There’s nothing pleasant about a fracture. Maybe for a second, back in high school; getting your crush to sign on your plaster cast gave you temporary relief, that’s about it.
Fractures are so incredibly painful, as if that wasn’t enough, you must deal with regular doctors’ appointments, the limitation in movement, depending on someone to take care of you etc. It is not pleasant.
First, they tell you, you can’t move at all when you so badly want to. Several weeks later, when you’re comfortable with resting, now, moving is the only thing you have to do.
We understand your dilemma.
Let’s look at why physiotherapy can help ease some of this frustration and help you enjoy moving, just like you used to. We’ll start at the very beginning.
What Is a fracture?
- A fracture is a discontinuity or a crack in the bone structure caused due to an excessive force. Fractures can be complete or incomplete depending on the extent to which the bony segments are separated from each other.
- From childhood up to middle age, only a large force can disrupt a bony structure. However, with age, decreasing bone density leaves the bone prone to fractures with small and seemingly harmless injuries.
- This is a condition that requires immediate medical attention. The good news is that the body can heal a fracture all by itself, once the bone has been reset to its pre-injury position. Your medical and rehabilitation team are there to facilitate this healing and remove the risk of complications.
- The primary goal would be to determine the extent of the fracture and reduce the fracture, in other words, set the broken bone back in place. Your orthopaedic surgeon will determine the best way to enable that. Sometimes in mild cases it is done manually by closed reduction, I.e., without cutting open skin and tissue, and then put in a cast so that the bone can grow and heal while being properly aligned.
Other times, such as in more severe cases, Open Reduction and Internal Fixation (ORIF) is the option your surgeon will decide to be the best for you.
What is Open Reduction Internal Fixation (ORIF)?
- In the case of a serious fracture, your orthopaedic surgeon may decide to opt for a surgery intervention. The words open reduction indicate it is an invasive procedure. Internal reduction is the term used when metal rods, screws or plates are used to hold the pieces of the bone in place to enable healing.
- Recovery after surgery can be estimated to take anywhere between 3-12 months depending on the severity of fracture and presence of complications. You will be advised to take pain medications, physiotherapy, rest, rest and some more rest!
- Your surgeon will let you know when you’re ready to begin physiotherapy and rehabilitation.
Why is Physiotherapy for fractures important?
- It’s only reasonable to assume that in case of fractures only the bones are affected. Unfortunately, this cannot be further from the truth. All bones are connected to muscles, tendons, and other soft tissue. Depending on the extent of the force that caused the fracture, several structures around the bone and joint are strained and even injured.
- Whether it is a closed or open reduction, you will be recommended several weeks of rest. You will also be strictly advised against weight bearing/lifting the affected leg or part of the body. In both these cases, there will be significant muscle weakness and stiffness. For example, a shoulder fracture will mean that the elbow and forearm are put in a cast/sling while the bone heals. This leads to weakness and or stiffness of muscles around the neck, elbow, and wrist.
- The bone that has been broken usually requires approximately 6 weeks to heal. Until then, your surgeon will advise complete immobilization.
- During this time your physiotherapist can provide education and strategies to maintain the integrity of surrounding tissue, muscles, and joints. If you are prescribed assistive devices such as crutches, your physiotherapist will train and educate you on strategies to use them. For example, training you to walk up and down the stairs, getting in and out of the car etc., while keeping in mind the weight-bearing-restrictions that your surgeon has recommended for you.
- After about 6 weeks, active rehabilitation can usually be the focus. Invariably, this is an approximate timeline, your surgeon will provide you with a specific timeline for your fracture.
- Your physiotherapist will plan a functional recovery program so you can return to your pre-injury levels of functioning.
What are the physiotherapy goals for fracture rehabilitation?
When your surgeon has lifted weight-bearing or lifting restrictions your physiotherapist will first perform an initial evaluation to assess range of motion, pain, strength, oedema, flexibility, gait or walking patterns, balance etc. This is followed by specific and individualized goals as per your surgeon’s recommendations. Goals usually include the following-
In addition to pain killers, modalities such as ultrasound and some postural techniques are used to manage symptoms of pain and swelling during the recovery process.
Restoring range of motion:
Manual therapy techniques, soft tissue release, stretching and mobility exercises are some strategies that your physiotherapist will use to improve your range of motion. It is important to work on range of motion as soon as your surgeon gives you the go ahead. The longer the delay, the harder it will become to fix the stiffness.
After a prolonged period of immobilization, your muscles are likely to be atrophied or weak, a structured strength training protocol will play a big role in your overall physical function and health. Your physiotherapist will prescribe an exercise regime to help you build strength to perform the activities you loved doing confidently.
Improving balance and coordination:
In case of lower extremity fractures, this is an important goal. Your physiotherapist will spend a significant amount of time in this aspect of recovery to not only improve mobility, but also to prevent falls and other injuries like sprains or strains.
For lower extremity fractures, your physiotherapist can help you choose an assistive device such as crutch, cane, or walker to help with indoor and outdoor mobility. Once you’re ready to graduate to independent walking, you will be re-assessed and trained for ambulation and gait.
For upper extremity fractures, this can look like task-oriented training such as lifting weights gradually etc. and controlling the arm to better perform meaningful functions.
In general, every fracture is different, and everyone heals at a different pace. Be sure to talk to your physiotherapist to determine the length of your rehab program.
Common obstacles to complete recovery:
- After a fracture, the prolonged immobilization period is not only hard but also extremely frustrating. Often, the frustration can lead to pre-mature weight bearing on the injured bone. This can result in incomplete healing and several complications. Patience is key with fracture healing, and as your physiotherapists we strongly recommend following your surgeon’s protocol and waiting for the go ahead.
- Other time, we have observed that after immobilization, some people are anxious about moving the area even after the surgeon has said its safe to do so. This is also unhelpful, as the stiffness and weakness only get worse with time. We would strongly recommend trusting your medical team and moving when it’s been cleared for you to do so.
At Revere, we understand how frustrating and disempowering this recovery process can feel for you. That’s why we are committed to ensuring you receive not only the best standards of physiotherapy care but also a compassionate and empowering team to motivate you on your worst days. We respect you and we are here to guide and support your rehabilitation journey.
If you feel ready, book an appointment with our expert physiotherapists. Share this article with friends and family who could benefit from the best physiotherapy services at Revere Physiotherapy.