The cast comes off and the wrist underneath looks thinner, feels stiff, and barely moves. This surprises people, who expected the fracture healing to be the hard part.
Stiffness after immobilisation is normal and expected. It also responds well to warmth and consistent movement.
Follow your therapist’s plan first
If you’ve had a fracture, surgery or a tendon repair, your surgeon and hand therapist will have given you a specific protocol. Some movements are restricted for weeks after certain repairs, and a general article can’t know which apply to you. See also heat after surgery.
What follows is general context. Your plan wins where they differ.
Why it stiffens
Joints not moved for weeks develop tightness in the capsule and surrounding tissue.
Muscles waste quickly, which is why the forearm looks thinner. Swelling that lingers also limits movement, and scar tissue after surgery adds its own restriction. A shoulder does the same thing when it stops moving: frozen shoulder.
None of this is permanent, but it needs weeks of steady work rather than a few enthusiastic days.
Heat before exercise
Warm tissue stretches further than cold tissue. Ten minutes of heat before your exercises means more range from the same effort. That’s the whole rationale: what the evidence says about heat before hands-on work.
- Rest the forearm and wrist on the pad, cover on, lowest setting, 10 minutes. Or use a bowl of warm water; on that choice, see moist heat vs dry heat.
- Do the exercises your therapist gave you straight afterwards. See “my physio said use heat” — but how, exactly?
- If the wrist swells or aches for hours afterwards, you did too much. Cut the repetitions, not the frequency.
Two cautions. Don’t use heat over a surgical wound that hasn’t fully healed, or over metalwork sites if your surgeon has advised against it. And if the hand still has numbness after the injury, keep heat off that area, because you may not feel it getting too hot.
The full list is in who should not use a heating pad; on numbness specifically, heating pads and reduced sensation; and on plates, screws and pins, heat pads with metal implants.
Typical early movements
Again, only if they’re part of your plan:
- Wrist bending up and down, slowly, within comfort
- Turning the palm up and down, keeping the elbow tucked at your side
- Fist to full finger extension, 10 times. If a finger catches on the way back, see trigger finger.
- Thumb to each fingertip
- Using the hand for light everyday tasks, which is often the best exercise of all
Little and often beats one long session: a few minutes, several times a day. Stiff, achy small joints in the morning respond to the same routine: hand arthritis morning stiffness.
Swelling
Some puffiness is normal for weeks. Elevating the hand above heart level and moving the fingers regularly helps. If the hand swells after heat, use less heat and more elevation for a few days. See hot or cold compress for swelling.
The scar, once it’s closed
After surgery, a scar that has stuck down to the tissue underneath will limit movement on its own, separately from the joint stiffness. It responds to consistent scar massage over months, and warmth beforehand makes that work easier. See tight scar tissue: where heat fits in scar massage.
Contact your therapist or doctor if…
- Pain is severe, burning, and out of proportion to what you’d expect, with marked swelling, colour changes, sweating or extreme sensitivity to light touch. This can indicate complex regional pain syndrome, and early treatment matters.
- The wound is red, hot, oozing, or you have a fever
- You have new or increasing numbness or tingling. See carpal tunnel and heat.
- The fingers look pale or feel cold
- Movement is going backwards rather than forwards
- You’ve had no hand therapy input at all after a fracture or surgery. Ask for a referral; outcomes are better with it.
The heat pad we use
We’ve supplied the Bremed BD7800 since 2010. It holds a steady temperature, covers a whole lower back and has a machine-washable cotton cover. Physiotherapy clinics in Singapore use it with their patients.
Clinically reviewed by: Nigel Chua (Hand Occupational Therapist) & Louise Yow (Physiotherapist). This article is general information, not a diagnosis. electricheatpad.com sells electric heat pads.
