Physiotherapy After Fracture: When to Start and How to Regain Strength & Mobility
The short version
- Rehabilitation usually starts long before the cast comes off. The joints above and below the injury, the other limb and the rest of the body all need to keep moving from the first week.
- "Wait until the plaster is removed" is the expensive mistake. Six weeks of total stillness produces stiffness and muscle wasting that then take months to undo — a second problem, caused by the recovery rather than the break.
- After a hip fracture the standard is the next day. NICE recommends a physiotherapy assessment and mobilisation on the day after surgery, then mobilisation at least once a day with regular review.1
- Know your weight-bearing status, in the surgeon's words. Non-weight-bearing, partial, or as tolerated — this single instruction decides what is safe, and guessing it is how fixations fail.
- Stiffness and swelling are treatable, not inevitable. Elevation, early controlled movement and a proper programme prevent most of what people accept as "it will always be like this now".
- Bone healing and function are two different timelines. A fracture can be united on X-ray while the limb is still weak, stiff and unusable. Union is the start of rehabilitation, not the end.
In most Indian families a fracture is treated as a waiting problem. Cast goes on, six weeks pass, cast comes off, and only then does anyone mention physiotherapy — usually because the limb has come out thin, stiff and frightening to move. By that point the patient is not recovering from a fracture. They are recovering from a fracture and six weeks of disuse. This page is about not letting that happen.
When should physiotherapy start after a fracture?
Usually within days, not after the cast comes off. The fractured segment is protected while it heals, but everything else — the joints above and below, the opposite limb, the trunk, general conditioning — should keep working from the start. What is safe for the fractured part itself depends entirely on the fracture, the fixation and your surgeon's instructions.
The clearest published example is hip fracture. NICE recommends offering a physiotherapy assessment and mobilisation on the day after surgery, unless medically or surgically contraindicated, and then mobilisation at least once a day with regular physiotherapy review.1 Not after a week of bed rest. The next day.
Even in the system that publishes that standard, it is not universally achieved: a UK audit found around 73% of hip fracture patients were actually mobilised out of bed the day after surgery.2 The gap between what is recommended and what happens is not unique to India — but it is worth knowing, because it means "nobody came" is a thing to chase rather than to accept.
Early movement is not the same as early loading
Starting early does not mean putting weight through a healing bone or forcing a stiff joint. It means moving what is safe to move, keeping circulation going, preventing the unaffected parts from wasting, and protecting the fracture while it does its job. The distinction between movement and load is the whole skill, and it is why the programme comes from a physiotherapist working to the surgeon's instructions rather than from a video.
Weight-bearing status: the instruction you must not guess
Before any leg, hip, ankle or foot fracture rehabilitation begins, one question has to be answered in writing: how much weight is this person allowed to put through the limb, and for how long? Every exercise, every transfer and every walking aid choice follows from that answer.
| Status | What it means in practice | What it usually requires |
|---|---|---|
| Non-weight-bearing (NWB) | The foot does not touch the ground at all, including for balance | Walker or crutches with good upper body strength; often a wheelchair for distance |
| Toe-touch or touch-down | The toes may rest on the floor for balance only, taking almost no weight | Walker or crutches; the classic instruction people misunderstand as "some walking is fine" |
| Partial weight-bearing (PWB) | A specified proportion of body weight, often given as a percentage or in kilograms | Walker or crutches, and practice with a weighing scale so the patient learns what it feels like |
| Weight-bearing as tolerated (WBAT) | As much as comfort allows, increasing gradually | Aid used as needed, reducing over time |
| Full weight-bearing (FWB) | Normal weight through the limb | Aid may still be used for confidence and balance early on |
Two rules families get wrong
First, partial weight-bearing is a measured amount, not "walk a little". Most people asked to put 20 kg through a leg will put far more, which is why physiotherapists teach it against a bathroom scale. Second, the status changes over time — it is reviewed at follow-up appointments, and continuing a restriction longer than necessary causes its own stiffness and weakness. Ask at every visit whether it has changed.
Not sure what is safe to do yet?
An assessment translates the surgeon's instructions into a daily programme — what to move, what to protect, and what to build next. Healthy Jeena Sikho arranges fracture rehabilitation at home across Chandigarh, Mohali, Panchkula and Kharar.
How recovery works, stage by stage
Fracture rehabilitation runs in four broad phases: protect and maintain, restore movement, rebuild strength, and return to function. The timings depend entirely on the bone, the fixation and the person, but the sequence does not change — and skipping a phase is what produces the limb that is strong but stiff, or moving but too weak to use.
