Physical Therapy for Fracture Rehabilitation: Symptoms, Types, and Treatment Plans

Fractures are common injuries that can occur due to trauma, falls, accidents, or even as a result of weakened bones from conditions like osteoporosis. Regardless of the cause, fractures can significantly disrupt daily life, causing pain, immobility, and a need for extensive rehabilitation. Physical therapy plays a crucial role in recovery, helping patients regain strength, mobility, and function. While we can conservatively treat certain types of fractures at EW Motion Therapy, even if your fracture requires surgery, your therapist will help you prepare for surgery and recover after - we are with you every step of the way. If this sounds like the right treatment plan for you, read on as we explore the most common fracture symptoms, the types of fractures physical therapists can treat, and the elements of a typical treatment plan to help guide you on your path to recovery.

Common symptoms of fractures

Recognizing the symptoms of a fracture is essential for seeking timely medical attention. While some fractures are immediately apparent, others may present more subtly. Here are the most common symptoms associated with fractures:

1. Intense/localized pain: The most immediate and noticeable symptom of a fracture is pain. This pain is often severe and sharp and exacerbated by movement or pressure at the injury site. 
2. Swelling and bruising: Swelling usually occurs around the fractured area due to inflammation and fluid buildup. Bruising may also be present, indicating internal bleeding from damaged blood vessels around the broken bone.
3. Deformity or misalignment: In some cases, the injured limb or area may look visibly deformed or out of alignment. This is especially common in fractures of the arms and legs, where the broken ends of the bone may shift out of place.
4. Inability to bear weight or move the limb: A fractured bone often makes it extremely painful or impossible to use the affected area. For instance, a person with a leg fracture may be unable to bear weight on that leg, while someone with an arm fracture may find it difficult to lift or move the arm.
5. Numbness or tingling: In some instances, nerve damage may occur near the fracture, leading to sensations of numbness, tingling, or weakness in the affected area.
6. Crepitus: A grating sensation or sound, known as crepitus, may be felt or heard when the broken ends of the bone rub against each other.

If you suspect you have a fracture, you must seek medical attention immediately. Proper diagnosis and treatment are critical to ensuring the bone heals correctly and to avoiding complications that could prolong recovery.

Conservative rehabilitation vs. surgery for fractures: how to choose

Deciding between a conservative approach and surgical intervention for fracture rehabilitation depends on several factors, including the type, location, and severity of the fracture, as well as the patient's overall health and lifestyle needs. Understanding when a conservative approach can be sufficient and when surgery becomes necessary is crucial for effective treatment and recovery.

When conservative rehabilitation is sufficient

A conservative approach, typically involving immobilization with a cast, brace, or splint, followed by physical therapy, can be effective for many fractures. This method allows the bone to heal naturally without the need for surgical intervention. Here are some scenarios where conservative treatment is usually sufficient:

1. Stable fractures: Stable fractures occur when the broken bone ends are correctly aligned and remain in place. These fractures are often the result of low-impact injuries, and the bones can heal effectively with immobilization alone. Examples include hairline fractures or small cracks that don't significantly disrupt the bone's alignment.
2. Non-displaced fractures: In non-displaced fractures, the bone breaks but maintains its proper alignment and position. Since the bone ends are already aligned, a cast or brace is typically enough to hold the bone steady while it heals. Once the bone has sufficiently healed, physical therapy can help restore movement and strength.
3. Fractures in areas with good blood supply: Bones with a good blood supply, such as the forearm or leg, tend to heal well on their own because blood delivers the necessary nutrients and cells to promote healing. As long as these fractures are stable and non-displaced, conservative treatment can be very effective.
4. Stress fractures: Stress fractures, often caused by repetitive strain or overuse, can frequently be managed conservatively. Rest, activity modification, physical therapy focusing on biomechanical corrections, and strength training are usually enough to promote healing.
5. Fractures in children: Children's bones are more pliable and have a remarkable ability to heal, often allowing for a conservative approach even with fractures that might require surgery in adults. Greenstick fractures, where the bone bends and partially breaks, are common in children and usually heal well with casting.

When surgery is necessary

While conservative treatment can be effective for many fractures, there are situations where surgery is the best or only option. Surgery may be required to properly align the bones, ensure stability, or address complications that could hinder natural healing. Here are common scenarios where surgery is necessary:

1. Displaced fractures: When the bone ends are not aligned, surgery is often required to realign and secure the bones. This is known as reduction, and it may be followed by the use of metal plates, screws, or rods to maintain stability while the bone heals.
2. Comminuted fractures: In comminuted fractures, the bone is shattered into several pieces, making it difficult for the body to heal the bone without surgical intervention. Surgery allows the surgeon to piece the fragments together and stabilize them with hardware.
3. Open (compound) fractures: Open fractures, where the bone pierces the skin, pose a significant risk of infection and require immediate surgical intervention. The surgery involves cleaning the wound, aligning the bone, and stabilizing it to prevent further damage and infection.
4. Fractures in areas with poor blood supply: Bones with limited blood supply, such as the scaphoid bone in the wrist or the head of the femur, may not heal well without surgical intervention. Poor blood supply can impede the natural healing process, making surgery necessary to ensure proper healing and prevent long-term complications like avascular necrosis (bone tissue death due to lack of blood supply).
5. Joint involvement: Fractures that extend into a joint can disrupt its smooth surface, leading to long-term issues like arthritis if not properly addressed. Surgery can help restore the joint's anatomy and function, preventing long-term damage.
6. Failure of conservative treatment: In some cases, conservative treatment may initially be attempted but does not result in adequate healing. If a fracture fails to heal (nonunion) or heals improperly (malunion), surgery may be required to correct the alignment and promote proper healing.

