Distal Radius Fracture ORIF — Complete Exercise Program

Hand & Wrist Elevation and Swelling Control

Keeping the hand above heart level and pumping the fingers — the most important thing you do in the first fortnight.

What it helps: Controls the swelling that is the main cause of stiffness after hand and wrist surgery. A swollen hand cannot make a full fist, and fingers left stiff in the first weeks are much harder to free later than the wrist itself is.

1. Rest the hand higher than your heart. Sitting, prop the whole forearm on a stack of cushions so the hand sits above chest level.
2. Standing, rest it on the opposite shoulder; lying down, support the whole forearm on pillows.
3. With the hand up, slowly make a loose fist and open it fully, spreading the fingers.
4. Repeat the slow fist-and-open several times, then let the hand rest in the raised position.
5. Come back to it regularly through the day rather than doing one long session.

Tips:

• Above the heart is the part that matters. A hand resting on your lap or in a sling at waist height is not elevated, and this is the commonest reason swelling does not settle.
• The fist-and-open is a pump: muscles squeezing push fluid back up the arm. Elevation alone works, but elevation with movement works far better.
• A hand that is puffy and stiff first thing in the morning usually means it spent the night down; support it on pillows in bed.

Commonly done as every hour while awake sets of 10 slow fists, daily.

Finger Range of Motion

Gentle bending and straightening to keep the finger joints moving.

What it helps: Keeps the finger joints moving through their full range — preserving the bend and straighten you need to grip, pinch, and use your hands for everything.

1. Open the hand wide, fingers straight.
2. Make a full fist, then open again.
3. Bend each finger one at a time toward the palm, then straighten.

Tips:

• Smooth, comfortable motion through the whole range.
• Do it often through the day, especially when the hand feels stiff.

Commonly done as 2–3 sets of 10, daily (several times).

Tendon Gliding (Finger Glides)

A sequence of finger positions that keeps the tendons sliding smoothly through the hand and wrist.

What it helps: Keeps the finger tendons sliding freely through their sheaths and the carpal tunnel — preventing stiffness and catching, and keeping the hand smooth and supple.

1. Start with fingers straight.
2. Bend just the top two knuckles into a "hook," then straighten.
3. Make a full fist, then straighten.
4. Bend the big knuckles only into a "tabletop," then straighten.
5. Make a "straight fist" (fingers curled but knuckles flat). Move slowly through each.

Tips:

• Move smoothly through the whole sequence.
• Gentle and controlled — these keep the tendons gliding, not strengthening.

Commonly done as 2–3 sets of 5–10 of each, daily.

Thumb Range of Motion

Gentle thumb movements that keep the base of the thumb mobile.

What it helps: Keeps the thumb's wide range — reaching, pinching, and opposing to the fingers — which is behind nearly every grip and pinch task the hand does.

1. Move the thumb out away from the palm, then back.
2. Touch the thumb tip to each fingertip in turn (opposition).
3. Make gentle circles with the thumb. Keep it comfortable.

Tips:

• Smooth, pain-free motion.
• Opposition (thumb to fingertips) is the key everyday motion to keep.

Commonly done as 2–3 sets of 8–10 each, daily.

Elbow Range of Motion

Gentle bending, straightening, and forearm turning to keep the elbow moving freely.

What it helps: Keeps the elbow and forearm moving through their full range — preserving the bend, straighten, and rotation you use for everyday tasks.

1. Bend the elbow to bring your hand toward your shoulder, then slowly straighten it all the way.
2. With the elbow tucked at your side and bent 90°, turn your palm up, then down.
3. Move smoothly through comfortable range; don't force the ends.

Tips:

• Keep the upper arm still — the movement is at the elbow and forearm.
• Sore is okay; sharp is a sign to ease back.

Commonly done as 2–3 sets of 10 each, daily.

Pendulum Swings

Gentle, relaxed swinging that eases the shoulder into motion without the muscles having to work.

What it helps: Coaxes the shoulder through gentle motion with the muscles relaxed — keeping the joint moving and easing stiffness when active movement is still uncomfortable.

1. Lean forward and support your good arm on a table or chair, letting the sore arm hang down relaxed.
2. Let the arm swing gently — small circles, then forward-and-back and side-to-side — using a gentle sway of your body, not the shoulder muscles.
3. Keep it loose and pain-free, like a relaxed pendulum.

