Fracture of collar bone, hairline fracture, leg fracture, hand fracture, bone fracture, colles fracture, hand fracture, femoral neck fracture, clavicle fracture are very common. Fracture treatment primarily includes immobilisation (plaster or bandage) followed by physiotherapy.
Once the fractured body part has been removed from cast / bandage then it is important to ensure that your recovery is completed full with physiotherapy treatment and not left half-healed.
Why is Physiotherapy important for fracture treatment?
Most fractures i.e. broken bones will heal in usually six weeks. But that is only half of the problem. Unfortunately when you have enough stress placed through your body to fracture a bone, there’s usually a lot of other soft tissues and structures that have been damaged in the process. Add to that the common use of immobilisation in plaster, you’ll have joint stiffness and considerable muscle weakness.
This may even effect joints that don’t seem related to the break. For example, a fractured shoulder may result in a very stiff elbow or wrist just because you were keeping your shoulder in a sling for a few weeks.
What is a Fracture?
A Fracture happens when there is a break in the continuity of a bone. It is common and on an average a person has two fractures, during a lifetime.
Most of the time, fractures are caused by a sudden injury that loads, stresses or pressurises the bone more than it can take – such as a direct blow, fall from a height, road traffic accidents, or a weight falling on to a part of the body. It may also be caused by an indirect trauma, such as falling on the outstretched hand leading to a fracture of the clavicle (collar bone).
A fracture may also be the result of some medical conditions which weaken the bones, for e.g. Osteoporosis, some cancers or osteomyelitis.
Risk factors associated with Fracture
Your risk of fracture depends, in part, on your age. Broken bones are very common in childhood, though children fractures are generally less complicated than fractures in adults. Most human bones are surprisingly strong and can generally stand up to fairly strong forces. However, if that force is too powerful, or there is something wrong with the bone, it can fracture.
As you age, your bones become brittle and you are more likely to suffer fractures from falls that would not occur when you are young. The older we get the less force our bones can withstand.
How is a broken bone treated / Components of Fracture Treatment?
A broken bone requires Immediate Medical Attention for proper healing and alignment of bone.
Treatment of a fracture will be determined by your doctor based on the following points:
- Age, overall health and medical history
- Severity of the condition
- Tolerance to specific medicines, procedures or therapies
- Your opinion or preference
[A] For fracture treatment, the patient will first be managed by a doctor, who will decide on management option, be it:
- Conservative: Conservative management of broken bones can be done with immobilization with casting or splinting
- Surgical: Surgical intervention includes usage of pins, screws or metal rods to hold the fracture segments in place.
Most fractured bones usually take 6 weeks to heal but that is only half of the problem.
A lot of soft tissues and structures gets damaged due to fracture and after immobilization in plaster for several weeks, you tend to get pain, joint stiffness and considerable muscle weakness. This may even affect other joints as well resulting into hindrance in daily activities.
[B] Physiotherapy Rehab is required to regain the muscle strength and function to complete the fracture treatment.
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 Physiotherapist may also assess the requirement and suggest and train you to use assistive devices during the recovery. Gait training is also done wherever, required.
When should you start Physiotherapy after a fracture?
Physiotherapy is often recommended by doctors to accelerate the healing process once bone is aligned. Physiotherapy manipulation, electrotherapy, joint mobilization techniques and exercises will aid strengthening the bone and the surrounding tissue. This process will help the patient recovery by accelerating healing, reduce pain and swelling, and improve range of motion.
Remember
- Seek treatment at an early stage
- Ensure your physiotherapist provides you with home exercises.
Physiotherapist will be involved during different phases of the recovery period.
Physiotherapy in the hospital for fracture treatment
If the fracture has been managed surgically or conservatively; a physiotherapist may visit you in the initial days itself.
Physiotherapist can help you with fracture treatment to:
- understand the weight bearing restrictions
- teach you how to use the assistive devices like a crutch, cane or walker for walking, climbing up and down the stairs
- strengthen and using the muscles of other limbs (not affected by the fracture) to bear the load of fractured part.
Example 1 : If you fracture your right leg , there will be restrictions on bearing weight on that leg, the muscles of left leg have to be strengthened so that it is able to bear the entire body weight while using an assistive device like walker or crutches.
Example 2: Similarly, for an upper limb fracture e.g. for an elbow fracture managed with an above elbow cast; movement or exercises for shoulder and wrist joint are advised to maintain and improve the strength of these joints and to prevent muscle stiffness over a period. They may help you with exercises for the upper back and neck muscles which in turn will aid the arm in carrying the extra weight of the cast and prevent neck pain or upper back pain.
Phase 2: Physiotherapy at home for fracture treatment
Homecare physiotherapy is reserved for people who are unable to leave the home due to an injury. Physiotherapist can help you
master using your assister device in your home environment. You may also engage in exercises to improve your overall endurance and strengthen the muscle around the fracture. At your house the therapist can also assess your home environment and make recommendations to make minor adjustments to allow you to move easily and safely in your house.
