
• Reduced balance
• Ongoing swelling
• Difficulty using stairs
• Reduced grip or hand function
• Difficulty lifting or reaching
• Reduced confidence putting weight through an injured leg
• Difficulty returning to work
• Reduced physical fitness after a period of inactivity
• Difficulty returning to exercise or sport
• Ongoing functional problems after the fracture has healed

Rehabilitation may begin at different stages depending on the type of fracture and medical guidance.

What happens during your first appointment?

Your first appointment begins with a discussion about the fracture and how it currently affects you.

The physiotherapist may ask about:

• How the injury happened
• Which bone was fractured
• When the fracture occurred
• Whether surgery was required
• How long you were in a cast, brace, boot or sling
• Current pain or swelling
• Current weight-bearing instructions
• Walking aids you use
• Activities you currently find difficult
• Work and exercise
• Previous injuries
• Other medical conditions
• What you would like to return to doing

The physical assessment may include:

• Joint movement
• Muscle strength
• Swelling
• Walking
• Balance
• Grip or upper-limb function where relevant
• Getting up from a chair
• Using stairs
• Everyday movements involving the injured area

The assessment helps determine what is appropriate at your current stage of recovery.

What rehabilitation may include

Treatment varies considerably depending on the fracture.

Movement exercises

A joint that has been immobilised may become stiff.

Movement exercises may be used to gradually restore useful range once movement is considered safe.

These exercises are usually progressed according to comfort and healing rather than forcing the joint through significant pain.

Strengthening

Muscles around an injured area can lose strength during periods of reduced movement.

Strengthening may begin with simple exercises before progressing towards resistance bands, weights, functional exercises or gym-based rehabilitation.

Walking rehabilitation

After a fracture involving the hip, pelvis, leg, ankle or foot, walking may need to be gradually rebuilt.

Treatment may include:

• Walking with crutches or a frame
• Gradually increasing weight-bearing when permitted
• Improving step pattern
• Increasing walking distance
• Reducing reliance on walking aids when appropriate
• Walking outdoors
• Practising uneven surfaces

Balance exercises

Lower-limb fractures can affect balance and confidence.

Rehabilitation may include standing, stepping, turning and single-leg exercises where appropriate.

Functional rehabilitation

Exercises can gradually become more similar to the movements you use during everyday life.

This may include:

• Standing from a chair
• Stairs
• Lifting
• Carrying
• Reaching
• Squatting
• Walking
• Work-related movements

Home exercise programme

You may receive exercises to practise between appointments.

The programme can be changed as movement, strength and confidence improve.

Recovery after a period in a cast or brace

A cast or brace helps protect a healing fracture, but keeping an area still for several weeks can affect the surrounding muscles and joints.

Once immobilisation is reduced or removed, you may notice:

• Stiffness
• Weakness
• Swelling
• Dry or sensitive skin
• Reduced confidence
• Difficulty using the area normally
• A feeling that the limb is smaller or weaker than before

These changes do not necessarily mean something has gone wrong.

Rehabilitation gradually reintroduces movement and load while the injured area continues recovering.

Managing stiffness

Stiffness is common after a fracture, particularly when a nearby joint has been immobilised.

For example, after an ankle fracture you may find it difficult to move the ankle normally, while a wrist fracture can leave the wrist and fingers feeling stiff.

Treatment may include:

• Active movement
• Gentle mobility exercises
• Functional movement
• Stretching where appropriate
• Hands-on treatment where suitable

Improvement may be gradual, particularly after a longer period of immobilisation.

Rebuilding strength

Muscles begin to lose strength when they are used less.

Following a fracture, weakness may affect both the muscles directly around the injury and the rest of the limb.

Exercises may progress from basic muscle activation towards:

• Body-weight exercises
• Resistance bands
• Weights
• Gym equipment
• Lifting and carrying
• Single-leg exercises
• Grip strengthening
• Work or sport-specific movements

The aim is to rebuild enough strength for the activities you want to return to.

