Physiotherapy is crucial for optimal fracture healing and regaining full function. It typically progresses through stages, adapted to the individual’s needs and the nature of the fracture.
Phases of Fracture Rehabilitation:
I. Immobilization/Acute Phase:
- Goal: Protect the healing bone and manage initial pain and swelling.
- Techniques:
- Pain and Oedema Management: Ice/cold therapy, elevation, gentle massage, and sometimes electrical stimulation (e.g., TENS).
- Maintaining Proximal/Distal Mobility: Performing gentle exercises for joints above and below the immobilized area to prevent stiffness and maintain circulation.
- Isometric Exercises: Gentle muscle contractions without joint movement to prevent muscle atrophy and maintain strength without stressing the fracture site.
- Education: Instruction on proper positioning, precautions, and signs of complications.
II. Early Mobilization/Intermediate Healing Phase:
- Goal: Gradually restore range of motion, begin light strengthening, and prepare for increased load. This phase typically starts once the bone shows initial signs of healing and the cast/immobilizer is removed (or as advised for internal fixation).
- Techniques:
- Graded Progressive Range of Motion (ROM) Exercises: Gentle active and passive movements to improve joint flexibility.
- Early Strengthening: Introduction of light resistance exercises using body weight, resistance bands, or light weights.
- Proprioceptive Exercises: Activities to improve joint awareness and balance, especially for lower limb fractures.
- Scar Tissue Management: Gentle massage and stretching to prevent adhesions if there’s a surgical incision.
- Weight-Bearing Progression: For lower limb fractures, a carefully structured program to gradually increase weight-bearing, often starting with partial weight-bearing using crutches or a walker.
III. Strengthening and Functional Phase (Advanced Healing):
- Goal: Restore full strength, endurance, balance, and functional movement for daily activities and return to sport/work.
- Techniques:
- Progressive Resistance Exercises: Increasing resistance and complexity of exercises to rebuild muscle strength and endurance. This can include:
- Open and Closed Kinetic Chain Exercises: Exercises where the hand or foot is free (open) or fixed (closed) to the surface, mimicking real-life movements.
- Functional Training: Exercises that mimic specific daily tasks, work-related movements, or sports-specific actions (e.g., squats, lunges, step-ups, lifting, carrying).
- Advanced Balance and Coordination Drills: Single-leg stands, dynamic balance activities, agility drills.
- Plyometrics: For athletes, introducing jumping and explosive movements in a controlled manner once sufficient strength and stability are achieved.
- Cardiovascular Conditioning: To improve overall fitness.
- Sport-Specific or Work-Specific Rehabilitation: Exercises and drills to prepare for return to specific activities.