Phase 3: Physiotherapy in the clinic for completing fracture treatment
The doctor may refer you to a Physiotherapist after you have recovered enough to travel from your home. This usually happens after the cast is removed and you can start mobilizing the area around the fracture (4-8 weeks). After thorough assessment a treatment strategy will be devised to:
- reduce pain (if present),
- improve your strength, mobility and
- make you functionally independent.
Physiotherapy after a fracture often focuses on removing the negative effects of immobilization. A Physiotherapist will use a combination of techniques and treatment equipment to address your concerns:
- Physical agents or modalities may be used to help reduce pain and swelling,
- Electrical stimulation (TENS) may also be used to help improve muscle recruitment.
- Weights, resistance bands and other equipment may be used to improve strength and mobility of the muscles and joints in and around the fracture.
- Scar massage and mobilization can help reduce scar adhesion after a surgical intervention.
All the above treatment along with the home exercise program will get you back to your optimum function.
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How do you reduce muscle stiffness after fracture?
Muscle stiffness is a common complication that occurs after a fracture. You can follow the following measure to keep this in check:
- Keeping the joints around the affected area mobile may prevent stiffness in these joints.
- After the cast is removed and as per doctor’s advice, stretching exercises can be performed to reduce muscle stiffness.
- Applying hot packs or hot water fermentation will improve the blood supply and make the joints more flexible.
- Using the affected limb more often in day to day activities will help to regain and restore its function, thus reducing stiffness.
What to expect from physiotherapy after fracture?
Physiotherapy plays a vital role in the management of a fracture. You may come across a physiotherapist at different intervals during the rehabilitation. In the initial phase physiotherapy may help you to improve the strength of the unaffected limbs, prevent stiffness in joints around the fractured limb. A physiotherapist may help you to use assistive devices correctly, if needed in case of lower limb fracture.
In the later phases of rehabilitation, physiotherapy may help you to reduce the pain, swelling in the affected areas using various modalities or manual therapy techniques. They may help you to regain the strength in the muscles, getting it back to normalcy. They may also help you to prevent and treat any stiffness following the fracture.
How long do you have to do physical therapy for a broken bone?
Each fracture is different and healing rate may vary from person to person. A fracture generally heels in about 6 to 8 weeks, and you should be back to normal within 12 weeks of a fracture. Physiotherapy rehabilitation should normally take about 6 to 8 weeks, but your program may be slightly shorter or longer depending on your case. example in case of a Colle’s fracture (wrist fracture) which generally occurs in elderly, rehabilitation will take longer due to age related osteoporosis and associated stiffness in the finger and wrist joints.
Home Remedies for Fracture Treatment: What can be done at home to aid quick healing of fracture?
Some of the Home remedies for stiff and painful joints after a fracture has healed include:
- Hot water bags or heating pads over the affected area may improve the blood circulation and make the joints more flexible.
- Stretching exercises performed regularly will improve the flexibility of the joints and muscle.
- Ice compressions or applying ice packs over the swollen area for 5-10 mins will ease the pain and may help in reducing the inflammation.
- If there is a scar that has got adhered to the skin after a surgery, massaging the area with oil may help.
- Using the affected limb in day to day activities at home may help to restore its function faster after the fracture has healed. For example, kneading dough may aid movement at the wrist joint and fingers, after a wrist or finger fracture. Climbing the stairs up and down may help with ankle movement post ankle joint fracture.
Caution: Always check with your doctor before starting any form of exercise.
Tips for Fracture healing
Here are a few Dos and don’ts related to fracture healing:
Do’s while your bone fracture is healing:
- Do elevate your broken bone above your chest level. This will help in reducing the swelling.
- Do take it easy. For the first few weeks after the fracture you will want to take it easy and avoid bumping or putting pressure on your fractured bone.
- Do exercise with your doctor’s permission. If your arm or leg is in a cast ask your doctor when you can start moving the muscles near the broken bone.
- Do pay attention to odor, if your cast gives out a foul smell do visit your doctor immediately it may be a sign of an infection.
- Do keep your cast clean.
Don’ts while your bone fracture is healing:
- Don’t ignore fever: a high temperature may indicate an underlying condition that needs medical attention.
- Don’t ignore discomfort: if you experience pain, tingling, numbness etc don’t ignore it. These are not normal signs of healing.
- Don’t get your cast wet: Water may compromise the effectiveness of the material used for the cast.
- Don’t apply lotion, powder or deodorant under the cast. They may cause bacterial growth.
- Do not remove the cast unless advised by the doctor. This may hamper the healing of the fracture.
As Mrs Ritu Sengupta suggests, please contact one of our clinics directly for advice specific to your fracture. You can make an appointment with ReLiva Physiotherapy & Rehab at any stage. This is especially important if you believe you are not making satisfactory progress in your recovery, or if your mobility is compromised.
This article is based on the contributions from Dr Priya Karthik (PT). Dr Priya is a highly experienced physiotherapist at Reliva and specialises in Rehab. She works across recoveries among adults, elderly as well as children.
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