Weight-bearing after a fracture

After some lower-limb fractures, you may be given specific instructions about how much weight you can place through the injured leg.

You may be told to remain:

• Non-weight-bearing
• Touch or partial weight-bearing
• Weight-bearing as tolerated
• Fully weight-bearing

These instructions depend on the fracture, treatment and stage of healing.

Physiotherapy should follow the guidance provided by your orthopaedic team. The amount of weight placed through the limb should not be increased simply because it feels better if medical restrictions are still in place.

Walking after a lower-limb fracture

Walking can feel unfamiliar after several weeks of reduced weight-bearing or immobilisation.

You may notice that you:

• Limp
• Take shorter steps
• Avoid placing weight through the injured side
• Walk more slowly
• Tire quickly
• Depend heavily on crutches
• Feel uncertain on uneven ground

Rehabilitation can gradually work towards a more comfortable and confident walking pattern.

As strength and healing progress, the programme may increase walking distance, speed and the variety of surfaces you can manage.

Using crutches or a walking frame

Walking aids may be needed while the fracture heals or while strength and balance recover.

Physiotherapy can help with:

• Correct use of crutches
• Walking safely
• Managing weight-bearing restrictions
• Using stairs
• Turning
• Moving around the home
• Gradually reducing support when appropriate

There is no benefit in stopping a walking aid before you can walk safely without it.

The decision should reflect both medical guidance and your physical ability.

Ankle and foot fracture rehabilitation

Ankle and foot fractures can affect walking, balance and the ability to push through the foot.

After immobilisation, you may experience:

• Ankle stiffness
• Calf weakness
• Swelling
• Reduced balance
• Difficulty walking
• Difficulty using stairs
• Reduced confidence on uneven ground

Rehabilitation may include:

• Ankle movement exercises
• Calf strengthening
• Balance work
• Walking practice
• Step exercises
• Gradually increasing walking distance
• Returning towards running or sport where appropriate

The programme should follow any ongoing weight-bearing restrictions.

Knee and lower-leg fracture rehabilitation

Fractures around the knee or lower leg can affect knee movement, leg strength and walking.

Treatment may focus on:

• Restoring knee movement
• Thigh strengthening
• Calf strengthening
• Walking
• Balance
• Sit-to-stand exercises
• Step and stair practice
• Gradually returning to normal activity

If surgery was required, rehabilitation will also take account of the procedure and any restrictions provided by the surgeon.

Hip and pelvic fracture rehabilitation

Hip and pelvic fractures can have a significant effect on mobility and independence.

Early rehabilitation may focus on basic activities such as:

• Getting out of bed
• Standing
• Walking with an aid
• Using the toilet safely
• Sitting and standing from a chair
• Managing stairs where required

As recovery continues, treatment may focus on improving leg strength, balance, walking distance and confidence outside the home.

The level and speed of rehabilitation will depend on the fracture, surgery and general health.

Wrist and hand fracture rehabilitation

Wrist and hand fractures can make gripping, lifting and everyday hand use difficult.

Following removal of a cast or splint, the wrist, hand or fingers may feel stiff and weak.

Rehabilitation may include:

• Wrist movement
• Finger and thumb exercises
• Grip strengthening
• Swelling management
• Hand coordination
• Lifting and carrying
• Returning to typing or manual tasks

The programme can become more specific to work, hobbies or sport as recovery progresses.

Shoulder and upper-arm fracture rehabilitation

A fracture around the shoulder or upper arm may initially require a sling and a period of protected movement.

As healing progresses, rehabilitation may gradually work on:

• Shoulder movement
• Elbow movement
• Reaching
• Shoulder strength
• Lifting
• Carrying
• Dressing
• Overhead activity

Shoulder stiffness can take time to improve after a fracture, particularly when the arm has needed to remain relatively still during healing.

