Intermediate Wrist and Hand Post-Fracture Rehabilitation

Published: July 26, 2026Updated: October 6, 2026

A 16-week intermediate program using kettlebells, and ellipticals to aid in the recovery process.

Quick summary

Professional rehabilitation program designed for effective recovery and pain management.

Medically reviewed by WellAlly Editorial TeamLast reviewed October 6, 2026Editorial policy

Key facts at a glance

Body part: upper-limb · wrist-hand
Injury type: post-fracture
Level: intermediate
Duration: 16
Sessions/week: 4
Minutes/session: 60
Evidence level: moderate
ICD-10: S62
Cost tier: moderate

Program Overview

This 16-week intermediate wrist and hand rehabilitation program is for people recovering from a wrist fracture who have moved past early healing and are ready to rebuild motion and strength. The goal is to gradually restore wrist movement, grip strength and everyday hand function safely, with supervision from your rehabilitation clinician, who will adjust the plan to your specific fracture and healing.

Before You Start

Only begin this program with your clinician's approval, especially if your fracture is recent or you have significant muscle wasting, as these need extra care. Avoid overloading the wrist, keep your spine in a neutral position during exercises, and always cool down afterward. Stop and contact your clinician if you have sharp or worsening pain, new numbness or tingling, swelling that keeps increasing, or if the wrist looks deformed.

Weekly Structure

The plan runs 16 weeks with 4 sessions per week, about 60 minutes each, using a kettlebell and elliptical. Early weeks focus on protected motion while your wrist stays supported. Middle weeks gradually add gentle movement, grip work and light strengthening. Later weeks build toward fuller motion and functional grip, always guided by your clinician's assessment of how your fracture is healing.

What a Typical Session Looks Like

Each session follows a warm-up, main work, and cool-down pattern. A light elliptical warm-up raises circulation before hand and wrist exercises; heat may be applied before exercise as advised. The main work includes active motion, gentle strengthening, soft tissue and joint work, and grip training or NMES as directed. Cool down with gentle stretching, then apply ice after exercise if recommended.

Tracking Progress

Your clinician uses the progression criteria at each phase to decide when you are ready to advance, rather than pushing ahead on a set timetable. Outcome measures such as the Jamar grip dynamometer, wrist range-of-motion goniometry, Purdue Pegboard, 9-Hole Peg Test, and the Boston Carpal Tunnel and Michigan Hand questionnaires track change over time and guide adjustments.

Recovery and Self-Care

Keep pain well controlled and avoid pushing into sharp pain; rest the wrist when it feels irritated and follow your splinting guidance. Watch for red flags such as increasing numbness, weakness in the thumb, spreading swelling, or pain that does not settle, and report these to your clinician. Consistent, gentle practice and adequate rest support healing.

Recovery phases

Week 1Immobilization Protection

Wrist in neutral position with thumb spica splint for distal radius fracture stability,Finger flexion/extension exercises to maintain tendon gliding within flexor digitorum superficialis and profundus,Pain controlled with <3/10 at rest,No active wrist motion permitted - strictly immobilized,Edema management with elevation and compression wrapping,Digital sensation intact - no median nerve compression signs

→ Advance to: Phase 2 - Early Protected Mobility

Week 2Immobilization Protection

Splint integrity maintained - no distal radius/ulna displacement on clinical exam,Continued finger ROM to prevent flexor tendon adhesions at A1 pulley,Carpal tunnel symptoms monitored - no thenar weakness or numbness,Wrist extensor isometric contractions with splint in place (extensor carpi radialis/ulnaris),Forearm pronation/supination limited to 50% - distal radius fracture healing,Scar tissue assessment if surgical approach used - incision healing progressing

→ Advance to: Phase 2 - Early Protected Mobility

Week 3Early Protected Mobility

Wrist flexion limited to 20 degrees with supination/pronation to 45 degrees,Gentle radiocarpal joint mobilization - capsular patterns assessed,Flexor tendon gliding exercises - hook fist, straight fist positions,Grip strength >30% contralateral side using Jamar dynamometer,No pain with passive wrist extension >30 degrees,Median nerve gliding exercises for carpal tunnel prevention

→ Advance to: Phase 3 - Controlled Motion

Week 4Early Protected Mobility

Wrist ROM flexion 30 degrees, extension 20 degrees achieved,Pronation/supination 60 degrees functional range,Grip strength 40% contralateral - thenar and hypothenar muscle activation,No tenderness at distal radius fracture site on palpation,Wrist extensor strengthening - extensor carpi radialis longus/brevis,Sensory examination normal - median, radial, ulnar nerve function intact

→ Advance to: Phase 3 - Controlled Motion

Week 5Controlled Motion

Wrist flexion 45 degrees, extension 35 degrees - midcarpal and radiocarpal motion,Pronation/supination 75 degrees - distal radioulnar joint functioning,Grip strength 50% contralateral - intrinsic muscle strength improving,No pain with resisted wrist extension (extensor carpi ulnaris),Carpal tunnel symptoms absent - negative Tinel's at carpal tunnel,Forearm strength 4/5 on manual muscle testing

→ Advance to: Phase 3 - Controlled Motion

Week 6Controlled Motion

Wrist flexion 50 degrees, extension 40 degrees within functional limits,Grip strength 55% - finger flexor tendon resilience,Forearm supination/pronation full with resistance - biceps and triceps integration,Radial deviation 15 degrees, ulnar deviation 20 degrees - midcarpal mobility,No pain with activities of daily living,Wrist flexor strengthening initiated - flexor carpi radialis

→ Advance to: Phase 3 - Controlled Motion

Week 7Controlled Motion

Wrist ROM near functional - flexion 55, extension 45 degrees,Grip strength 60% contralateral -FDS/FDP tendon integrity,Pronation/supination 85 degrees - distal radioulnar joint stability,Resisted wrist flexion without pain - flexor carpi ulnaris activation,No clicking/popping at radiocarpal joint,Touch typing resumed - median nerve function normal

→ Advance to: Phase 4 - Strengthening

Week 8Controlled Motion

Functional wrist ROM achieved - flexion 60, extension 50 degrees,Grip strength 65% - thenar eminence strength 4/5,Ulnar/radial deviation near full - intercarpal ligament integrity,No restrictions in light ADLs,Forearm rotation full and pain-free - distal radius fracture union clinically,Carpal stability tests negative - no scapholunate/glycerin laxity

→ Advance to: Phase 4 - Strengthening

Week 9Strengthening

Grip strength 70% - progressive resistance exercises,Wrist flexor/extensor strength 4/5 MMT - FCR/ECRL/ECRB,Pronation/supination against resistance - supinator and pronator teres,Dexterity testing improving - Purdue Pegboard functional,No pain with heavy lifting <5kg,Carpal tunnel symptoms absent - nerve conduction studies improving if done

→ Advance to: Phase 4 - Strengthening

Week 10Strengthening

Grip strength 75% - Jamar reading approaching pre-injury,Wrist proprioception training - joint position sense,Radial and ulnar deviation against resistance - extensor carpi ulnaris,Finger flexion strength 80% - FDS/FDP tendon load tolerance,No pain with functional tasks,Forearm supination/pronation 5/5 strength

→ Advance to: Phase 4 - Strengthening

Week 11Strengthening

Grip strength 80% - return to work activities progressing,Wrist flexor/extensor endurance training - 10+ repetitions,Dexterity near normal - box and blocks test improving,No tenderness at distal radius fracture site - bony healing,Power grip 70% - thenar/hypothenar coordination,Light tool use permitted if occupational demands