What Happens During Fracture Immobilisation?
When a limb is immobilised in a cast or brace for 4–8 weeks, significant changes occur: muscle atrophy (up to 30% strength loss per week), joint stiffness from capsular and soft tissue contractures, reduced proprioception (joint position sense), and cardiovascular deconditioning in extended immobilisation.
When Does Physiotherapy Begin?
In some cases, physiotherapy begins while the cast is still in place — focusing on maintaining strength in the muscles above and below the injury. Once the fracture is confirmed healed by X-ray, active rehabilitation begins.
Phase 1 — Restoration of Range of Motion
Gentle active and passive exercises restore joint flexibility. Swelling management continues with elevation, ice, and compression where appropriate. The therapist works carefully within pain-free ranges to avoid disrupting the healing bone.
Phase 2 — Strength Restoration
Progressive resistance exercises rebuild muscle strength. For lower limb fractures, weight-bearing is increased in a controlled, stepwise manner. For upper limb fractures, functional tasks are reintroduced progressively.
Phase 3 — Functional Retraining
Return to normal daily activities — walking, stair climbing, cooking, driving — is practised and refined. Proprioceptive and balance training reduces re-injury risk.
Special Considerations for Elderly Patients
Fractures in older adults, especially hip fractures, require particularly careful rehabilitation. The goal is restoring pre-fracture function and preventing future falls through comprehensive balance and strengthening programs.