Fracture Rehabilitation.
What is fracture rehabilitation?
A fracture — a break in the continuity of a bone — is one of the most common injuries presenting to physiotherapy. Fractures range from hairline stress fractures that require only load management to complex multi-fragment fractures requiring surgical fixation and months of structured rehabilitation. What they share is that healing the bone is only the beginning of recovery — restoring the strength, movement, proprioception and functional capacity of the injured limb requires specific, progressive rehabilitation that bone healing alone cannot achieve.
Fracture rehabilitation broadly divides into two pathways: conservative management for fractures that do not require surgery, and post-surgical rehabilitation following open reduction and internal fixation (ORIF), where metal hardware — plates, screws, rods or nails — is used to hold fracture fragments in position while healing occurs. The rehabilitation principles overlap but the timelines, precautions and specific interventions differ considerably.
Why does rehabilitation matter after a fracture?
Several consequences of fracture and its treatment create specific rehabilitation needs that do not resolve spontaneously with rest.
Muscle atrophy develops rapidly during immobilisation — research shows measurable muscle wasting within days of immobilisation, and significant atrophy within weeks. The muscles surrounding the fracture site are most affected, but disuse of the entire limb contributes to broader weakness that affects function well beyond the fracture itself.
Joint stiffness from capsular contraction, cartilage changes and soft tissue shortening develops during immobilisation and becomes progressively harder to reverse the longer it persists. Early, guided range-of-motion work — within the limits set by the fracture stability and surgical fixation — prevents stiffness from becoming established.
Proprioceptive deficits — impaired joint position sense — develop following both the injury and the immobilisation, significantly increasing re-injury risk on return to activity. This is particularly relevant for lower limb fractures where single-leg stability is required for walking, stairs and sport.
Bone remodelling requires progressive mechanical loading — the Wolff's law principle that bone adapts its structure in response to the mechanical loads placed on it. Physiotherapy-guided progressive loading during fracture rehabilitation stimulates optimal bone remodelling and restores the bone's capacity to withstand the demands of activity.
Conservative fracture rehabilitation
Many fractures — particularly stable upper limb fractures, hand and wrist fractures, rib fractures, and stress fractures — are managed without surgery, using a period of splinting, casting or activity restriction followed by progressive rehabilitation.
Stress fractures — fatigue injuries of bone from repetitive loading exceeding the bone's adaptive capacity — are a particularly common presentation in runners and military recruits. Management centres on load reduction to allow bony healing, followed by a carefully graduated return-to-load program that progressively rebuilds the bone's capacity. Rushing the return-to-running program after a stress fracture is the most common cause of recurrence and progression to complete fracture.
Rib fractures — from direct trauma or repetitive coughing — are painful and limit breathing depth. Physiotherapy focuses on breathing techniques, pain management positioning and progressive mobilisation. Deep breathing exercises are critical to prevent the pneumonia risk that develops when pain inhibits normal breathing mechanics.
Post-surgical fracture rehabilitation
For fractures requiring surgical fixation — including pelvic fracture fixation, neck of femur fracture fixation, scaphoid fracture fixation, clavicle ORIF, proximal humerus ORIF, and fixations following fracture — physiotherapy begins as early as the surgeon permits and follows a structured progression from acute management through to full functional return.
The early phase focuses on swelling management, gentle movement within the limits of the fixation, and maintaining strength in adjacent muscle groups that can be safely exercised without stressing the repair. Isometric exercises maintain muscle engagement without stressing the fracture.
The intermediate phase introduces progressive weight-bearing for lower limb fractures and active strengthening for upper limb fractures as the fixation consolidates. Gait retraining and normalisation of movement patterns that have been disrupted by pain, swelling and protected weight-bearing are critical during this phase.
The late phase focuses on sport and function-specific rehabilitation — restoring the specific demands of the patient's activity goals through objective testing of strength, power and movement quality rather than symptom resolution alone.
Real time ultrasound assists in retraining deep stabilising muscle activation where pain and surgery have disrupted normal neuromuscular patterns. Clinical Pilates provides a controlled low-impact environment for progressive strengthening during the intermediate rehabilitation phase. Dry needling addresses pain and muscle guarding in the surrounding musculature.
For patients whose fracture occurred in a workplace accident or motor vehicle incident, WorkCover and CTP funded physiotherapy and capacity assessment is available.
