Physiotherapy is essential for restoring full function, strength, and mobility to the wrist and hand after a Colles fracture, whether treated with a cast, splint, or surgery (Open Reduction Internal Fixation – ORIF). The rehabilitation program is highly individualized and progresses through various stages.

• Early Stage (During Immobilization and Immediately After Cast Removal):

  • Pain and Edema Management:
    • Cryotherapy (Ice application): to reduce swelling and pain.
    • Elevation: keeping the hand and wrist elevated above the heart to minimize swelling.
    • Gentle Compression: if permitted, light compression to control edema.
  • Maintaining Unaffected Joint Mobility:
    • Active Range of Motion (AROM) for fingers, thumb, elbow, and shoulder:
      • to prevent stiffness.
      • Patients encouraged to frequently make a fist, extend fingers, move their thumb, and perform full elbow and shoulder movements.
  • Scar Management (Post-Surgical):
    • Scar Massage:
      • once wound healing is complete.
      • gentle massage with techniques like deep friction to prevent adhesions, improve tissue mobility, and reduce sensitivity.
    • Desensitization techniques:
      • tapping.
      • exposure to various textures and immersion in different materials to reduce hypersensitivity.

• Mid to Late Stage (After Cast Removal and Initial Healing):

  • Manual Therapy:
    • Joint Mobilization (Maitland, Mulligan, Kaltenborn concepts):
      • to restore normal joint play and accessory movements essential for full ROM.
    • Specific joint focus:
      • Distal Radioulnar Joint (DRUJ) Mobilization: to improve pronation and supination.
      • Radiocarpal Joint Mobilization: gentle glides and traction to enhance wrist flexion, extension, radial, and ulnar deviation.
      • Intercarpal Joint Mobilization: addressing stiffness between the wrist’s small carpal bones.
    • Mobilization with Movement (MWM – Mulligan Concept):
      • sustained glide combined with active movement to immediately improve ROM and alleviate pain.
  • Soft Tissue Mobilization:
    • Myofascial Release (MFR):
      • to release tightness in forearm flexors/extensors, hand muscles, and fascial planes.
    • Transverse Friction Massage:
      • directly on tendons or ligaments with inflammation or restriction.
  • Progressive Range of Motion (ROM) Exercises:
    • Active-Assisted ROM (AAROM):
      • assisted by the unaffected hand.
    • Passive Range of Motion (PROM):
      • performed by a therapist or assistant.
    • Self-Stretching:
      • guiding patients to independently perform wrist stretches (flexion, extension, radial/ulnar deviation, pronation, and supination).
  • Strengthening Exercises:
    • Isometric Exercises:
      • gentle muscle contractions without movement, early stage.
    • Progressive Resistance Exercises (PREs):
      • with light weights, resistance bands, or therapy putty/balls.
      • targeting wrist flexors, extensors, pronators, supinators, and grip muscles.
    • Finger and Thumb Strengthening:
      • for fine motor skills and grip strength.
  • Neuromuscular Re-education and Proprioception:
    • exercises to enhance balance and coordination.
    • activities involving fine motor control, manipulating small objects, or proprioceptive challenges (e.g., wrist position sense with eyes closed).
  • Functional Activities:
    • gradual reintroduction of tasks such as:
      • writing.
      • typing.
      • opening jars.
      • wringing out cloths.
      • light lifting.
    • aimed at integrating strength, mobility, and coordination into daily activities.

• Advanced Stage (Return to Activity/Sport):

  • Plyometric Exercises:
    • e.g., medicine ball throws.
    • designed to improve power and reaction time.
  • Agility Drills:
    • for athletes preparing to return to sport.

Overall, recovery from a Colles fracture can span several months to a year, depending on injury severity and individual healing progress.