Phase 1 — Protect and maintain
Goal: protect the fracture while losing as little as possible everywhere else.
- Move the joints above and below the injury as permitted — fingers and shoulder for a wrist fracture, hip and toes for a leg fracture.
- Elevation and swelling control, because swelling drives stiffness more than most people realise.
- Static muscle contractions inside the cast where allowed, to slow muscle loss.
- Keep the rest of the body working — the other limb, the trunk, general activity.
- Walking aid training with the correct weight-bearing status.
- Clot prevention as prescribed, and watching for a hot, swollen, painful calf.4
Phase 2 — Restore movement
Goal: get the range back, before strength work can be meaningful.
- Usually begins once the cast or splint is removed, or earlier if the fixation allows protected movement.
- Gentle active movement first, progressing as the joint tolerates. Expect stiffness and expect it to improve.
- Scar and soft-tissue work where there has been surgery, once the wound is fully healed.
- Continued swelling management, which often flares when movement increases.
- Pain that eases within an hour of exercise is acceptable; pain that lasts into the next day means too much.
Phase 3 — Rebuild strength
Goal: turn a moving limb into a usable one.
- Progressive resistance work, increasing gradually as healing allows.
- Weight-bearing progression for lower limb fractures, in line with the surgeon's current instruction.
- Balance and proprioception — the sense of where the limb is, which is reliably lost and rarely trained.
- Gait retraining, because limping patterns adopted during protection become habits.
- Endurance, since weeks of reduced activity cost general fitness too.
Phase 4 — Return to function
Goal: back to work, stairs, squatting, driving, sport — whatever the person actually needs.
- Task-specific practice of the real demands: stairs, Indian-style toilet, carrying, climbing on and off a scooter.
- Higher-load and impact work where the goal requires it, reintroduced in stages.
- Return-to-work and return-to-driving decisions, which depend on the limb and the job, not on the calendar.
- A maintenance programme, because strength gained is lost if the work stops abruptly.
Indicative only. The timing of each phase depends on the bone, the type of fracture, the fixation used, age, bone quality and other conditions. Your surgeon's instructions take precedence.
How it differs by fracture site
The principles are the same everywhere; the priorities are not. A wrist fracture is mostly a stiffness problem, a hip fracture is mostly a mobility and independence problem, and an ankle fracture is mostly a weight-bearing and balance problem. Open fractures, and pelvic and spinal injuries, are managed as complex fractures and follow separate specialist pathways.5
| Site | Main risk if rehabilitation is delayed | Early priorities |
|---|---|---|
| Wrist and forearm | Stiff fingers and a frozen shoulder from wearing a sling and not moving the arm | Finger, elbow and shoulder movement from day one; elevation; grip work once permitted |
| Hip | Loss of independence, chest infection, pressure injury, clots, and never walking again | Assessment and mobilisation the day after surgery, then at least daily1 |
| Ankle and foot | Persistent swelling, stiffness and poor balance leading to repeat injury | Strict weight-bearing status, elevation, toe and knee movement, later balance work |
| Shoulder and humerus | Frozen shoulder, which is often harder to treat than the original fracture | Elbow, wrist and hand movement immediately; pendular shoulder movement when allowed |
| Knee and tibia | Knee stiffness and quadriceps wasting that limits standing from a chair | Static quadriceps work, knee range as permitted, careful weight-bearing progression |
| Spine | Deconditioning, and pain patterns that persist after healing | Brace and movement rules from the surgeon, posture, safe log-rolling, graded activity |
| Rib | Chest infection from shallow breathing and suppressed coughing | Breathing exercises and supported coughing, pain control good enough to allow both |
| Fragility fractures in older adults | A second fracture, often within a year | Rehabilitation plus bone health assessment and falls prevention alongside |
For an older adult after a hip fracture, the home setup and the first weeks are covered in home care after hospital discharge, and the equipment checklist in the post-surgery equipment checklist. Bathroom changes are in the bathroom safety guide.
