How can physiotherapy help?
A skilled and experienced physiotherapist will be able to work with you on your recovery to:
- Address any associated injuries
- Restore movement in the affected joint(s)
- Improve muscle strength
- Support you in achieving your physical or sporting goals
What if it's "only a fracture"...
Fractures can occur from a traumatic event e.g. a fall, playing sports or a road traffic accident. However, they can also occur when the bone becomes fragile in a condition called osteoporosis, which is more common in older adults.
"Why is it still hurting? It was only a fracture, not a complete break," is one of the most common questions we hear as physiotherapists.
The answer to this is fairly simple. A fracture is the medical term for any broken bone and the severity ranges from a small hairline crack, right through to a serious traumatic fracture with associated soft tissue injuries that may require surgery.
For this reason the word 'fracture' could be quite a big deal!
How do I know if I've got a fracture?
As mentioned above, there are several different types of fractures and their particular pattern can generally indicate the cause.
- Transverse – usually a break straight across the shaft of a bone
- Spiral – high velocity twisting force
- Oblique – indication of the bone breaking diagonally
- Comminuted – compression or crush injuries that can have more than two bits
- Impacted – the bone fragments are forced together and do not usually move
- Greenstick – occur in children where bones are more ‘springy’ and almost bend in on each other and then crack slightly (like a twig).
You will usually require an X-ray to confirm that you have a fracture, and to determine the best course of management. If associated soft tissue injuries are suspected you may need to have further imaging.
Here at the London Clinic we use the latest imaging technology. We are the first private clinic to offer 3-T MRI scanning.to provide exceptional detail to both you and your referring consultant.
Once diagnosed your fracture will generally fit into one of two categories - stable or unstable:
- Stable - these fractures will generally be managed conservatively e.g. immobilised and given time to heal without the need for metal plates, pins or screws
- Unstable – these fractures may require a period of casting or surgical fixation, and be immobilised for some time - usually about 6 weeks
It’s important to follow any advice from your physiotherapist once your fracture has been set to ensure that it heals in the correct position. You should also check that you’re doing everything you need to maintain your strength, flexibility and overall fitness levels whilst it’s healing.
Why do some fractures take longer than others to heal?
Fractures usually begin to regenerate and repair immediately. This repair process allows new cells to form in the fracture site - a spontaneous and natural action forming new bone tissue.
Different bones heal at different rates:
- Lower arm – (radius/ulna) six weeks
- Lower leg – (femur) six to 12 weeks
The time required for bone healing can also be affected by different factors, including the type of fracture and the patient’s age. Other factors that may negatively affect bone healing are:
- Poor diet
- Excessive alcohol consumption
- Underlying medical conditions e.g. diabetes
However, there are positive steps a patient can take to help the chances of a fracture healing in good time:
- Eating a well-balanced diet
- Ensuring you get enough Vitamin-D and calcium in your diet or supplementation
- Keeping active as advised by your physio
- Addressing any fear or anxiety about returning to previous activity/sports
Differences between mal-union vs. non-union fractures
The treatment of fracture mal-unions and non-unions often requires an orthopaedic surgical team approach.
This occurs when the bone heals out of normal alignment - other mal-union symptoms can include:
- Reduced functioning in the area
Cases of mal-union don’t always require treatment because some will not cause impaired functioning. But if the altered bone positioning is significant and damaging, it often requires surgical treatments to allow for future mobility.
Surgical treatment options for a mal-union fracture
Surgical procedures can help realign severe cases of mal-union. An orthopaedic surgical procedure called an osteotomy is commonly used to restore the appropriate alignment of bones that have not healed properly.
Surgeons can perform these techniques in an osteotomy to correct a mal-union:
This occurs when the bone does not heal or only partially heals following an extended recovery period.
In some cases a bone may require up to nine months to completely heal. If your doctor, surgeon or physiotherapist does not see any signs of progressive healing over this extended period of time, you may have a non-union fracture.
It may be that the body has not produced enough bone tissue to repair the broken bone. Depending on the severity of the non-union, symptoms could include:
- Reduced functioning in the area
Surgical treatment options for a non-union fracture
- Stimulate bone healing using bone grafts
- Restore damaged bones and tissues around the non-union
- Fill the bone gaps with plates, screws and pins to stabilize the bone
Non-surgical treatment options following a mal- or non-union fracture
- Shockwave therapy
- Electrical stimulation
My fracture has healed, so why am I still in pain?
Everyone is different and no two people will have exactly the same mechanism of injury. That’s why it is important to have an individual physiotherapy assessment.
Here at The London Clinic you can come straight in for an assessment from our First Contact Practitioner or from one of our expert physiotherapists.
However, there are a few common reasons why you still might be in pain:
- Your joint can be very stiff as a result of being immobilised in a cast and this stiffness can cause pain
- When your cast is removed your fracture will have healed enough for you to start moving it gently - but we know that it takes three months for your fracture to become strong enough for you to start really loading it, and 12-18 months before the bones have fully remodelled. This means that your body is still healing at this point
- Perhaps most importantly, if you have had enough trauma to cause a fracture to the bone, you will likely have injured the soft tissues (muscles, cartilage, tendons and ligaments) around the area. Often these can be slow to heal if left untreated.
So, how can physiotherapy help?
Fractures often heal well, but they can also come with treatable complications such joint stiffness, muscle weakness, issues with tendons and damage to your nerves.
Effective physiotherapy often involves spending more time treating the injured soft tissues than the fracture itself. The doctors whose primary concern is to manage your fracture can unfortunately overlook these.
An expert musculoskeletal physiotherapy assessment can identify and treat many complications, helping to restore your normal range of movement, strength and function as quickly as possible.
Our expert physiotherapists also have the use of effective evidence based modalities such as shockwave therapy which stimulates the body’s own healing mechanism to heal tendon problems.
What should I expect from my physiotherapist?
Your treatment will depend very much on the problems identified during your initial assessment, but may include a mixture of the following:
- Soft tissue manual therapy, particularly to manage oedema, swelling and trigger points
- Scar management if you had surgery to fix the fracture
- Stretching exercises to regain joint range of movement, and optimise muscle length and tone
- Manual therapy and mobilisations to the joints to assist you in regaining good movement at the joints around the break
- Structured and progressive strengthening regime
- Balance and control work and gait (walking) re-education where appropriate
- Return to sport preparatory work and advice where required.
The physiotherapy team at The London Clinic have a well-equipped gym with state of the art equipment such as the Keiser pulley system (), and the Alter-G anti-gravity treadmill. This equipment enables the team to rehabilitate you faster but more importantly effectively, with the aim of reducing any down time.
For those patients that are non-weight bearing for a period of time we also have an aquatic therapy pool. This means you can to continue exercising to increase muscle strength, balance, flexibility and your cardiovascular system even in the presence of any weight-bearing restrictions.
Any views expressed in this article are those of the featured specialist(s) and should not be considered to be the views or official policy of The London Clinic.