Tips:

• The movement comes from rocking your body, not from working the shoulder.
• Keep the swings small and comfortable.

Commonly done as 2–3 sets of 1–2 min, a few times a day.

Gentle Neck Isometrics

A steady, held press against your own hand — strengthens the neck with no movement.

What it helps: Strengthens the deep muscles that support and steady your neck without moving it — a safe, comfortable way to build the support that eases neck pain.

1. Sit tall with a gentle chin-tuck. Place your palm on your forehead.
2. Press your head lightly into your hand and your hand back into your head — a steady, comfortable push with NO movement of the neck.
3. Hold, relax, and repeat. Do the same with the hand on the back of the head, then each side.

Tips:

• Light pressure — about 20–30% effort. This is not a strength test.
• No actual neck movement: the head stays still while the muscles work.
• Keep the gentle chin-tuck throughout.

Commonly done as 5 each direction sets of Hold 5–10 seconds, daily.

Walking Program

Short, frequent walks build endurance and confidence.

What it helps: Comfortable, frequent walking keeps the joints loose, builds your stamina, and rebuilds confidence on your feet. Little and often beats long and tiring.

1. Take short walks at a comfortable pace.
2. Increase your distance gradually as you feel able.

Tips:

• Use your assistive device as directed.

Commonly done throughout the day.

Wrist Range of Motion

Gentle bending and side-to-side motion to keep the wrist moving freely.

What it helps: Keeps the wrist moving through its full range — preserving the bend, straighten, and side-to-side motion you use for everyday hand tasks.

1. Rest your forearm on a table with your hand just past the edge, hand open and relaxed.
2. Bend the wrist up so the back of the hand rises, then down so the fingers drop, through a comfortable range.
3. Then move the hand side to side — toward the thumb, then toward the little finger.
4. Finally make slow circles.

Tips:

• Smooth, comfortable motion — don't force the ends.
• Keep the forearm supported so only the wrist moves.
• No weight for this one. It is about movement, not strength — that is what separates it from wrist curls.

Commonly done as 2–3 sets of 10 each, daily.

Forearm Rotation

Strengthens the muscles that turn the palm up and down.

What it helps: Strengthens the muscles that rotate the forearm — the motion behind turning a key, a doorknob, or a screwdriver.

1. Tuck your elbow in at your side, bent to 90 degrees, and hold a hammer by the end of its handle.
2. Slowly rotate your forearm to turn the palm up, then down, through a comfortable range.
3. The hammer head swings from one side to the other as you turn — that arc is the whole movement.
4. Keep the elbow pinned to your side throughout.

Tips:

• Holding the hammer toward the head end adds gentle resistance — slide your grip to adjust.
• Keep the elbow still; only the forearm rotates.
• No hammer? A light hand weight works the same way.

Commonly done as 2–3 sets of 10–12 each way, most days.

Wrist Deviation (Side-to-Side)

Strengthens the muscles that move the wrist toward the thumb and little-finger sides.

What it helps: Strengthens the side-to-side wrist muscles — important support for the thumb-side tendons and for steady, controlled wrist use.

1. Rest the forearm on a table with the hand off the edge, thumb up, holding a light weight or hammer.
2. Slowly raise the hand toward the thumb side, then lower with control.
3. Keep the forearm still; the motion is at the wrist.

Tips:

• Light resistance, controlled motion.
• A hammer held toward the head adds gentle, adjustable load.

Commonly done as 2 sets of 10–12, most days.

Tendon Gliding (Finger Glides)

A sequence of finger positions that keeps the tendons sliding smoothly through the hand and wrist.

What it helps: Keeps the finger tendons sliding freely through their sheaths and the carpal tunnel — preventing stiffness and catching, and keeping the hand smooth and supple.

1. Start with fingers straight.
2. Bend just the top two knuckles into a "hook," then straighten.
3. Make a full fist, then straighten.
4. Bend the big knuckles only into a "tabletop," then straighten.
5. Make a "straight fist" (fingers curled but knuckles flat). Move slowly through each.

Tips:

• Move smoothly through the whole sequence.
• Gentle and controlled — these keep the tendons gliding, not strengthening.

Commonly done as 2–3 sets of 5–10 of each, daily.

Finger Range of Motion

Gentle bending and straightening to keep the finger joints moving.