Stiffness, swelling and wasting: the second injury
Most of what people struggle with three months after a fracture is not the bone. It is joint stiffness, persistent swelling, muscle wasting and lost balance — all consequences of protection rather than of the break, and all substantially preventable.
| Problem | Why it develops | What reduces it |
|---|---|---|
| Joint stiffness | A joint held still shortens the surrounding tissue; swelling accelerates it | Move everything that is allowed to move, from the first week, every day |
| Persistent swelling | Injury and immobility both reduce the drainage that normally clears fluid | Elevation above heart level, muscle pumping movements, compression where advised |
| Muscle wasting | Muscle is lost quickly with disuse, and quadriceps particularly fast | Static contractions inside the cast, work on the rest of the body, early progressive strengthening |
| Lost balance and position sense | The joint's position sensors are disrupted by injury and disuse | Specific balance training, which is commonly skipped and is why people re-injure |
| Limping that outlasts the fracture | A protective walking pattern becomes a habit and loads other joints | Gait retraining once weight-bearing allows, rather than assuming it corrects itself |
| Frozen shoulder after an arm injury | Weeks in a sling with the shoulder never moved | Moving the shoulder and elbow from the start, within whatever the surgeon permits |
| Fear of using the limb | Entirely normal after a painful injury, and it silently limits everything | Graded, supervised loading so confidence is rebuilt with evidence rather than reassurance |
What the family and patient can do daily
- Elevate the limb above heart level for periods through the day, particularly in the first weeks.
- Move every joint that is free to move, several times a day, without waiting to be told again.
- Do the static muscle contractions inside the cast if the physiotherapist has taught them.
- Keep the rest of the body active — the good limb, the trunk, general movement.
- Use the aid exactly as instructed, including the number of points of contact and which side.
- Watch for increasing pain, numbness, tingling or colour change, and report it the same day.
- Keep the plaster dry and never push anything inside it to scratch.
- Eat properly. Healing needs protein and general nutrition, and appetite often drops after injury.
Bone healing and functional recovery are two clocks
Families usually track one date: when the X-ray shows union. But a united fracture and a working limb are different achievements. Union means the bone will take load. Function means the muscles, joints, balance and confidence around it have caught up, and that typically takes considerably longer.
| Milestone | What it actually means |
|---|---|
| Cast or splint removed | The fracture no longer needs external protection. The joint is usually at its stiffest on this day, which is normal and not a setback |
| X-ray shows union | The bone has healed enough to take load. It does not mean the limb is strong, and it does not mean rehabilitation is finished |
| Full weight-bearing allowed | Permission to load, not an ability to walk normally. Gait usually still needs retraining |
| Range of movement restored | The joint moves. Strength work can now be meaningful |
| Strength restored | Usually the longest phase, and the one most often abandoned early because the limb "looks fine" |
| Back to full activity | Depends on the demand — a desk job, a construction job and a sport are three different finish lines |
This is why "the doctor said it has healed, so why is he still limping?" is such a common question three months in. Nothing has gone wrong. The bone finished first, and the rest of the limb was never given the work it needed to catch up.
Equipment that supports fracture recovery
For upper limb fractures, very little is needed. For lower limb and hip fractures, the setup decides whether the person can get to the toilet safely — and in Indian homes, the bathroom is the problem, not the bedroom.
Walker or crutches
Chosen by the physiotherapist to match the weight-bearing status and the patient's upper body strength.
Wheelchair
For distance and for follow-up visits during non-weight-bearing periods, so the patient still leaves the house.
Commode chair
Indian-style toilets are unusable after most lower limb fractures. This is usually the first real crisis at home.
Raised seating and grab bars
Getting up from a low chair or bed is the movement that most often exceeds the weight-bearing limit by accident.
Adjustable bed
For hip and spine fractures, and for anyone who cannot get in and out of an ordinary bed safely.
Shower chair and non-slip mat
The bathroom is the highest-risk room in the house during any fracture recovery.
Most of this is needed for weeks rather than years, which makes rental the sensible option — the requirement shrinks as weight-bearing progresses. The full range is in the post-surgery equipment checklist.
When to stop and call a doctor
Seek urgent medical care for any of these
- Severe or rapidly increasing pain that is not controlled by prescribed medication, especially with a tight, swollen limb.
- Numbness, pins and needles, or loss of movement in the fingers or toes beyond the cast.
- Fingers or toes that are pale, blue, cold or very swollen.
- Pain, swelling, warmth or redness in one calf, or sudden breathlessness or chest pain.4
- Fever, or a surgical wound that is red, discharging, smelling or opening.3
- A cast that becomes too tight, too loose, cracked or wet through.
- A sudden change in the shape of the limb, or a snap or give during activity.
- Burning pain, extreme sensitivity to touch, and colour or sweating changes in the limb, which can indicate a pain condition needing early treatment.
- Another fall, particularly in an older adult or someone on blood thinners.
Aching after exercise that settles within an hour or so is expected. Pain that is worse the next day means the last session was too much and the programme needs adjusting — not that you should push harder.
