We all know how the treatment for a fractured bone goes.
You go to the doctor’s office. Get some scans. Get a cast fixed on your broken limb. The cast comes off after some time and that’s it. Right?
Not so fast. Many people don’t realize that the treatment for a broken bone doesn’t end when the orthopedic doc removes the cast.
Physical therapy (PT) plays a big role in your fracture rehab after the removal of the cast.
Before you can understand why physiotherapy is so important during the post-cast phase, you first need to know what your body goes through when you have a cast on.
What Happens to Your Leg or Arm in a Cast?
The purpose of a cast is to immobilize the bone or joint and restrict movement. Although that’s ideal for fracture recovery, it takes a toll on the muscles, ligaments, and joints of your arm and leg.
Plaster cast complications include joint stiffness, cartilage degradation, ligament weakness, and muscle atrophy to name a few. (Reference)
Your legs and arms can become stiff and lose muscles when they’re in a cast. The stiffness you feel after removing the cast is because of joint capsular stretch.
Joint Capsule is a thick fibrous tissue that envelops a joint.(Reference) It usually has two layers. The inner layer usually produces fluid as well to help the joint move. The job of a joint capsule is to protect the joint and allow it to move through its full range of motion.
This capsule becomes rigid when it stays in the same position for too long. So when you move your joint after a plaster cast, the joint capsule contributes to the overall joint stiffness.
What Happens to Muscles After Being in a Cast?
Wearing a cast can cause muscle atrophy (loss of muscle mass). You might be surprised by how fast you lose muscle in a cast. A study suggests that you can lose up to 30% of muscle mass in two weeks of not using it.
Your muscles undergo atrophy while placed in a cast because of a decreased neural sensation and the obvious physical restrictions to movement. (Reference)
That’s the reason why people tend to lose calf muscle belly after leg fractures. (Reference)
The smaller or deeper muscles go first because they have less strength to begin with as compared to other bigger muscles.
Sometimes, after the cast is removed, you might feel weakness in an activity that you think shouldn’t be affected because of the cast. For instance, some people can lose a bit of grip strength when their arm is in a cast.
That’s because the muscles in your hand that help with gripping originate from your arm. Immobilization of these muscles can affect your wrist and hand movements.
How Does Physical Therapy Help After Plaster Cast Removal?
Physical therapy can help you strengthen your muscles, increase flexibility and range of motion of the joints, improve mobility, and train you to return to activities.
The key to a good recovery after cast removal is to start your PT slow. Don’t jump (literally and figuratively) back into the activities that you were doing before the cast.
Begin with simple low-intensity exercises and later progress to the more complex ones.
A bone isn’t completely healed once the cast is removed. That makes strengthening the muscles and ligaments through physiotherapy all the more important to protect the bone from getting reinjured.
Working with a trained physical therapist is ideal for rehab after a fracture. Because then you will increase just the right level of intensity and work on the exact muscles that need strengthening.
How Do You Regain a Calf Muscle After a Cast?
Doing PT exercises is a great way to regain your lost muscle mass after cast removal.
The good news is that casts don’t stay on for too long when you have a fractured bone. Six weeks is the average duration that plaster is applied. But that number can vary depending on the type and location of your fracture.
In any case, it’s not too long. Yes, you’ll probably lose some muscle mass. But you can easily gain it back with a bit of PT and home exercises.
Some people find it easier to exercise in the water because they don’t feel as much of their body weight as they do on land. Research also supports the use of aquatic physical therapy for tissue and bone injury rehab especially if your lower limb(s) is involved. (Reference)
Here are some exercises you can do for recovering your calf muscle mass after a fracture. You’ll notice that these are low intensity and basic activities. But don’t overlook them for being simple. Doing these exercises can help you recover in the most optimal way:
1. Toe Raises
Stand on your toes while holding onto a chair or something sturdy for support.
Do this multiple times a day.
It can help you with strengthening the calf muscles which tend to get weak after a leg fracture.
2. Ankle Pumping and Rotations
While sitting with your legs straight out, move your toes as far away from your body as you can. Then bring them towards your body.
Repeat.
Think of it as if you were peddling a bike or pressing on the accelerator of your car. You can also rotate your ankle in all directions. Moving your ankle this way can help you reduce joint stiffness at your ankle.
3. Calf Stretches
Sit with your legs extended. Put a towel around your foot and hold both the ends of it in your hands.
Slowly pull the towel towards you until you feel a stretch in your calf muscles.
It can help to relax the calf and reduce any ankle stiffness that you might have.
4. Knee to Chest
Lie on your back on a comfortable surface and wear loose clothing.
Bring one knee towards your chest. Then hold the knee with your arms and bring it towards the chest even more.
This exercise works great if your hip is involved in the cast.
It stretches the muscles on the front of the thigh and helps tackle hip stiffness.
5. Straight Leg Raises
Lie on your back on a comfortable surface and wear loose clothing.
Lift one leg all the way up without bending your knee. Bring it down.
Lift the other leg up so that the only movement you make is at the hip joint. Repeat.
This exercise helps to reduce hip stiffness and stretches hamstrings and the calf muscles.
If you’ve had a cast on your arm, then here are some exercises to help you reverse muscle atrophy:
1. Wrist Movements
Sit comfortably with your wrist supported on a surface. Bend your wrist such that your palm comes closer to your arm. Then move your wrist in the opposite direction.
You can also rotate your wrist in all directions as if you were stirring a pot. This exercise helps to strengthen the wrist muscles which often become weak after a forearm fracture.
It also reduces wrist stiffness. For further strengthening, you can hold a weighted object such as a water bottle or a hammer in your hand while you perform these movements.
2. Wrist and Elbow Stretches
While sitting comfortably, hold your wrist out such that your palm is turned away from your arm.
With your good hand, pull down the fingers of your weak arm so that you feel a stretch in your forearm.
Hold the stretch for 10-15 seconds, then release. This exercise helps to increase muscle flexibility which is compromised by being in a cast.
3. Shoulder Movements
Stand and move your shoulders in all directions.
You can start by lifting your arm in the forward direction, then lifting it sideways and then rotating it in circular motions. This should help open the shoulder’s range of motion and decrease shoulder joint stiffness that can develop as a secondary side-effect of your arm being in a cast.
If you want to strengthen the muscles around your shoulder, you can do these exercises while holding free weights or a resistance band.
Learn about more shoulder exercises to injury proof your shoulder.
How Do You Prevent Muscle Loss in a Cast?
Well, you can’t really. At least not as much as you’d like.
The purpose of putting your arm or leg in a cast is to restrict its movements. And when that happens, muscles naturally begin to lose mass.
You can try to minimize the muscle loss by wiggling your fingers or toes because that’s probably the only movement you can do. You can’t put weight on your leg when you have a cast on and you can’t lift heavy objects if your arm is in a cast.
So it can be difficult if not impossible to prevent muscle loss entirely when you have a cast on.
In Summary
Having stiff joints, loss of muscle mass and pain in end ranges of movement are common symptoms that people complain of after suffering a fracture.
But these restrictions don’t have to be forever.
Physical therapy rehabilitation not only helps you recover faster after the removal of a cast but also prevents re-injury.
Doing a few simple exercises after the cast comes off can pay off in the short and the long term. The physical therapy regimen you need depends on your specific case.
If you’re recovering from a fracture and need guidance on the exercises you need, then contact us for help.
Disclaimer: This article is for informative purposes only. We provide well-researched and authentic information. Do not consider this personalized health advice. Please contact a licensed healthcare professional for medical issues and health concerns.