The fracture clinic appointment where the cast comes off is often the last one. The bone has healed, the X-ray is satisfactory, and you are discharged with an advice sheet. What nobody quite prepares you for is the limb underneath: stiff, thin, weak and strange to use. That is the normal starting point for the second half of the recovery, and the half that determines what the limb ends up able to do.
Six weeks of immobilisation does predictable things, and all of them are reversible:
Bone healing and functional recovery run on different clocks. Union at six weeks means the bone will take load, and the limb around it is at the start of its own timeline.
For a wrist fracture, which is the commonest of the lot, published rehabilitation guidance describes stiffness for one to two months after the cast comes off as the usual course. For older people, those with osteoarthritis or those with high-energy injuries, residual stiffness can persist considerably longer.
A workable general shape, applying across most limb fractures:
Ankle and lower limb fractures follow the same pattern with weight-bearing added as a variable, which our article on ankle surgery recovery covers where surgery was involved.
Movement first. Little and often beats one long session. Five to six short bouts a day, each taking the joint to the edge of comfortable range and holding briefly, produces more change than a single heroic effort. Stiffness that eases within half an hour of stopping is acceptable feedback.
Then load. Range without strength gives you a joint that moves and cannot be trusted. Progressive resistance is what restores the muscle that disappeared, and it needs to be genuinely progressive, adding weight or repetitions week by week rather than repeating the same band exercise for two months.
Then the specific demand. Grip and rotation for a wrist, calf capacity and single-leg balance for an ankle, overhead reach and carrying for a collarbone or upper arm. Our article on how soft tissues heal covers the underlying principle that tissue organises itself around the load you give it.
A cast immobilises one region and the consequences spread beyond it. A wrist in plaster for six weeks reliably produces a stiff elbow, a tight shoulder and a sore neck from carrying the arm awkwardly. An ankle in a boot changes how the hip and back work on that side, and those changes outlast the boot.
Good practice during immobilisation is to keep everything not in the cast moving deliberately, several times a day. If the cast is already off, the assessment should still cover the whole chain, because a shoulder that stopped moving in week two is a separate problem needing separate attention.
Our article on upper arm aching pain covers one of the ways this shows up after an arm injury.
Waiting to see whether these settle costs range that then takes months to win back.
What has changed in clinic is the point at which people arrive after a fracture. More are turning up months later, having been discharged from the fracture clinic with a healed X-ray and an exercise sheet, and having assumed that the stiffness and weakness would simply resolve on their own timetable. Late summer and autumn bring the reliable local pattern behind this: ankles from the first weeks of the football season, collarbones and wrists off bikes on the Cuckoo Trail, which runs 14 miles from Heathfield down through Hailsham to Polegate, and wrists from falls once the lanes get slippery.
The clinical point is that the discharge from fracture clinic marks the end of the bone’s story rather than the limb’s. Muscle lost during six weeks in a cast does not come back through daily use alone, because daily use never asks enough of it. Loaded, progressive work does, and it needs the load to increase week on week. Left to itself, a wrist ends up with a grip that works for a kettle and fails on a jar, and an ankle ends up with a calf that walks fine and cannot run.
For the loaded stage, 1:1 rehab and strength training is where that work happens.
Is it normal for my wrist to be this stiff after the cast?
Yes. One to two months of stiffness after cast removal is the usual course, and longer in older adults or after a high-energy injury.
Should I push into pain?
To the edge of comfortable range, held briefly. Discomfort that settles within about half an hour is acceptable. Sharp pain or pain that lingers into the next day means you have gone too far.
Do I need physiotherapy after a simple fracture?
Not always. Many people recover well with good advice. It becomes worthwhile when range stalls, when strength is clearly behind, or when the limb has a demanding job to return to.
Will my limb ever be the same?
For most straightforward fractures, yes, given adequate rehabilitation. Joint fractures and high-energy injuries can leave some residual stiffness.
How soon can I return to sport?
Judged on capacity rather than dates: full range, strength within reach of the other side, and confidence under the specific demands of the sport. Our guide to returning to sport after injury covers the criteria.
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