Deciding between a conservative approach and surgery for fracture rehabilitation involves careful evaluation by medical professionals, including orthopedic surgeons and physical therapists. The choice depends on the specific characteristics of the fracture, the patient's overall health, and the potential for optimal healing without surgical intervention. Whether through conservative care or surgery, the goal is always to achieve a full recovery, allowing you to return to your daily activities safely and confidently.

Types of fractures physical therapists can treat

Physical therapists play a vital role in the rehabilitation process following many types of fractures. The specific approach to therapy may vary based on the fracture's location, severity, and the patient’s overall health. During a physical therapy evaluation, a fracture is typically one of the injuries a therapist will try to rule out because some diagnoses, like compression fractures, are more challenging for a physical therapist to treat. However, there are some common types of fractures that physical therapists often help treat.

1. Simple (closed) fractures: These fractures occur when the bone breaks but does not pierce the skin. Physical therapy can help restore mobility and strength after the bone has been set and stabilized.
2. Compound (open) fractures: In these fractures, the broken bone pierces the skin, increasing the risk of infection. Physical therapy can help with rehabilitation, which often involves managing wound care in conjunction with mobility restoration. 
3. Stress fractures: Often caused by repetitive stress or overuse, these small cracks in the bone are common in athletes. Physical therapy focuses on activity modification, strengthening, and addressing biomechanical issues to prevent recurrence.
4. Comminuted fractures: These involve the bone breaking into several pieces and typically require surgical intervention. Post-surgical physical therapy is crucial for restoring function and minimizing stiffness.
5. Greenstick fractures: Common in children, these fractures occur when the bone bends and partially breaks. Therapy can help children regain full range of motion and strength without stressing the healing bone.
6. Compression fractures: Often occurring in the spine, these fractures are usually caused by osteoporosis or trauma. Physical therapy can help alleviate pain, improve posture, and strengthen supporting muscles.
7. Displaced fractures: In these fractures, the bone fragments are not aligned properly. After surgical correction or casting, therapy focuses on regaining alignment and function through targeted exercises.

Physical therapists are trained to treat patients with a spectrum of fracture types, customizing treatment plans to meet individual needs and goals.

Elements of a typical fracture rehabilitation treatment plan

Physical therapy for fractures is tailored to each patient’s specific needs, taking into account the type of fracture, location, patient age, overall health, and activity level. However, there are common elements that typically form the foundation of most fracture rehabilitation plans:

Initial assessment and goal-setting

The rehabilitation process begins with a thorough assessment of the patient’s condition, including a review of medical history, the specifics of the fracture, and any surgical interventions. The physical therapist will evaluate the range of motion, strength, pain levels, and functional limitations to establish a baseline. From here, realistic short-term and long-term goals are set, such as reducing pain, increasing range of motion, and restoring function.

Pain management

Managing pain is a crucial aspect of the initial stages of rehabilitation. Physical therapists may use various techniques to help alleviate pain, including:

• Ice or heat therapy: Applying ice in the early stages can reduce swelling and pain, while heat can be useful later to relax muscles and improve blood flow.
• Electrical stimulation: Techniques like TENS (Transcutaneous Electrical Nerve Stimulation) can help reduce pain and improve muscle function.
• Manual therapy: Gentle hands-on techniques can help alleviate pain, improve circulation, and reduce muscle tension around the injury site.

Restoring range of motion

After the initial healing phase, which may involve immobilization with a cast or brace, the focus shifts to restoring the range of motion in the affected joint or limb. This phase involves:

• Gentle stretching: Targeted stretches help to slowly and safely improve flexibility and movement in the affected area.
• Joint mobilizations: These manual techniques performed by the therapist help improve joint movement and reduce stiffness.

Strengthening exercises

Strengthening the muscles surrounding the fracture site is essential for supporting the healing bone and preventing future injuries. A physical therapist will guide patients through:

• Isometric exercises: These exercises involve muscle contractions without movement, providing a safe way to begin strengthening without stressing the healing bone.
• Progressive resistance training: As healing progresses, resistance exercises using weights, resistance bands, or body weight are introduced to build strength and endurance.

Functional training

Functional training is a key component of rehabilitation. It focuses on exercises that mimic everyday activities or specific movements relevant to the patient's lifestyle or sport. This phase aims to help patients return to their daily routines safely and confidently, whether it involves walking, lifting, or returning to sports.

Education and injury prevention

An often overlooked but critical element of rehabilitation is patient education. Physical therapists provide guidance on:

• Proper body mechanics: Teaching patients how to move safely and efficiently to avoid placing undue stress on the healing bone.
• Home exercise programs: Therapists will prescribe exercises that patients can continue at home to maintain progress between therapy sessions.
• Preventive strategies: This includes advice on fall prevention, proper footwear, or activity modifications to reduce the risk of future fractures.

Fractures can be a significant setback, but with the right rehabilitation approach, patients can regain their strength, mobility, and independence. Physical therapy is vital in this journey, providing individualized care that addresses pain, restores function, and helps prevent future injuries. Whether dealing with a simple fracture or a more complex break, working with a skilled physical therapist can make all the difference in achieving a successful recovery. If you or a loved one has experienced a fracture, consider reaching out to a physical therapist to explore how they can support your rehabilitation process and get you back to doing the activities you love. We consider it a privilege to help our clients with fractures at EW Motion Therapy heal efficiently and return to their favorite activities. If you’re curious about what physical therapy might cost you, click the button below to download our free pricing guide.