If you have had the unfortunate injury of a fracture or broken bone, then you may understand how painful this can be. A broken bone requires swift medical attention to ensure proper healing and alignment of the bone.
After a fracture, your bone will be set, or reduced, by a doctor. Reduction of the bone can be done manually. For more serious fractures, a surgical procedure called an open reduction internal fixation (ORIF) may be necessary to make sure that all the bone pieces are in the correct place and healing can occur.
Often after fracture, the bone needs to be stabilized or immobilized to ensure proper healing. This is usually accomplished using a cast. For simple fractures, your doctor may elect to apply a removable cast so that gentle motion can occur around the injury site. After complex fractures or an ORIF procedure, you may be required to wear a cast that is not to be removed. If you fracture your shoulder or arm, you may be required to wear a sling to keep the arm immobilized. Check with your doctor to ensure that you understand what is expected of you in regard to immobilization.
Starting Physical Therapy after Fracture
After a fracture, physical therapy may be ordered to help ensure you return to optimum function as quickly as possible. You may encounter a physical therapist at different times after suffering a fracture.
In the Hospital
After you fracture a bone, a physical therapist may visit you in the hospital. If you break your leg or ankle, a physical therapist may instruct you in how to walk with an assistive device, like a cane or crutches. This includes how to use the device to walk up and down stairs or to get into and out of a car. Be sure to ask questions if you have any. Remember, learning a new skill takes practice, so be sure to practice using your device while the physical therapist is with you.
If you fracture your arm, you may be required to keep your arm in a sling to help with healing. In the hospital, your physical therapist may teach you how to apply and remove the sling.
When you return home from the hospital after a fracture, your doctor may order physical therapy at home. Home care physical therapy usually is reserved for people who are unable to leave the house as a result of their injury.
Your physical therapist can help you master using your assistive device in your home environment. You may also engage in exercises to help improve your overall endurance or to strengthen the muscles around the fracture site.
If you break your leg or ankle, your doctor may have specific weight-bearing restrictions that you must follow. Your physical therapist can help you maintain these restrictions to ensure that you do not put too much stress on the healing bone. Lifting restrictions may be in place after an arm or shoulder fracture.
At your house, your physical therapist can also assess your home environment. He or she can make recommendations to make minor adjustments to allow you to move safely around your home.
In the Clinic
When you have recovered enough to travel from your home, your doctor may refer you to a physical therapy clinic to help with restoring normal function after your fracture. Usually, this occurs after the cast has been removed and you can start mobilizing the area around the fracture. You may still have to follow weight-bearing precautions or lifting restrictions at this point, so be sure to consult with your doctor so you understand what your limitations are. Your first visit with your physical therapist will usually involve an evaluation and assessment. Your therapist will likely take measurements of body parts around the fracture site. This might include measurements of:
- Range of motion
- Girth or swelling
- Gait (for lower extremity fractures)
After the initial evaluation, your physical therapist can work with you to devise a treatment strategy to help you recover fully. Physical therapy after a fracture often focuses on overcoming the negative effects of being immobilized by a cast or sling. Immobilization may cause loss of motion and strength and decreased functional mobility.
Physical therapy after fracture can also help you improve your functional mobility. If you have fractured your leg, your physical therapist can help you improve walking and help decide if you should walk with a walker, crutches, quad cane, or standard cane. If you have fractured an arm or shoulder, functional activities that focus on reaching and grasping may be included.
Physical agents or modalities may be used to help with pain and swelling. Electrical stimulation may also be used to help improve muscle recruitment. You should remember that while passive treatments like electrical stimulation or ultrasound may be used, you should also be engaged in active activities in your physical therapy.
Exercises to improve range of motion and strength may also be started. Particular focus should be placed on the fractured area and the joints around the fracture. If you broke a bone near your elbow, mobility exercises should be included for your elbow, wrist, and shoulder. Likewise, a fracture of the tibia (shin) should include exercises for the knee, ankle, and hip. Exercise can also help ensure that your bone can tolerate the loads and stresses that you may encounter during normal everyday function. Be sure to speak with your doctor and physical therapist to learn the correct exercises for your specific condition.
A fracture can be painful and can lead to significant functional loss and disability. Depending on the severity of the injury, the loss may be temporary or permanent. Physical therapy can help you return to optimum functional mobility as quickly as possible.
Kisner, C., & Colby, L. A. (1996). Therapeutic exercise: Foundations and techniques. (3 ed.). Philadelphia: FA Davis.