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The Cast Is Off. The Bone Did Its Job. Now the Wrist Needs You.
Start gentle wrist movement the day the cast comes off, usually around 6 weeks: bend and straighten, side to side, and palm up and palm down, 10 reps each, 4 to 6 short sessions a day. No weights yet.
Add soft grip and light 0.5 to 1 kg (1 to 2 lb) wrist curls from about week 8. Weight through the hand comes last. Most people have everyday function by about 3 months; full strength takes 6 to 12 months.
The exercises after a wrist fracture matter more than the fracture did.
The bone knits in about six weeks whatever you do. Whether you get a wrist that works is decided in weeks 6 to 12, which is exactly the period most people are discharged into with a photocopied sheet and no follow-up.
What comes out of the cast is stiff, weak, swollen and frightened of load. All four are normal. All four respond to work.
Skip that work and the stiffness that was soft and changeable at week 7 has started to set by month 4. Then you’re working twice as hard for half the gain.
Your surgeon or fracture clinic may give you different dates. Use theirs.
What exercises can I do while still in the cast?
This is the part people skip, and it costs them weeks later. The wrist rests. Nothing else should.
- Finger pumping. Full fist, then straighten fully. 10 times, every hour you’re awake.
- Tendon glides. Five positions: fingers straight, hook fist, full fist, tabletop, straight fist. 10 reps each, 3 to 4 times a day. A stiff hand at cast removal is a second problem on top of the first. More on keeping things moving inside the cast: broken wrist cast.
- Thumb. Touch the thumb to each fingertip in turn, 10 rounds, if the cast leaves it free.
- Elbow and shoulder. Bend and straighten the elbow, then raise the arm overhead with the other hand helping. 10 reps each, 3 to 4 times a day. A stiff shoulder after a wrist fracture is common, and avoidable.
- Elevation whenever sitting. Hand above heart level, fingers moving while it’s up.
What exercises should I do after the cast comes off? (weeks 6 to 8)
Start with movement only. NO weights, no gripping loads, no push-ups.
Warm the wrist in warm water for 5 minutes first, then:
- Bend and straighten. Forearm resting on a table, hand over the edge. Bend down, then lift up. 10 reps, holding each end for 5 seconds.
- Side to side. Forearm and palm flat on the table. Slide the hand toward the thumb, then toward the little finger. 10 reps.
- Palm up, palm down. Elbow tucked into your side, bent to 90 degrees. Turn the palm to the ceiling, then to the floor. 10 reps, 5-second hold. Holding a wooden spoon or a light hammer by the handle gives you a lever.
- Prayer stretch. Palms together in front of your chest, slowly lower the hands until you feel the stretch. Hold 15 seconds, 5 times.
- Fist and straighten, still, every day.
Short and often beats long and occasional. Five minutes six times a day works better than thirty minutes once.
Light daily use counts as exercise too: cutlery, keyboards, washing your own hair with that hand. Use it.
Chase rotation. A wrist that bends beautifully but will not turn the palm up still cannot carry a plate or take change.
Why turning your palm up matters most
Turning the palm up is the movement that most often lags after a wrist fracture, and the one people don’t notice is missing until they try to take change from a cashier or carry a bowl of soup. Daily life rarely asks for a full palm-up turn, so it hides…until week 10, when it’s already harder to get back.
Work it from the day the cast comes off. If it’s still stuck, see can’t turn your palm up after a wrist fracture.
When can I start strengthening after a wrist fracture? (weeks 8 to 12)
This is the deciding phase. Early stiffness is wet cement. Old stiffness is set concrete.
- Soft gripping. A sponge, then therapy putty or a soft ball. 10 to 15 reps, 2 to 3 sets a day. Not a spring gripper.
- Light wrist curls, both directions. Forearm on the table, holding 0.5 to 1 kg (1 to 2 lb), a can of beans works. Lift and lower slowly, 10 to 15 reps, palm down and then palm up.
- Rotation under load. The hammer from week 6, now held further down the handle so the head weighs more.
- Weight through the hand, last. Hands on a table, lean gently through the wrist, building time and pressure week by week. Only once movement is comfortable.
Keep pushing range at the same time, especially bending the wrist back and turning the palm up. Those two come back last and matter most.
How much should wrist fracture exercises hurt?
- Fine: aching after exercise that settles within an hour.
- Expected: swelling in the evening, stiffness in the morning, a firm bump at the fracture site (that’s healing bone), and weakness that lasts months.
- Too much: pain that’s still raised the next morning, or range that’s going backwards. Drop the dose and keep moving. Swelling is often what’s driving it; see swelling and edema after a hand injury.
Months 3 to 12: strength and confidence
- Months 3 to 6: grip strength rebuilds over months, not weeks. Pushing up from a chair, carrying groceries, push-ups from your knees, each returns in order as the wrist proves itself.
- Months 6 to 12: the last few degrees of movement, full grip, and the confidence to land on that hand again. Heavy lifting, push-ups on flat palms, contact sport and climbing often land here.
I had a plate, not a cast. Is it different?
Yes, earlier. A plate holds the bone rigidly, so many surgeons start gentle wrist movement out of a removable splint within the first 2 weeks, once they’ve OK’d it. The bone still heals on bone’s schedule, so heavy loading waits until at least 6 to 8 weeks either way. See plated wrist fracture rehab.
When can I drive, work and go back to the gym?
Typical ranges. Your surgeon’s protocol wins.
- Driving: not in a cast. Usually once you can grip the wheel firmly and turn it quickly, often 1 to 2 weeks after cast removal. See driving after a hand injury.
- Desk work: often within 1 to 2 weeks of the fracture, typing with the cast hand helping.
- Light manual work, or lifting a full kettle: around 8 to 10 weeks.
- Heavy manual work: 3 months or more, sometimes closer to 6.
- Gym: legs, cardio and the other arm straight away. Light wrist loading from 8 to 12 weeks. Push-ups, planks and burpees on flat palms from about 3 months, built up gradually.
If your wrist isn’t getting better
Track one question: what can this wrist do this week that it couldn’t do last week?
At week 8, a stiff wrist is still in the OPEN part of its window. By month 4 or 5 the window is closing, and every degree costs more effort than the last. Recovery that’s stalled for 2 to 3 weeks straight needs a plan change, not more patience.
That’s where a hand therapist earns their keep: measuring every movement in degrees, finding the actual block (joint, tendon, swelling or nerve), and splinting for stiffness when exercises plateau. More in stiff hand and fingers after a cast or surgery, and the full recovery arc is in wrist fracture recovery, week by week.
Go to the ER if
- Your fingers turn white, blue or cold.
- Pain in the cast is severe and escalating, and isn’t eased by elevation and pain meds.
- Your fingers are going numb and you can’t move them.
Call your surgeon or doctor today if
- New or worsening numbness in the thumb, index and middle fingers.
- Pain that’s escalating rather than settling, with color change, sweating, and skin so sensitive that clothing hurts. Read about CRPS promptly, not later.
- The thumb tip stops lifting off a flat table, weeks or months after the fracture. That’s a ruptured EPL tendon, not weakness, and exercises won’t bring it back.
- After surgery: redness, warmth, discharge from the wound, or a fever.
Get it checked if
- No measurable progress for 2 to 3 weeks in a row, or range going backwards.
- You still can’t turn your palm up properly by 3 months.
- A painful clunk on the little-finger side every time you rotate.
- The wrist is swollen and painful, not just puffy, at 3 months.
The cast protected the bone. Nothing protected the wrist, and that is what the next six weeks are for.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. A wrist that’s stalled for 2 to 3 weeks after the cast deserves a review this week.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.