Myths worth dropping
| Commonly believed | Verdict | What is actually the case |
|---|---|---|
| "Start physiotherapy after the cast comes off" | Myth | Rehabilitation of the rest of the limb and body starts far earlier. What waits is loading the fracture itself. |
| "Complete rest helps bone heal faster" | Myth | The fracture is protected, not the whole person. Total rest causes stiffness, wasting, clots and deconditioning. |
| "Massage the fracture site with oil to heal it" | Harmful | Massaging over a healing fracture or a fresh surgical wound can cause harm. Any soft-tissue work is done by a physiotherapist, after healing, on their instruction. |
| "If it hurts, it must be damaging" | Partly | Some discomfort during controlled rehabilitation is expected. Pain that persists into the next day is the signal to adjust, and sudden severe pain always needs review. |
| "The X-ray is normal, so recovery is complete" | Myth | Union means the bone can take load. Strength, movement and balance are separate and usually lag behind by months. |
| "Partial weight-bearing just means walk carefully" | Harmful | It is a measured amount, often a specific number of kilograms, and most people exceed it badly without training. |
| "Calcium tablets are the main thing" | Partly | Nutrition matters and bone health should be assessed after a fragility fracture, but supplements do not restore strength, range or balance. Movement does. |
| "Older patients cannot rehabilitate" | Myth | Age is a reason to start sooner, not to give up. Guidance for hip fracture assumes rehabilitation aimed at returning to pre-fracture residence and independence.1 |
Fracture rehabilitation at home with Healthy Jeena Sikho
- We work from your surgeon's instructions. Weight-bearing status, movement restrictions and timelines come from the treating team; the programme is built around them, not around a generic protocol.
- Assessment before any exercise. What is safe to move now, what must be protected, and what the next progression looks like — written down, with a review date.
- Partial weight-bearing taught properly. Practised against a scale so the patient actually knows what the limit feels like, rather than guessing at it.
- Sessions at home, on your own stairs and bathroom. The obstacles that matter are in your house, not in a clinic.
- Equipment arranged alongside. Walker, crutches, wheelchair, commode chair and adjustable bed on rental, stepped down as weight-bearing progresses.
- Across Chandigarh, Mohali, Panchkula and Kharar, with a physiotherapy centre in Sector 71, Mohali for when travelling becomes practical.
- Trusted since 2015. ISO 9001:2015 certified home healthcare, operating across North India.
Related guides: post-surgery equipment checklist, home care after hospital discharge, joint replacement recovery at home, bathroom safety after surgery or stroke and the recovering at home hub. Equipment is on the hospital bed on rent and mobility aids pages.
Fracture rehabilitation at home across Chandigarh, Mohali, Panchkula and Kharar. Call +91 98769 78488 or WhatsApp +91 98759 15278.
Frequently Asked Questions About Physiotherapy After Fracture
When should physiotherapy start after a fracture?
Usually within days rather than after the cast comes off. The fracture itself is protected, but the joints above and below, the opposite limb and general conditioning should keep working from the start. After a hip fracture, NICE recommends a physiotherapy assessment and mobilisation on the day after surgery unless contraindicated, then mobilisation at least once a day with regular review.
Can I do physiotherapy while still in a cast?
Usually yes, for everything outside the cast. That typically means moving the fingers, elbow and shoulder for an arm fracture, or the hip and toes for a leg fracture, plus static muscle contractions inside the cast where the physiotherapist has taught them, elevation for swelling, and general activity. What is permitted for the fractured segment itself depends on the fracture and fixation, and comes from your surgeon.
What does partial weight-bearing actually mean?
A specified proportion of body weight through the limb, often given as a percentage or in kilograms — not "walk a little". Most people asked to put a set weight through a leg substantially exceed it, which is why physiotherapists teach it using a bathroom scale so the patient learns what the limit feels like. The status is reviewed at follow-up and changes over time, so ask at every visit whether it still applies.
Why is my joint so stiff after the cast is removed?
Because a joint held still for weeks shortens the tissue around it, and swelling accelerates the process. The day the cast comes off is usually the stiffest the joint will be, which is normal rather than a setback. Most of that stiffness responds to graded movement, and much of it is preventable by moving everything that was free to move during the immobilisation period.
My X-ray shows the fracture has healed, so why am I still weak?
Bone healing and functional recovery are two different timelines. Union means the bone can take load; it says nothing about muscle strength, joint range, balance or confidence, all of which are lost during protection and have to be rebuilt deliberately. This is the point at which rehabilitation should intensify, not stop.
How long does fracture rehabilitation take?
It depends on the bone, the type of fracture, the fixation, age, bone quality and what the person needs to return to. As a general shape, protection and maintenance come first, then restoring movement, then rebuilding strength — which is usually the longest phase — and then returning to full function. Strength work is the phase most often abandoned early because the limb looks normal.