What it helps: Keeps the finger joints moving through their full range — preserving the bend and straighten you need to grip, pinch, and use your hands for everything.

1. Open the hand wide, fingers straight.
2. Make a full fist, then open again.
3. Bend each finger one at a time toward the palm, then straighten.

Tips:

• Smooth, comfortable motion through the whole range.
• Do it often through the day, especially when the hand feels stiff.

Commonly done as 2–3 sets of 10, daily (several times).

Median Nerve Glides

Gentle gliding movements that keep the median nerve moving freely through the wrist.

What it helps: Keeps the median nerve gliding smoothly through the carpal tunnel — easing the irritation behind carpal tunnel tingling without over-stretching a sensitive nerve.

1. Start with a gentle fist, wrist neutral.
2. Open the fingers straight, then bend the wrist back so the palm faces forward and fingers point up.
3. Gently add a thumb stretch with the other hand if comfortable, then return. Move slowly through the sequence.

Tips:

• Gentle gliding — never a hard stretch, which can irritate a sensitive nerve.
• Stop short of strong tingling; ease back if symptoms increase.

Commonly done as 2–3 sets of 5–10, daily.

Hand & Wrist Elevation and Swelling Control

Keeping the hand above heart level and pumping the fingers — the most important thing you do in the first fortnight.

What it helps: Controls the swelling that is the main cause of stiffness after hand and wrist surgery. A swollen hand cannot make a full fist, and fingers left stiff in the first weeks are much harder to free later than the wrist itself is.

1. Rest the hand higher than your heart. Sitting, prop the whole forearm on a stack of cushions so the hand sits above chest level.
2. Standing, rest it on the opposite shoulder; lying down, support the whole forearm on pillows.
3. With the hand up, slowly make a loose fist and open it fully, spreading the fingers.
4. Repeat the slow fist-and-open several times, then let the hand rest in the raised position.
5. Come back to it regularly through the day rather than doing one long session.

Tips:

• Above the heart is the part that matters. A hand resting on your lap or in a sling at waist height is not elevated, and this is the commonest reason swelling does not settle.
• The fist-and-open is a pump: muscles squeezing push fluid back up the arm. Elevation alone works, but elevation with movement works far better.
• A hand that is puffy and stiff first thing in the morning usually means it spent the night down; support it on pillows in bed.

Commonly done as every hour while awake sets of 10 slow fists, daily.

Elbow Range of Motion

Gentle bending, straightening, and forearm turning to keep the elbow moving freely.

What it helps: Keeps the elbow and forearm moving through their full range — preserving the bend, straighten, and rotation you use for everyday tasks.

1. Bend the elbow to bring your hand toward your shoulder, then slowly straighten it all the way.
2. With the elbow tucked at your side and bent 90°, turn your palm up, then down.
3. Move smoothly through comfortable range; don't force the ends.

Tips:

• Keep the upper arm still — the movement is at the elbow and forearm.
• Sore is okay; sharp is a sign to ease back.

Commonly done as 2–3 sets of 10 each, daily.

Grip Strengthening

Builds hand and forearm grip strength with a ball or putty.

What it helps: Builds the grip and forearm strength behind almost every hand task — and supports the tendons at the elbow that grip relies on.

1. Hold a soft ball or therapy putty in your hand.
2. Squeeze firmly and hold a few seconds, then relax fully.
3. Work through comfortable effort; stop short of sharp pain.

Tips:

• Full squeeze, full relax — both matter.
• Grip work loads the elbow tendons, so build it gradually if you have tennis or golfer's elbow.

Commonly done as 2–3 sets of 10–15, most days.

Wrist Curls

Strengthens the forearm muscles in both directions.

What it helps: Builds balanced forearm strength in both directions — the everyday strength behind a comfortable, capable wrist and grip.

1. Rest your forearm on a table with your hand just past the edge, holding a light weight.
2. Palm up: curl your wrist upward, then lower it slowly.
3. Turn your forearm over so the palm faces down, then lift the back of your hand upward and lower it slowly.
4. Move smoothly through a comfortable range.

Tips:

• Light weight, controlled motion.
• Your forearm stays resting on the table — only the wrist moves.
• Build the forearm in both directions for balance.

Commonly done as 2–3 sets of 12–15 each, most days.

