If your fracture has been casted, rehabilitation with a physiotherapist at Evidence Sport and Spine generally begins once the cast is removed around six weeks post injury. While you are in the cast simple finger movements, neck range of motion exercises as well as pendular exercises to assist with pain and maintain your shoulder range of motion will be your only exercises.
If you have had surgery to fixate your humeral fracture then rehabilitation at Evidence Sport and Spine will begin as soon as your surgeon recommends it. Surgical fixation aims to make the fracture site stable therefore in most cases gentle non-weight bearing exercises to maintain range of motion are safe to do early on and will often be recommended even immediately after surgery. In other cases, rehabilitation will not be recommended until after the bones have shown some evidence of healing on X-ray (usually around six weeks.) Each surgeon will set his own specific restrictions based on the type of fracture, surgical procedure used, personal experience, and whether the fracture is healing as expected.
Even if extensive physiotherapy for your humerus does not begin immediately, at Evidence Sport and Spine we highly recommend maintaining the rest of your body’s fitness with regular exercise. If your humerus has been surgically repaired, maintaining general cardiovascular fitness can be done with lower extremity fitness activities such as walking or using a stationary bike or stepper machine. If your fracture has been casted, activities such as these may need to wait until the bone shows some healing on X-ray as the cast is used more for traction rather than total immobilization. After surgical fixation, weights or weight machines for your lower extremity and opposite arm are also acceptable to use as long as the restrictions regarding your healing humerus are strictly abided by. Generally, lifting any weight with your injured limb will not be allowed and will be difficult as your humerus heals so you may require a friend to assist you with your workout setup if you are keen to continue while your bone heals. Your physiotherapist can discuss the most appropriate way for you to maintain your fitness while abiding by your surgeon’s restrictions and can provide a general fitness program specific to your needs.
When the initial cast is removed or immediately after surgery, you may experience some pain when you start to move your shoulder, wrist, elbow and forearm. If you were in a cast this pain is from not using the joints regularly. If you have had surgery, the pain is likely from the surgical process itself. Your pain may also be from concurrent soft tissue injury that occurred when you fractured your humerus. Your physiotherapist will focus initially on relieving your pain. We may use modalities such as heat, ice, ultrasound, or electrical current to assist with decreasing any pain or swelling you have around the fracture site or anywhere along the arm, into the shoulder or into the hand. Due to some of the muscles of the neck and upper back connecting to the shoulder, you may also have some pain in these regions that we will treat in order to make movement of your entire upper body easier. We may massage the neck, upper back, shoulder, elbow, forearm, or wrist to improve circulation and assist with the pain.
The next part of our treatment will focus on regaining the range of motion, strength, and dexterity in your wrist, hand, elbow, and shoulder. If you have been casted, your arm will look and feel quite weak and atrophied after the cast is removed. Your physiotherapist will prescribe a series of stretching and strengthening exercises that you will practice in the clinic and also learn to do as part of your home exercise program. These exercises may include the use of rehabilitation equipment such as light weights or Theraband that provide added resistance for your upper limb. The shoulder joint is the upper limb’s link to the rest of the body so it needs to be strong and well controlled for the limb and hand to work well. We may also use an upper body bike to encourage coordinated movement of the entire upper limb.
If necessary, your physiotherapist will mobilize your joints. This hands-on technique encourages the stiff joints of your shoulder, elbow, and wrist to move gradually into their normal range of motion. Fortunately, gaining range of motion and strength after a humeral fracture occurs quickly. You will notice improvements in the functioning of your limb even after just a few treatments with your physiotherapist. As your range of motion and strength improve, we will advance your exercises to ensure your rehabilitation is progressing as quickly as your healing fracture allows. Graduated heavier exercises and endurance work will be added in concordance with the known healing time of bone in order to ensure the stresses can be withstood.
As a result of any injury, the receptors in your joints and ligaments that assist with proprioception (the ability to know where your body is without looking at it) decline in function. A period of immobility will add to this decline. Although your humerus is not traditionally thought of as weight-bearing bone, even an activity such as assisting yourself with your arms to get out of a chair or pulling a glass from a cupboard requires weight to be put through or lifted by your humerus and for your body to be proprioceptively aware of your limb. If you are an athlete, then proprioception of your upper extremity is paramount in returning you to sport after a humerus fracture. Your physiotherapist will liaise with your surgeon regarding the optimal time to start exercises that target proprioception by putting weight through the healing humerus bone via the hand. These exercises might include activities such rolling a ball on a surface with your hand, holding a weight up overhead while moving your shoulder, or push- ups on an unstable surface. Advanced exercises will include activities such as ball throwing or catching. For athletes we will encourage exercises that mimic the quick motions of the sports or activities that you enjoy participating in.
Generally, the strength and stiffness one experiences after a humerus fracture responds extremely well to the physiotherapy we provide at Evidence Sport and Spine. With our initial one-on-one physiotherapy treatment along with the ongoing exercises of your home program, the strength, range of motion, endurance and proprioception gradually improve towards near full recovery/function over a period of 3-6 months even though the actual final stages of bone healing won’t occur for another 6-12 months after that. Over time, most patients are able to return to all activities they were doing before the injury. If, however, during rehabilitation your pain continues longer than it should or physiotherapy is not progressing as your physiotherapist would expect, we will ask you to follow-up with your surgeon to confirm that the fracture site is tolerating the rehabilitation well and ensure that there are no hardware issues that may be impeding your recovery.
Evidence Sport and Spine provides services for physiotherapy in Calgary.