Keep track of when and where you feel pain and discuss it with your doctor.
1. A fragility fracture - The first sign of weak bones
2. Factors that affect your bones
3. Steps to take after you have broken a bone
4. Prevent Falls to Prevent Fractures
5. Pain Management
Resources
Pain Management
What to expect after a fracture
Pain is your body’s normal response to a broken bone and injuries to the tissue around it. There are three stages of pain that a person may experience after a fracture: acute pain, sub-acute pain and chronic pain.
After a fracture occurs, most people will feel what is called acute pain. Medication to reduce this type of pain is often prescribed during this stage. Acute pain will decrease with time.
In order for a broken bone to heal, it may need a cast, a brace, a splint, surgery or any mix of the above. Whatever method is used to treat your broken bone, the key is to reduce or immobilize the fracture for many weeks so that the bone can set or heal.
- Reduce means to bring the broken ends of the bone as close together as possible to speed up the healing process. Sometimes, this needs surgery.
- Immobilize means to stop the broken ends of the bone from moving apart again so the fracture can “set” or heal. A cast, a brace, a splint or surgery may be used to immobilize the area around the fracture.
- A broken bone in the back is managed by a mix of rest and the correct method of controlled movement.
It is important that you follow the instructions you are given by your doctor in terms of rest and movement. You may be asked to avoid certain movements so that you do not make the injury worse.
A broken bone and the surrounding soft tissue damage need a minimum of six to eight weeks to heal. However, depending on your general health and the condition of your bone and soft tissue, healing can take much longer. For example, osteoporotic bones take longer to heal than normal bones. During this time, it is usually necessary to reduce and modify your activities.
The acute pain that you may have felt right after the injury will decrease with time, but in the weeks after your fracture, some pain may continue and this is called sub-acute pain. This is mainly because the lack of movement that was needed to help your bone heal has caused the soft tissue around the injury to stiffen and the muscles to weaken. Also, scarring and ongoing inflammation may have started in the soft tissue while the fracture was healing, which can also make movement hard and cause pain.
Physical therapy is often recommended at this stage of recovery. A physical therapist can help:
- prevent or reduce the stiffness that can occur during fracture healing,
- provide exercises to strengthen weakened muscles and improve range of motion,
- break down scar tissue and reduce inflammation, and
- help to overcome fear of movement.
The points listed above help to reduce pain and improve the function of the injured body part. The physical therapist may use ultrasound, electrical stimulation, massage or other methods to help you recover from a fracture. Physical therapy may require you to do exercises.
Medication may also be used at this stage to help control pain or inflammation.
During this stage of recovery you may be advised by your doctor to begin using the injured body part as much as possible for your usual activities even though you may still have some pain. Gradually over the next few months, movements usually become easier and more comfortable and may eventually return to normal. Slowly, the pain may completely go away.
It is normal to be fearful of some movements or activities. The memory of the pain can be powerful and the fear of breaking another bone can often lead to anxiety and reduced activity. Despite your fear, it is important to start some gentle movement at this time; it will not be harmful. If you are uncertain, see a Bone Fit™ trained healthcare professional in your area* or, if one is not available, a healthcare provider such as a physical therapist or occupational therapist, or talk to your doctor.
Your doctor or healthcare provider can advise you about what is reasonable for you to expect for your recovery. It is important to remember that at this stage you may have pain but that does not always mean you are causing further harm. Your healthcare team will help you reduce your risk of a second fracture.
Many people who fracture will heal and recover to the point where they no longer feel any pain. However, some people may continue to feel pain long after the fracture and soft tissues have healed. Full healing from a fracture can take anywhere from many weeks to many months and sometimes even many years.
Pain that persists after full healing is expected to have taken place is called chronic pain. Chronic pain may be due to nerve damage, the development of scar tissue, an aggravation of underlying arthritis or any number of other causes.
The choice of treatment will depend on your injury and the specific cause of the pain. Some examples of how to manage chronic pain include physical therapy, exercises and medications. These examples may not cure your pain but they may help to control or reduce the pain. Controlling pain can help you manage your day-to-day activities and enjoy a better quality of life.
If your pain continues, talk to your healthcare provider about other ways that are available to manage your pain to help with your daily living and overall quality of life. It is important that you consult with your healthcare provider to ensure that all possible reasons for the ongoing pain have been looked at.
Again, it is important to remember that at this stage you may have pain but that does not mean you are causing further harm; returning to a reasonably physically active lifestyle will help reduce your risk of a second fracture. If you are uncertain, see a Bone Fit™ trained healthcare professional in your area, or a healthcare provider such as a physical therapist or occupational therapist, or talk to your doctor.
The Bone Fit™ trained healthcare professionals in your area, doctor or other healthcare provider can advise you about what is reasonable for you to expect for your recovery. Your healthcare team will help reduce your risk of a second fracture.
