Fracture Clinic

A cast, backslab, splint or brace does exactly one thing: it holds the injured area still so the bone can knit³. That stillness is necessary, and it also has a cost.

Muscle that isn't being used starts to change quickly. Muscle cross-sectional area can drop by roughly 3 to 10 per cent within the first 7 to 14 days of casting, and strength losses can reach 20 to 30 per cent when immobilisation runs longer². Joints stiffen too: range-of-motion deficits have been reported in around 25 to 40 per cent of people after a cast comes off, particularly when they were immobilised for more than four weeks². Put plainly: immobilised muscles tend to weaken and wither, and rehabilitation with strengthening exercise is often what's needed to reverse it¹.

There's a second thing, and it changes how we pace the early weeks. Once the cast is off, the new bone is still temporary: a softer callus that's gradually being replaced by real bone, and it can be injured more easily than you'd expect for at least the next month or so¹. That's why we don't load everything hard the day you're cleared. It isn't caution for its own sake.

And it isn't only physical. Being in a cast is wearing: anxiety and claustrophobic responses during immobilisation have been reported in around 20 to 30 per cent of people². If you've felt flat, frustrated or quietly worried about whether the limb will come good, that's a common part of this, not something you're imagining.

Your first session is an assessment, not a set of exercises handed over at the door.

We start with what happened: the break, how it was managed, how long you were immobilised, and what your treating doctor or orthopaedic team has cleared you to do. If you have a discharge letter, a fracture clinic review date or recent imaging, bring it or tell us about it. We work with those instructions, not around them.

Then we measure where the limb is now. How much movement you have and where it stops. How much strength there is compared with the other side. What's swollen, what's painful, and what you're avoiding without noticing. This is the part that turns "it feels weak" into something specific enough to track and improve.

We explain what we find, in plain English, before we recommend anything. You should leave the first appointment understanding which of your limitations are stiffness, which are weakness, and which are the normal early stage of a bone that's still maturing, because those three need different responses.

Then we agree on the target. Gripping a steering wheel. Getting back on the bike. Lifting your toddler without thinking about it. Returning to a job that needs the hand or the ankle you broke. The plan gets built backwards from whatever you name.

The staging below is the shape of the program. The actual timeframes are yours, and they depend on the bone you broke, how long it was immobilised, what your treating doctor has cleared, and how the limb responds as we go.

• Stage one: protect what's still healing. Working within your doctor's restrictions on weight-bearing and load while the callus is still maturing¹, settling swelling and pain, and sorting out how you get through daily tasks safely in the meantime.
• Stage two: get the movement back. Restoring range at the stiff joint, to a point where you can move without guarding. Early on this is often gentle, frequent, and a bit boring. It's the stage most people skip, and the one that limits everything that follows.
• Stage three: rebuild the strength. Progressive loading of the muscles that wasted while you were immobilised, plus the ones above and below that quietly compensated. Loading increases on the basis of what the limb tolerates, tracked session to session, not on a fixed calendar.
• Stage four: back to the actual thing. Rehearsing the real task you came in for, under real conditions: the grip, the surface, the weight, the speed. A limb that performs well in a clinic and falls apart at work isn't finished.

A note on the evidence. The research is much clearer about the problem (that immobilisation reliably costs you muscle and movement^1,2) than it is about any single technique being the best fix. So we don't promise a particular modality is the thing that will get you there. We assess, we load progressively, we re-measure, and we change what isn't working.

Often, yes, and it's usually worth it.

While the injured area stays immobilised exactly as your doctor has instructed, there's frequently useful work available elsewhere: keeping the joints above and below the cast moving, maintaining strength in the rest of the limb, managing swelling, and working out how to handle daily tasks without overloading the injury. Starting here means you arrive at cast-removal day with less ground to make up.

If you're still in the middle of the immobilisation phase and want to understand what you're wearing and why (a fibreglass cast versus a removable cam boot, what fitting and removal involve, and how the choice affects what comes next), we've written that up separately in Cast vs Cam Boot: What to Expect During Fracture Recovery.