Hand Putty Exercises

All-around hand strengthening with therapy putty — grip, pinch, and spread.

What it helps: Builds all-around hand and finger strength — grip, pinch, and the muscles that spread the fingers — the foundation of strong, capable hands for daily tasks.

1. Squeeze the putty in a full fist, then release.
2. Pinch the putty between the thumb and each fingertip in turn.
3. Press the putty flat and dig individual fingers in; spread the fingers against a loop of putty.

Tips:

• Comfortable effort; full squeeze and full release.
• Putty comes in firmnesses — start soft and progress as you get stronger.

Commonly done as 2 sets of 10 each, most days.

Wrist Range of Motion

Gentle bending and side-to-side motion to keep the wrist moving freely.

What it helps: Keeps the wrist moving through its full range — preserving the bend, straighten, and side-to-side motion you use for everyday hand tasks.

1. Rest your forearm on a table with your hand just past the edge, hand open and relaxed.
2. Bend the wrist up so the back of the hand rises, then down so the fingers drop, through a comfortable range.
3. Then move the hand side to side — toward the thumb, then toward the little finger.
4. Finally make slow circles.

Tips:

• Smooth, comfortable motion — don't force the ends.
• Keep the forearm supported so only the wrist moves.
• No weight for this one. It is about movement, not strength — that is what separates it from wrist curls.

Commonly done as 2–3 sets of 10 each, daily.

Forearm Rotation

Strengthens the muscles that turn the palm up and down.

What it helps: Strengthens the muscles that rotate the forearm — the motion behind turning a key, a doorknob, or a screwdriver.

1. Tuck your elbow in at your side, bent to 90 degrees, and hold a hammer by the end of its handle.
2. Slowly rotate your forearm to turn the palm up, then down, through a comfortable range.
3. The hammer head swings from one side to the other as you turn — that arc is the whole movement.
4. Keep the elbow pinned to your side throughout.

Tips:

• Holding the hammer toward the head end adds gentle resistance — slide your grip to adjust.
• Keep the elbow still; only the forearm rotates.
• No hammer? A light hand weight works the same way.

Commonly done as 2–3 sets of 10–12 each way, most days.

Thumb & Wrist Stretch

A gentle stretch for the thumb-side tendons of the wrist.

What it helps: Eases tension in the thumb-side wrist tendons — gently loosening the tight, irritated tendons that limit thumb and wrist use.

1. Hold the arm out, thumb up. Gently bend the wrist downward and toward the little-finger side until you feel a mild stretch along the thumb side of the wrist.
2. Hold gently; keep it comfortable.
3. You can tuck the thumb lightly into the palm first for a touch more — but never force it.

Tips:

• A gentle, mild stretch only — thumb-side tendons are easily over-stretched.
• Ease off if it sharpens.

Commonly done as 3 sets of Hold 15–20 sec, daily.

Finger Extension (Rubber Band)

Strengthens the muscles that open the hand and straighten the fingers.

What it helps: Builds the often-overlooked muscles that open the hand — balancing the strong gripping muscles and supporting smooth, comfortable finger movement.

1. Place a rubber band around the outside of your fingers and thumb.
2. Open the fingers and thumb apart against the band's resistance.
3. Slowly close back with control.

Tips:

• Use a band light enough to do smoothly.
• Controlled open and close — both directions matter.

Commonly done as 2 sets of 10–15, most days.

Stationary Bike

Builds motion and endurance with low impact.

What it helps: Keeps the joints moving and nourished while you build endurance — all with no pounding. One of the gentlest ways to stay active when a joint is sore.

1. Set the seat so pedaling is comfortable.
2. Pedal at an easy pace.
3. Increase your time gradually.

Commonly done as directed.

Eccentric Wrist Extension

Slow lowering of the wrist that rebuilds the tendons on the outside of the elbow (tennis elbow).

What it helps: Rebuilds the wrist-extensor tendons on the outside of the elbow through slow, controlled loading — the proven way to make tennis-elbow tendons stronger and more resilient.

1. Rest the forearm on a table, palm down, hand off the edge, holding a light weight.
2. Use your other hand to help lift the wrist up.
3. Let go with the helping hand and lower the weight down slowly over 3–4 seconds. Help it back up and repeat.

