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Rehab After a Fracture: Physical Therapy in Brooklyn Once the Cast Comes Off

By Dr. Jack Engelberg, PT, DPT · · 4 min read

Whether you slipped on an icy sidewalk in January, fell off a bike, or tripped over a toy at home, a broken bone turns your life upside down for a while. Once the bone has healed enough for the cast, splint or boot to come off, many people are surprised by how stiff, weak and unsteady the area feels. That's normal, and it's exactly what physical therapy is designed to address.

Common Fractures That Benefit From Physical Therapy

  • Wrist fractures — such as a distal radius fracture from falling on an outstretched hand
  • Shoulder fractures — including the upper arm (proximal humerus) and collarbone
  • Elbow fractures
  • Hip fractures — usually treated with surgery, especially common in older adults after falls
  • Ankle fractures — often from twisting injuries
  • Foot fractures — including metatarsal and stress fractures
  • Knee and lower leg fractures — including the kneecap and tibia
  • Spinal compression fractures — sometimes related to osteoporosis

Why Is Rehab Needed After a Fracture?

During healing, the injured area is usually protected with a cast, splint, boot, sling or limited weight-bearing. While that protection allows the bone to heal, it also leads to:

  • Stiffness in the joints above and below the fracture
  • Muscle weakness and loss of muscle mass
  • Swelling that lingers
  • Reduced balance and coordination, especially after leg fractures
  • Changes in how you walk or use your arm
  • Fear of moving or re-injury

Joints that are immobilized for weeks can also develop significant stiffness. For example, a frozen shoulder can develop after an arm injury that kept the shoulder still.

How Physical Therapy Helps

Evaluation

Your therapist will review your fracture type, how it was treated (cast, surgery with plates or screws, etc.), and your surgeon's or physician's restrictions, then measure swelling, motion, strength, sensation and function.

Treatment May Include

  • Range-of-motion exercises — to restore movement in the joints that were immobilized
  • Manual therapy — joint mobilization and soft tissue work to reduce stiffness
  • Scar management — after surgery, to keep the skin and tissues moving freely
  • Swelling management — compression, elevation and movement strategies
  • Progressive strengthening — matching the bone's healing stage and your physician's guidance
  • Gait training — weaning from crutches, walker or boot, and walking normally again
  • Balance training — especially after lower limb fractures and in older adults
  • Hand and fine-motor work — after wrist and hand fractures (occupational therapy is available at our Boro Park office)
  • Return to work, sport and daily activities

Progression always respects bone healing. Your therapist follows the weight-bearing and activity guidelines from your orthopedic team.

What You Can Do at Home

  • Move what you're allowed to move. Keep the joints above and below the fracture active within your restrictions.
  • Elevate the limb to reduce swelling, especially after the cast comes off.
  • Follow weight-bearing instructions exactly. Doing too much too soon can disrupt healing.
  • Eat well with adequate protein, calcium and vitamin D, as advised by your physician.
  • Avoid smoking, which can slow bone healing.
  • Make your home safer to prevent another fall: clear clutter, add lighting and use grab bars. See our guide to fall prevention.

When to See a Physical Therapist

Consider physical therapy:

  • When your cast, splint or boot is removed
  • After fracture surgery
  • If you're still stiff, weak or limping weeks after a fracture
  • If you're nervous about falling again

Contact your physician promptly if you notice increasing pain, new swelling, redness or warmth, fever, numbness or tingling, skin color changes, calf pain or swelling, or if a limb looks deformed.

Frequently Asked Questions

My cast just came off and my arm looks thin and stiff. Is that normal?

Yes. Muscles shrink and joints stiffen with immobilization. Most people regain a lot of strength and motion with a structured program.

Can therapy start while I'm still in a cast?

Sometimes. Your therapist can work on the joints and muscles that aren't immobilized, and on walking with crutches or a walker.

Should I get checked for osteoporosis after a fracture?

If the fracture happened from a minor fall, especially if you're over 50, ask your physician whether bone density testing makes sense.

Ready to get started? Call the Refuah office nearest you

Schedule an evaluation by phone, or book online at refuahpt.com.

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About the author. Dr. Jack Engelberg, PT, DPT is a Doctor of Physical Therapy and owner of Refuah Physical & Occupational Therapy, with offices in Midwood and Boro Park, Brooklyn, and on Staten Island.

Medical disclaimer: This article is for general education only and is not medical advice, diagnosis or treatment. Everyone’s situation is different. Talk with your physician or a licensed physical therapist about your symptoms. If you think you have a medical emergency, call 911.

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