Post-Fracture Rehabilitation

A fracture that has healed radiologically is not a fracture that has fully recovered. After cast removal or surgical fixation, the affected limb is typically stiff, weak, and mechanically de-conditioned - sometimes significantly so. Physiotherapy after a fracture in a child or adolescent restores range of motion, rebuilds strength and coordination, and gets them back to the activities they care about in a structured and safe way.

Why do children need physiotherapy after a fracture?

Children’s bones heal quickly - often faster than adults’ - but the surrounding soft tissues (muscles, tendons, ligaments, joint capsule) need specific rehabilitation to restore function. After a period of immobilisation in a cast or splint:

• Joints become stiff (particularly the wrist, elbow, knee, and ankle)
• Muscles weaken significantly, sometimes losing a large proportion of their pre-fracture strength
• Proprioception (the sense of where the limb is in space) is disrupted, which affects balance and coordination
• Compensatory movement patterns often develop during immobilisation and need to be corrected

Without physiotherapy, recovery is slower, compensatory patterns can persist, and the child may avoid activities or develop fear of re-injury that affects their return to sport and play.

What is different about fracture rehab in children?

The key child-specific consideration is the growth plate. If the fracture involved a growth plate (a Salter-Harris fracture), the rehab timeline and approach requires attention to whether the growth plate has been disrupted and whether monitoring by an orthopaedic surgeon is needed. Physeal fractures can affect bone growth if managed incorrectly. Our physiotherapist will liaise with your child’s orthopaedic team on the specific management protocol where growth plate involvement is confirmed.

Children also typically progress through rehabilitation faster than adults, and age-appropriate activities - play, sport, and school - are used as functional milestones to target, not just clinical measurements.

What does a session at Goji involve?

Your child’s first session will review the fracture details (location, type, how it was managed), the immobilisation period, and the imaging findings. Our physiotherapist will then perform a physical assessment of the affected limb - range of motion, swelling, strength, and functional movement - and compare it with the unaffected side to establish the degree of deficit. The rehabilitation programme is built around the child’s age, the fracture location, the activity goals, and the treating surgeon’s clearance for progressions.

Early sessions focus on reducing stiffness and gentle mobility restoration. Progressively, strength, coordination, and sport-specific or activity-specific loading are introduced. Our physiotherapist will give you and your child clear milestones - this is when you can go back to PE, this is when you can return to training, this is when you are cleared for contact sport - rather than open-ended “wait and see” guidance.

Common post-fracture presentations at Goji

• Distal radius fractures (wrist): the most common fracture in children; often require cast immobilisation
• Clavicle (collarbone) fractures: common in falls and contact sport; typically managed conservatively
• Lateral condyle and supracondylar humerus fractures (elbow): more complex; often require surgical fixation and close orthopaedic follow-up
• Ankle fractures: including physeal fractures in adolescents; require careful management of return to weight-bearing
• Metatarsal fractures: common in sport; management varies by location and fracture type
• Tibial and fibular fractures: typically require a period of non-weight-bearing followed by graduated reloading

Frequently asked questions

When should my child start physio after a fracture?

Physiotherapy typically starts after the cast or immobiliser has been removed and the orthopaedic team has confirmed the fracture is healed on imaging. This is usually 4-6 weeks for upper limb fractures and 6-8 weeks for lower limb, though this varies significantly by fracture type and location. Contact us once your child has had their follow-up orthopaedic appointment and bring the discharge instructions if available.

My child’s cast came off last week and their wrist is very stiff. Is this normal?

Yes. Joint stiffness after cast removal is expected - the joint capsule and surrounding soft tissues tighten during immobilisation. Regaining full range of motion is the first goal of physiotherapy and usually progresses relatively quickly in children with consistent exercise. Do not force the joint - aggressive passive stretching can cause problems. Physiotherapy uses graded active movement first.

My child had a growth plate fracture. Are there any long-term risks?

Salter-Harris fractures involving the growth plate can, in rare cases, cause growth disturbance - particularly in higher-grade injuries (Types III-V). The risk and monitoring approach depends on the fracture type, the bone affected, and the child’s remaining growth. This is primarily managed by the orthopaedic team; our physiotherapist will design the rehab programme to stay within the orthopaedic team’s parameters.

How long until my child can go back to sport?

This depends on the fracture, the sport, and the child’s recovery progress. As a rough guide: most children can return to non-contact sport and PE within 6-10 weeks of cast removal, and contact sport 2-4 weeks after that - subject to meeting strength, range of motion, and movement quality benchmarks. Our physiotherapist will give you specific, objective criteria for each stage rather than date-based estimates.

My child is scared to use their arm since the fracture. Is that normal?

Yes. A degree of fear of re-injury is very common, particularly in children who had a painful fracture experience. Physiotherapy can address this through gradual, graded exposure to loading - building confidence alongside function. Our physiotherapist is experienced in managing this with children across a wide age range.

Do children need the same rehab as adults after a fracture?

The principles are similar but the approach differs. Children heal faster, are motivated by different functional goals (play, sport, school PE), have growth plate considerations, and generally respond very well to physiotherapy. The programme is adapted to age, developmental stage, and the activities that matter to that child specifically.