What to expect from some specific types of fractures
The four most common sites for broken bones due to osteoporosis are the wrist, the shoulder, the hip and the spine. Bones in the spine are called vertebrae.
A broken wrist or a shoulder fracture from osteoporosis may occur when someone falls with their arm outstretched to break the fall. The impact may cause the forearm bone to break near the wrist, or it can cause the upper arm bone to break near the shoulder. These types of fractures can cause severe pain, which often results in a trip to the emergency room. X-rays are often taken to identify if and where a fracture has occurred. In most cases, a cast, splint or sling is used to prevent the bone from moving while the break heals, but sometimes, surgery is required. Your doctor will recommend exercises or referral to a physical therapist once it is time to begin restoring movement and strength.
Hip fractures from osteoporosis are usually the result of a fall and most commonly occur in people in their late 70s or 80s. A broken hip will require hospitalization and will often require an operation to repair the break. Most hospitals have a plan for rehabilitation that follows hip surgery. If you have broken your hip, you are at high risk for any other kind of fracture from osteoporosis, including another broken hip. To reduce the risk of fractures, medication, a calcium-rich diet and adequate vitamin D supplementation are recommended.
A hip fracture will affect all aspects of your daily life. Medication can be used to manage your pain. Physical therapists will recommend bed exercises to increase strength and range of motion right after surgery. They will also encourage you to stand and walk with a walker as soon as possible.
Occupational therapists are healthcare workers trained to assist you to learn ways to restore independence with daily tasks such as getting dressed, bathing or preparing a meal. As you continue to heal, a physical therapist will teach you exercises to strengthen the muscles that support and control the hip joint. A physical therapist or occupational therapist may recommend that you use assistive devices such as a raised toilet seat, a long-handled reacher, a sock aid, a long-handled sponge, a shower chair or a transfer bench, a bed pan or woman’s urinal, and other items to make activities of daily living easier for you to do.
After hip surgery, avoid movements that bend the hips more than 90 degrees, such as raising your knee higher than hip level even when you are sitting, or leaning too far forward, or crossing your legs. Your recovery will depend on how well you were able to function and your general state of health before the fracture. Regular physical activity is encouraged to improve your quality of life and to help reduce your risk of another fracture.
Broken bones in the spine are referred to as vertebral compression fractures or spine fractures. The spine is one of the most common sites of broken bones as a result of osteoporosis. Imagine each bone in your spine as a square block. When the bone breaks, it is like the “box” becomes squashed or compressed or flattened.
A spine fracture can happen very suddenly as a result of a fall, or something more minor such as sneezing, coughing, reaching, lifting or carrying. Some spine fractures do cause pain. The pain can vary from mild to severe pain in the back. This pain may bring about a visit to the hospital or doctor’s office where an X-ray may confirm a broken bone in the spine.
Two-thirds of broken bones in the spine happen without causing any pain at all and are found either:
- on an X-ray for another purpose, or
- because your healthcare provider thinks you may have lost height.
Painless spine fractures are just as important as painful ones. If you have had a broken bone in your back that was caused by osteoporosis, whether it was painful or not, you need osteoporosis treatment to reduce your risk of another fracture. Treatment will include medication, a calcium-rich diet, adequate vitamin D supplementation and exercise.
A broken bone in the spine will go through the same stages of healing as any other broken bone. If the break is painful, medication to reduce the pain is usually prescribed during the acute stage. You may or may not be admitted to the hospital for the first few days of this stage. Admission to hospital will depend on the severity of your pain and the severity of the fracture. There are other procedures that your healthcare provider may suggest called kyphoplasty or vertebroplasty.
During the recovery process, it is important to remember that all pain hurts but not all pain is harmful. A consultation with a physical therapist or healthcare worker familiar with broken bones can help to guide you through your recovery process.
During the recovery process, many types of movement may be painful even when you use correct movement techniques. An important part of your recovery is to learn to carry out safe movement techniques that are done in a way that does not put any additional strain on the spine.
Take charge: manage your pain!
- If you have pain, your doctor may prescribe medication to reduce pain. Pain usually gets better as you heal.
- In order for a broken bone to heal, it may need a cast, a brace, a splint, surgery or a combination of treatments. Your doctor will discuss the plans for your treatment and follow-up. Healing can take a couple of months or longer, depending on your health and the type of injury.
- During this time, your doctor will give you instructions about rest and movement. You may need to work with a physiotherapist, kinesiologist or other fitness professional to learn to move safely and get back to your normal activities. If needed, your therapist will recommend assistive devices such as a cane or walker and show you how to use them safely.
Eating healthy foods that give you enough protein and calcium and taking vitamin D supplements will not directly affect your pain. It will help you heal and reduce the risk of another fracture.
Review your chart to see if your pain is getting better, and what actions help ease your pain. If you cannot manage your pain or it gets worse, call your doctor.