Wrist Fracture Rehab: What Physiotherapy Does After a Distal Radius Fracture

The distal radius is the most commonly fractured bone in the arm. It sits just above the wrist joint, and it breaks most often from a fall onto an outstretched hand. The scenario is consistent whether the person is 25 or 75: the hand goes down, the body's weight comes down behind it, and the bone gives way.

The cast period handles the healing. This article is about what happens after the cast comes off, and why the weeks immediately after removal matter as much as the weeks before.

What the distal radius is and why it breaks where it does

The forearm has two bones: the radius and the ulna. The radius is the larger of the two and carries most of the load transferred from the hand to the arm. The distal end, the end closest to the wrist, is where the radius articulates with the eight small carpal bones that form the wrist joint. It is also the point where the bone is widest and most exposed to a fall impact force.

When a person falls and reaches a hand out to break the fall, the impact load travels up through the hand and concentrates at the distal radius. The bone breaks at a predictable location, just above the wrist joint, and the fracture pattern depends on the angle and magnitude of the force.

The most common patterns are Colles fractures, where the wrist snaps back and the bone fragments displace in a characteristic direction, and Smith fractures, the reverse pattern where the wrist is in a bent-down position at impact. Colles is far more common. Both involve the same bone at the same location.

Distal radius fractures are among the most common fractures seen in pickleball players and older adults with fall risk. Our article on falls and wrist fractures in pickleball covers the prevention side of this specific injury.

What six weeks in a cast does to the wrist

The cast immobilises the wrist and typically the thumb side of the hand for four to six weeks while the fracture heals. This is necessary. It is also what creates the rehabilitation problem.

During immobilisation, the wrist joint stiffens. Ligament and capsule tissue tighten without movement. The skin over the wrist and forearm tightens and loses its normal mobility. Grip strength drops significantly: studies on grip strength after distal radius fracture typically show losses of 40 to 60 percent of the uninjured side at cast removal. Forearm rotation, particularly supination (turning the palm upward), and wrist extension (bending the hand back) are the two functional motions most consistently restricted.

At the same time, the bone is not fully healed at six weeks. The fracture site is consolidated enough to remove the cast, but it is not the same as pre-fracture bone strength. Full bone remodelling takes twelve to eighteen months. This matters for physiotherapy because the early weeks after cast removal are a window for mobility work, not yet a window for heavy loading.

The four phases of recovery

Physiotherapy for a distal radius fracture follows a phase structure tied to what the bone and tissue can handle at each stage.

Phase 1: Cast phase, weeks 0 to 6. During this period, the physiotherapist or the treating surgeon's team typically advises keeping the fingers, elbow, and shoulder moving to reduce stiffness and maintain circulation. Finger tendon gliding exercises and shoulder range-of-motion exercises prevent the joint from seizing up while the wrist is immobilised. Some people see a physiotherapist during this phase; many do not until cast removal.

Phase 2: Early mobility after cast removal, weeks 6 to 10. This is the most important phase for preventing lasting stiffness. Immediately after cast removal, the wrist is stiff, swollen, and tender. The priority is gentle, pain-guided range-of-motion work: wrist flexion and extension, forearm rotation (pronation and supination), and composite finger flexion (making a full fist, which many people cannot do immediately after cast removal because finger tendon tightness has accumulated).

Scar mobilisation begins here if the person had surgical repair, since a scar from a plate incision will tighten and restrict movement if not addressed. Oedema (swelling) management through elevation, compression, and active movement is also part of this phase.

The bone is still consolidating during this phase. The load prescription is zero: no strengthening, no resistance, just controlled movement within the pain-free range.

Phase 3: Strength rebuilding, weeks 10 to 16. When movement is close to symmetrical with the uninjured side, loading begins. This is where grip strengthening, wrist flexor and extensor resistance work, and forearm rotation with resistance are introduced progressively. Functional tasks (gripping, lifting, turning keys) are practiced as activity-specific loading.

Isokinetic or dynamometer testing is useful here to measure grip strength and pinch strength objectively and compare to the uninjured side. A limb symmetry index of 80 percent or above on grip and pinch is a reasonable benchmark before advancing to heavier tasks.

Phase 4: Return to activity, week 12 onward for non-operative, week 16 onward for surgical cases. Return to most activities of daily living typically happens within 8 to 12 weeks of cast removal for non-operative cases. Return to sport or demanding physical work is later: racquet sports, heavy manual work, and anything requiring wrist loading under impact require near-full strength symmetry and bone consolidation.