Exercises should be progressed according to the fracture and medical guidance rather than forcing movement too early.

Rehabilitation after fracture surgery

Some fractures require surgery using plates, screws, rods or other fixation.

Rehabilitation after surgery still depends on how stable the fracture is and what restrictions the surgeon has provided.

Treatment may include:

• Restoring movement
• Managing swelling
• Rebuilding strength
• Walking
• Improving balance
• Scar management once the wound has healed
• Returning to normal activities

The presence of surgical fixation does not automatically mean that the area can be loaded without restriction.

Follow the guidance provided by the orthopaedic team.

Managing swelling

Swelling can remain after a fracture even when the bone is healing well.

It may increase after longer periods of standing, walking or using the injured area.

Depending on the injury, management may include:

• Appropriate movement
• Elevation
• Gradually increasing activity
• Compression where recommended
• Regular exercises

A sudden or significant increase in swelling should be assessed rather than automatically treated as a normal part of recovery.

Pain during rehabilitation

Some discomfort can occur when a stiff or weak area begins moving again.

The level and behaviour of pain are important.

Rehabilitation does not require you to force through severe pain. Exercises can be adjusted according to your stage of recovery and how the area responds.

A sudden significant increase in pain, particularly after a new injury or fall, should be assessed appropriately.

Balance and confidence after a fracture

A fracture can affect confidence as well as physical ability.

After several weeks of protecting an injured leg, you may feel uncertain when:

• Standing without support
• Walking outdoors
• Using stairs
• Stepping off a kerb
• Walking on uneven ground
• Returning to exercise

Balance and strengthening exercises can gradually reintroduce these situations.

The aim is to rebuild trust in the injured area while maintaining appropriate safety.

Getting up from a chair

Lower-limb fractures can make standing from a chair more difficult because of weakness, stiffness or reduced confidence.

Physiotherapy may include:

• Foot positioning
• Forward movement of the body
• Leg strengthening
• Repeated sit-to-stand practice
• Gradually reducing reliance on the arms

As strength improves, different chair heights can be introduced.

Managing stairs

Stairs place greater demands on strength and balance than level walking.

Rehabilitation may include:

• Step exercises
• Leg strengthening
• Balance
• Controlled lowering
• Safe use of a handrail
• Practising with a walking aid if required

The goal may initially be to use stairs safely before progressing towards a more normal stair pattern.

Returning to everyday activities

Fracture rehabilitation should eventually move beyond basic exercises.

Your goals may involve:

• Walking around the home
• Shopping
• Cooking
• Dressing
• Driving
• Carrying shopping
• Using stairs
• Caring for children
• Gardening
• Household tasks
• Walking outdoors
• Returning to hobbies

Exercises can gradually become more specific to these activities.

Returning to work

The amount of rehabilitation needed before returning to work depends on the location of the fracture and the physical demands of your job.

A desk-based role may require enough movement and comfort for sitting, typing and travelling.

A physical job may require:

• Standing for longer periods
• Walking
• Lifting
• Carrying
• Climbing
• Kneeling
• Reaching
• Using tools

Rehabilitation can gradually prepare you for these demands.

A phased return or temporary adjustment to duties may sometimes be appropriate.

Returning to driving

Returning to driving depends on the fracture, which limb was affected, your movement and your ability to control the vehicle safely.

You should be able to perform the movements needed for driving and respond appropriately in an emergency.

You should also follow any restrictions provided by your doctor, surgeon or fracture team.

If you are still using a cast, significant brace or medication that affects your ability to drive safely, additional restrictions may apply.

Returning to exercise

Once the fracture has healed sufficiently and normal everyday movement is improving, rehabilitation can progress towards exercise.

Depending on your goals, this may include:

• Walking
• Cycling
• Swimming
• Gym training
• Running
• Exercise classes
• Recreational activities

Returning gradually allows strength, movement and confidence to develop alongside the increasing physical demand.