Our physiotherapists Eliane Machado, Bethany Kippen and Emma Cameron all have experience in fracture rehabilitation across upper and lower limb regions and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
A fracture — a break in the continuity of a bone — is one of the most common injuries presenting to physiotherapy. Fractures range from hairline stress fractures that require only load management to complex multi-fragment fractures requiring surgical fixation and months of structured rehabilitation. What they share is that healing the bone is only the beginning of recovery — restoring the strength, movement, proprioception and functional capacity of the injured limb requires specific, progressive rehabilitation that bone healing alone cannot achieve.
Fracture rehabilitation broadly divides into two pathways: conservative management for fractures that do not require surgery, and post-surgical rehabilitation following open reduction and internal fixation (ORIF), where metal hardware — plates, screws, rods or nails — is used to hold fracture fragments in position while healing occurs. The rehabilitation principles overlap but the timelines, precautions and specific interventions differ considerably.
Why does rehabilitation matter after a fracture?
Several consequences of fracture and its treatment create specific rehabilitation needs that do not resolve spontaneously with rest.
Muscle atrophy develops rapidly during immobilisation — research shows measurable muscle wasting within days of immobilisation, and significant atrophy within weeks. The muscles surrounding the fracture site are most affected, but disuse of the entire limb contributes to broader weakness that affects function well beyond the fracture itself.
Joint stiffness from capsular contraction, cartilage changes and soft tissue shortening develops during immobilisation and becomes progressively harder to reverse the longer it persists. Early, guided range-of-motion work — within the limits set by the fracture stability and surgical fixation — prevents stiffness from becoming established.
Proprioceptive deficits — impaired joint position sense — develop following both the injury and the immobilisation, significantly increasing re-injury risk on return to activity. This is particularly relevant for lower limb fractures where single-leg stability is required for walking, stairs and sport.
Bone remodelling requires progressive mechanical loading — the Wolff's law principle that bone adapts its structure in response to the mechanical loads placed on it. Physiotherapy-guided progressive loading during fracture rehabilitation stimulates optimal bone remodelling and restores the bone's capacity to withstand the demands of activity.
Conservative fracture rehabilitation
Many fractures — particularly stable upper limb fractures, hand and wrist fractures, rib fractures, and stress fractures — are managed without surgery, using a period of splinting, casting or activity restriction followed by progressive rehabilitation.
Stress fractures — fatigue injuries of bone from repetitive loading exceeding the bone's adaptive capacity — are a particularly common presentation in runners and military recruits. Management centres on load reduction to allow bony healing, followed by a carefully graduated return-to-load program that progressively rebuilds the bone's capacity. Rushing the return-to-running program after a stress fracture is the most common cause of recurrence and progression to complete fracture.
Rib fractures — from direct trauma or repetitive coughing — are painful and limit breathing depth. Physiotherapy focuses on breathing techniques, pain management positioning and progressive mobilisation. Deep breathing exercises are critical to prevent the pneumonia risk that develops when pain inhibits normal breathing mechanics.
Post-surgical fracture rehabilitation
For fractures requiring surgical fixation — including pelvic fracture fixation, neck of femur fracture fixation, scaphoid fracture fixation, clavicle ORIF, proximal humerus ORIF, and fixations following fracture — physiotherapy begins as early as the surgeon permits and follows a structured progression from acute management through to full functional return.
The early phase focuses on swelling management, gentle movement within the limits of the fixation, and maintaining strength in adjacent muscle groups that can be safely exercised without stressing the repair. Isometric exercises maintain muscle engagement without stressing the fracture.
The intermediate phase introduces progressive weight-bearing for lower limb fractures and active strengthening for upper limb fractures as the fixation consolidates. Gait retraining and normalisation of movement patterns that have been disrupted by pain, swelling and protected weight-bearing are critical during this phase.
The late phase focuses on sport and function-specific rehabilitation — restoring the specific demands of the patient's activity goals through objective testing of strength, power and movement quality rather than symptom resolution alone.
Real time ultrasound assists in retraining deep stabilising muscle activation where pain and surgery have disrupted normal neuromuscular patterns. Clinical Pilates provides a controlled low-impact environment for progressive strengthening during the intermediate rehabilitation phase. Dry needling addresses pain and muscle guarding in the surrounding musculature.
For patients whose fracture occurred in a workplace accident or motor vehicle incident, WorkCover and CTP funded physiotherapy and capacity assessment is available.
Our physiotherapists Eliane Machado, Bethany Kippen and Emma Cameron all have experience in fracture rehabilitation across upper and lower limb regions and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