Tips:

• The work is in the slow lowering, not the lift.
• Start with a very light weight (even a soup can); add load only as it stays comfortable.
• Some mild ache during/after is normal with tendon work.

Commonly done as 3 sets of 10–15, daily (or every other day).

Grip Strengthening

Builds hand and forearm grip strength with a ball or putty.

What it helps: Builds the grip and forearm strength behind almost every hand task — and supports the tendons at the elbow that grip relies on.

1. Hold a soft ball or therapy putty in your hand.
2. Squeeze firmly and hold a few seconds, then relax fully.
3. Work through comfortable effort; stop short of sharp pain.

Tips:

• Full squeeze, full relax — both matter.
• Grip work loads the elbow tendons, so build it gradually if you have tennis or golfer's elbow.

Commonly done as 2–3 sets of 10–15, most days.

Eccentric Wrist Flexion

Slow lowering of the wrist that rebuilds the tendons on the inside of the elbow (golfer's elbow).

What it helps: Rebuilds the wrist-flexor tendons on the inside of the elbow through slow, controlled loading — the proven way to strengthen golfer's-elbow tendons.

1. Rest the forearm on a table, palm UP, hand off the edge, holding a light weight.
2. Use your other hand to help curl the wrist up.
3. Let go and lower the weight down slowly over 3–4 seconds. Help it back up and repeat.

Tips:

• The work is in the slow lowering.
• Start very light and progress gradually; mild ache with tendon work is normal.

Commonly done as 3 sets of 10–15, daily (or every other day).

Hand Putty Exercises

All-around hand strengthening with therapy putty — grip, pinch, and spread.

What it helps: Builds all-around hand and finger strength — grip, pinch, and the muscles that spread the fingers — the foundation of strong, capable hands for daily tasks.

1. Squeeze the putty in a full fist, then release.
2. Pinch the putty between the thumb and each fingertip in turn.
3. Press the putty flat and dig individual fingers in; spread the fingers against a loop of putty.

Tips:

• Comfortable effort; full squeeze and full release.
• Putty comes in firmnesses — start soft and progress as you get stronger.

Commonly done as 2 sets of 10 each, most days.

Progressive Strengthening

Gradually increases strength as you recover.

What it helps: Gradually raises the challenge as you get stronger, so your body keeps adapting and improving rather than plateauing.

1. Begin with no added weight and get the movement smooth and comfortable first.
2. When a set starts to feel easy, add a light load - the ankle cuff shown here, a dumbbell or a band.
3. Sit tall, straighten the knee against the weight, hold briefly, then lower slowly.
4. Step the load up in small amounts rather than in jumps.

Tips:

• Progress one thing at a time - more weight or more repetitions, not both in the same week.
• If your form slips before the set ends, the load is too heavy.
• The ankle-weight knee extension is the example drawn. The same rule of small steps applies to whichever exercises your program includes.

Commonly done as directed.

Upper Body Conditioning

Keeps your arms and shoulders strong — helpful for crutches and staying active.

What it helps: Keeps your arms and shoulders strong — especially helpful for using crutches and staying active during recovery.

1. Sit tall in a chair without arms, both feet flat on the floor and your back supported.
2. Hold a light weight in each hand, arms relaxed at your sides, palms turned in toward your thighs.
3. Raise both arms out to the sides until they are level with your shoulders.
4. Lower them slowly back to your sides.

Tips:

• Stay seated and supported while you're non-weight-bearing.
• Light weights are plenty — a resistance band, or no weight at all, works just as well.
• The lift stops at shoulder height.

Commonly done a few times a week.

Swimming

Low-impact, full-body conditioning.

What it helps: Full-body conditioning with the water carrying your weight, so your muscles work hard with almost no load on the joints.

1. Wait until any wound is fully healed and you have been cleared to swim.
2. Start with a few easy lengths, resting between them.
3. Build the distance gradually across sessions rather than within one.

Tips:

• The picture shows front crawl. Which stroke suits you depends on which joint was operated on, and your care team can say which to begin with.
• The water carries most of your weight, so a session can feel easier than it was - judge it by how you feel the next day.
• Walking in chest-deep water is a gentler place to start than swimming lengths.

Commonly done as able.

Strength Training

Maintains and builds long-term strength.

What it helps: Builds and maintains long-term strength to keep you active, resilient, and independent.