Should I massage the fracture site with oil?
No. Massaging over a healing fracture or a fresh surgical wound can cause harm, and nothing should be applied to a wound that is not fully healed. Soft-tissue and scar work has a place in fracture rehabilitation, but it is done by a physiotherapist after healing and on their instruction, not as a home remedy during the healing phase.
Is some pain during fracture physiotherapy normal?
Discomfort during and shortly after controlled exercise is expected, and it should settle within about an hour. Pain that is still worse the next day means the last session was too much and the programme needs adjusting. Severe or rapidly increasing pain, particularly with a tight swollen limb, numbness or colour change in the fingers or toes, needs urgent medical review rather than perseverance.
Why did I develop a frozen shoulder after a wrist fracture?
Usually because the arm was kept in a sling and the shoulder was never moved. The wrist was protected correctly and the shoulder was accidentally immobilised alongside it. Moving the shoulder and elbow from the start, within whatever the surgeon permits, prevents most of this, and it is one of the clearest reasons early physiotherapy matters even for a straightforward fracture.
What equipment is needed at home after a leg or hip fracture?
Typically a walker or crutches matched to the weight-bearing status, a commode chair since Indian-style toilets are unusable, raised seating and grab bars, a wheelchair for distance during non-weight-bearing periods, and an adjustable bed for hip and spine fractures. Most of it is needed for weeks rather than years, which makes rental sensible as the requirement shrinks.
Can older adults recover well after a hip fracture?
Age is a reason to start rehabilitation sooner, not to abandon it. Guidance for hip fracture assumes a multidisciplinary programme with early identification of goals aimed at recovering mobility and independence and returning to the pre-fracture residence, with mobilisation from the day after surgery. Delay is what causes the worst outcomes, not age by itself.
Do you provide fracture physiotherapy at home in the Tricity?
Yes. Healthy Jeena Sikho provides fracture rehabilitation at home across Chandigarh, Mohali, Panchkula and Kharar, working to your surgeon's weight-bearing and movement instructions, with a physiotherapy centre in Sector 71, Mohali for when travelling becomes practical. Walkers, crutches, wheelchairs, commode chairs and adjustable beds can be arranged alongside on rental. Call +91 98769 78488 or message +91 98759 15278 on WhatsApp.
References and further reading
- National Institute for Health and Care Excellence. Hip fracture: management — Recommendations , NICE clinical guideline CG124 — including recommendation 1.7.1 (offer a physiotherapy assessment and, unless medically or surgically contraindicated, mobilisation on the day after surgery), 1.7.2 (offer mobilisation at least once a day and ensure regular physiotherapy review) and 1.8.1 (a multidisciplinary Hip Fracture Programme with early identification of goals to recover mobility and independence and facilitate return to pre-fracture residence).
- National Institute for Health and Care Excellence. 2019 surveillance of hip fracture: management (CG124) — reporting that the proportion of people with hip fracture mobilised out of bed the day after surgery was 73.3% in 2018.
- National Institute for Health and Care Excellence. Fractures (non-complex): assessment and management , NICE guideline NG38.
- National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism , NICE guideline NG89.
- National Institute for Health and Care Excellence. Fractures (complex): assessment and management , NICE guideline NG37.
Reviewed by Dr. Ashnoor Kaur, Physiotherapist, Healthy Jeena Sikho.
Medical disclaimer. This page is general educational information about rehabilitation after a fracture. It is not medical advice and does not replace assessment by a qualified doctor, orthopaedic surgeon or physiotherapist. No specific exercise programme is prescribed here deliberately, because what is safe depends on the bone, the type of fracture, the fixation used, bone quality and the surgeon's instructions. Weight-bearing status, movement restrictions, the timing of cast or splint removal, and clearance to drive, return to work or resume sport must all be determined by your treating team, and their instructions take precedence over anything on this page. Do not begin, change or intensify a programme, do not load a limb beyond the permitted weight-bearing status, and do not apply oil, turmeric or any other substance to a healing fracture site or surgical wound. Timelines given here are indicative only and vary widely. Seek urgent medical care for severe or rapidly increasing pain, a tight swollen limb, numbness, tingling or loss of movement in the fingers or toes, fingers or toes that are pale, blue or cold, pain or swelling in one calf, sudden breathlessness or chest pain, fever, a wound that is red, discharging or opening, a cast that becomes too tight, loose, cracked or wet, or a sudden change in the shape of the limb. Healthy Jeena Sikho arranges physiotherapy, nursing and attendant services and supplies home medical equipment, and does not diagnose conditions or independently set clinical parameters.