What the physiotherapy session looks like

Initial sessions after cast removal focus on assessment: range of motion in all wrist and forearm directions, grip and pinch strength, skin and scar mobility, and a functional movement screen. The physiotherapist measures where the deficits are and maps a program around them.

Hands-on treatment includes joint mobilisation to restore passive range of motion, soft tissue work on the forearm and wrist, and specific manual techniques to address restrictions in the midcarpal and radiocarpal joints. For surgical cases, incision scar mobilisation is a specific skill and is typically started at eight to ten weeks when the scar has matured enough to be worked.

Exercise prescription is individualised: what movement is available, what is restricted, and what daily activities matter most to the person. Someone who plays guitar has different priorities from someone who works in construction. The program is built around those priorities.

Timeline expectations

For non-operative distal radius fractures, the typical timeline is:

• Return to light daily tasks (typing, eating, dressing): 6 to 8 weeks after cast removal
• Return to moderate tasks (driving, carrying bags): 8 to 10 weeks
• Return to most activities: 10 to 12 weeks
• Full strength recovery: 3 to 6 months

For surgical cases, where a plate has been inserted to hold the bone in position, the immobilisation period is sometimes shorter (plates allow earlier movement), but the overall recovery timeline is typically 4 to 6 months to full function, and up to 12 months for complete strength recovery.

These timelines assume physiotherapy starts promptly after cast removal or after surgical wound healing. People who delay physiotherapy by several months typically experience more residual stiffness and longer recovery.

Red flags to report to your surgeon or physiotherapist

Not all wrist fracture recovery follows a predictable path. Contact your treating clinician or surgeon if you experience any of the following:

• Increasing rather than decreasing pain more than six weeks after injury
• Colour or temperature changes in the hand or fingers (blue, purple, or cold hand suggests circulation concerns)
• Significant burning or electric pain in the hand (possible nerve involvement)
• Swelling that is substantially worsening after six weeks
• Finger flexion that is not returning after two to three weeks of therapy

Complex regional pain syndrome (CRPS) is a rare complication of distal radius fracture where pain and swelling become disproportionate to what the healing timeline would predict. Early recognition and treatment change the outcome significantly.

Booking physiotherapy after a wrist fracture in BC

Physiotherapy for distal radius fracture is direct-access in BC: you do not need a referral to book. Your surgeon may refer you automatically; if not, you can book independently.

Most extended health plans cover physiotherapy for fracture rehabilitation under the standard physiotherapy benefit. If the fracture is from a fall at work, WorkSafeBC covers physiotherapy through the EAPP and standard claim process. If the fracture was from a motor vehicle accident, ICBC covers physiotherapy as part of the claim.

Physiotherapy is available at all five of our Metro Vancouver studios: Lougheed, Coquitlam, Richmond, New Westminster, and North Burnaby.

Frequently asked questions

Can I do physiotherapy while still in a cast?

Yes, but the focus is limited to fingers, elbow, and shoulder during the cast phase. The wrist itself is not worked until after cast removal. Some physiotherapists see patients during the cast phase to prevent unnecessary stiffness from accumulating; others see patients starting at cast removal. Both approaches are reasonable depending on how the early weeks are going.

My wrist still feels weak months after the cast came off. Is that normal?

Grip strength after distal radius fracture can take 3 to 6 months to recover in non-operative cases and up to 12 months after surgical repair. If you did not do formal physiotherapy after cast removal, starting now is still useful. Strength can improve significantly even months after the initial injury.

Will my wrist ever feel completely normal?

Most people return to full or near-full function. Some residual stiffness or mild aching with sustained gripping or wrist extension is common and usually improves over the first year. A small percentage of people, particularly older adults with pre-existing wrist changes or those with complex fracture patterns, have some lasting limitation. The physiotherapy goal is maximal functional recovery, not necessarily perfect symmetry.

Does it matter if I use my right or left hand?

The dominant hand is typically slower to feel fully recovered because people test it against a higher standard in daily tasks. The recovery process is the same. The physiotherapist will assess both hands to establish the deficit accurately.

This article is general information, not personal medical advice. The phases and timelines described apply to typical distal radius fractures and may differ based on fracture type, surgical approach, and individual healing.

Sources

• Brigham and Women's Hospital Distal Radius Fracture Rehabilitation Protocol
• CHCPBC: College of Health and Care Professionals of BC
• Falls and wrist fractures in pickleball
• Shoulder impingement exercises and shoulder rehab at Launch Rehab