1. Work the major muscle groups two or three times a week, leaving a day between sessions.
2. Use a weight you can lift with good form for the whole set - the last repetition should feel hard, not impossible.
3. Lower slowly. The controlled way down is where much of the benefit sits.
4. Add a little weight only once the current one feels comfortable.

Tips:

• The dumbbell squat shown is one example. Which exercises suit you depends on the joint you are recovering from, and your program will say.
• Breathe out on the effort rather than holding your breath.
• Muscle soreness a day or two later is expected. Pain in the joint itself while you lift is a sign to lighten the weight.

Commonly done a few times a week.

Functional Strength Training

Task-based strengthening that rebuilds the movements of daily life and activity.

What it helps: Trains the real movements of daily life — lifting, carrying, squatting — with good mechanics, so everyday tasks feel easier.

1. Work through functional movements — squats, step-ups, lunges, and balance — as cleared.
2. Add resistance gradually.

Tips:

• Quality of movement first, then load.

Commonly done several times a week.

Grip Strengthening

Builds hand and forearm grip strength with a ball or putty.

What it helps: Builds the grip and forearm strength behind almost every hand task — and supports the tendons at the elbow that grip relies on.

1. Hold a soft ball or therapy putty in your hand.
2. Squeeze firmly and hold a few seconds, then relax fully.
3. Work through comfortable effort; stop short of sharp pain.

Tips:

• Full squeeze, full relax — both matter.
• Grip work loads the elbow tendons, so build it gradually if you have tennis or golfer's elbow.

Commonly done as 2–3 sets of 10–15, most days.

Flexibility Exercises

Maintains a comfortable range of motion.

What it helps: Keeps your joints and muscles moving through a comfortable range, so you stay supple and move with ease.

1. Sit tall on a chair and slide one leg forward, heel on the floor and toes up.
2. Hinge forward from the hips and reach gently toward that foot until you feel a stretch behind the thigh.
3. Hold for around 30 seconds, breathing normally, then ease back.
4. Repeat on the other side.

Tips:

• A stretch should feel like a long pull, never a pinch - and never bounce into it.
• Muscles stretch more easily when they are warm, so after a walk is a good time.
• The seated hamstring stretch drawn here is one example; your program may include stretches for other areas too.

Commonly done most days.

Upper Body Conditioning

Keeps your arms and shoulders strong — helpful for crutches and staying active.

What it helps: Keeps your arms and shoulders strong — especially helpful for using crutches and staying active during recovery.

1. Sit tall in a chair without arms, both feet flat on the floor and your back supported.
2. Hold a light weight in each hand, arms relaxed at your sides, palms turned in toward your thighs.
3. Raise both arms out to the sides until they are level with your shoulders.
4. Lower them slowly back to your sides.

Tips:

• Stay seated and supported while you're non-weight-bearing.
• Light weights are plenty — a resistance band, or no weight at all, works just as well.
• The lift stops at shoulder height.

Commonly done a few times a week.

Cycling

Low-impact endurance and motion.

What it helps: Low-impact endurance that keeps the joints moving smoothly while you build fitness — easy on the body, good for the long run.

1. Set the saddle so your knee stays slightly bent at the bottom of the pedal stroke.
2. Begin with light resistance on flat ground, pedalling smooth, full circles.
3. Build the time you ride before you build the resistance or the hills.

Tips:

• Many people start on a stationary bike and move outdoors, as drawn here, once balance and confidence are back. The pedalling is the same either way.
• A saddle set too low is the usual reason a hip or knee feels cramped while riding.
• Your surgeon can say when getting onto a road bike is reasonable for you.

Commonly done as able.

Low-Impact Recreational Activities

Enjoyable activities that protect your joint.

What it helps: Getting back to the activities you enjoy in ways that are kind to your joints — the whole point of building this strength.

1. Choose activities that keep you moving without jarring the joint - walking, cycling and golf are three common ones.
2. Start with a short session and add time before you add intensity.
3. Spread them across the week rather than doing everything in one day.
4. Keep the effort at a level where you could still hold a conversation.

Tips:

• The picture shows three examples, not a list to work through - the best activity is the one you will keep doing.
• A little stiffness the next day is usual; a flare that lingers means the session was too long, not that the activity was wrong.
• Your surgeon or therapist can say when each activity is a reasonable one to add.

Commonly done as you like.