Returning to the gym

Gym-based rehabilitation may be useful during later recovery.

Exercises can progress towards:

• Resistance machines
• Free weights
• Squats
• Lunges
• Step exercises
• Pressing or pulling
• Cardiovascular training

The amount of load should be progressed according to healing and physical ability.

Being pain-free during one exercise does not necessarily mean that the bone and surrounding tissues are ready for unrestricted heavy training.

Returning to running and sport

Returning to sport usually requires more than the fracture simply being healed.

You may also need to regain:

• Strength
• Balance
• Joint movement
• Coordination
• Endurance
• Confidence

Later-stage rehabilitation may include:

• Jogging
• Running
• Jumping
• Landing
• Hopping
• Changes of direction
• Sport-specific movements

The progression depends on the fracture and the demands of the activity.

Recovery can continue after the bone has healed

Bone healing is only one part of recovery.

Even when imaging or medical review confirms that a fracture has healed, you may still experience:

• Weakness
• Stiffness
• Reduced balance
• Swelling
• Reduced endurance
• Lack of confidence

These physical changes can continue improving through rehabilitation.

For this reason, being told that the fracture has healed does not necessarily mean you should immediately return to every previous activity at full intensity.

Older adults and fractures

A fracture can have a greater impact on mobility when someone already has reduced strength or balance.

Rehabilitation may therefore include broader goals such as:

• Maintaining independence
• Improving walking
• Reducing falls risk
• Increasing leg strength
• Using an appropriate mobility aid
• Managing stairs
• Returning to community activities

If a fracture occurred after a relatively minor fall, further medical assessment may also be appropriate to consider bone health and future fracture risk.

Preventing further falls

If a fracture happened because of a fall, rehabilitation may consider why the fall occurred.

This may include assessing:

• Leg strength
• Balance
• Walking
• Turning
• Mobility aids
• Confidence
• Stairs
• Uneven surfaces

The aim is not to guarantee that another fall will never occur, but to address factors that may improve safety and mobility.

Following your fracture team’s guidance

Different fractures can have very different restrictions.

Your fracture or orthopaedic team may provide guidance about:

• Weight-bearing
• Use of a cast or brace
• Movement
• Lifting
• Driving
• Work
• Exercise
• Returning to sport

Physiotherapy should work within these instructions.

If restrictions change after an X-ray or follow-up appointment, the rehabilitation programme can be adjusted.

When further medical assessment may be needed

Some symptoms require medical review rather than simply continuing rehabilitation.

Seek appropriate assessment if you experience:

• A sudden significant increase in pain
• A new inability to use or put weight through the injured area
• New deformity
• Rapidly increasing swelling
• Significant redness or heat
• Wound discharge after surgery
• Fever or feeling significantly unwell
• New persistent numbness
• Sudden significant weakness
• A new injury or fall involving the healing fracture
• New chest pain or unexplained shortness of breath

Follow any specific warning signs provided by your fracture or orthopaedic team.

Treatment based on your goals

The aim of fracture rehabilitation is different for every person.

You may want to:

• Walk without crutches
• Restore movement after a cast
• Use stairs confidently
• Return to work
• Drive again
• Improve grip strength
• Lift and carry comfortably
• Return to the gym
• Run again
• Return to sport
• Regain confidence after a fall

Your rehabilitation programme can be developed around these goals and progressed as healing, strength and movement improve.

How long does fracture rehabilitation take?

There is no single recovery timeline for every fracture.

Rehabilitation depends on:

• Which bone was fractured
• The severity of the injury
• Whether surgery was required
• How long the area was immobilised
• Your general health
• Muscle strength
• Joint stiffness
• Other injuries
• The activities you want to return to

Some people need only a relatively short period of rehabilitation after the fracture heals.

Others may require longer-term treatment where there has been major injury, surgery, prolonged immobilisation or significant loss of mobility.