1st Phase: Protection and initial healing
A broken collarbone causes a lot of pain and it feels impossible to simply move your injured arm. The collarbones serves as a link between the arm and the body, therefore each time you and move your arm you feel pain. In this phase rest, ice application and the use of a sling to minimize the amount of movement and load on your injured collarbone. The main concern is to prevent continuous inflammation and pain.
Avoid using anti-inflammatory medication continuously. If you have severe pain, try to rather use medication without an anti-inflammatory component. That way, your pain will be under control, you’ll be able to get enough sleep and you’ll be able to move. Once the pain is under control, you can reduce the use of your medication and eventually stop taking it completely.
Use strapping to support your shoulder joint shift the load to other areas.
It is important to understand what you should and shouldn’t do. You can make better decisions if you know what’s going on.
2nd Phase: Establish pain free range of movement
During your physical examination, it will become clear what kind of movements you are able to do, and what you should avoid. When you remove your arm from the sling you should aim to move the arm through full range of motion without pain. Some of these movements include:
- Open and close your hand.
- Move your wrist up and down.
- Bend and straighten your elbow.
- With a bent elbow rotate your forearm with your hand palm facing up and then facing down.
- Make small circular movements from your shoulder while your affected arm is hanging freely.
This is known as your pain free range of movement. You are safe to move within this range and initially our exercises will be targeted between these boundaries of your pain. The aim is that, with time, your pain-free range of movement improves and painful movements become less intense. With these pain free movements you are also ensuring that the other joints of the arm don’t become stiff and weak because of the immobilization in the sling.
3rd Phase: Tissue healing
During this phase of treatment, we monitor the progress of healing and the formation of new bone and scar tissue. With or without surgery, there will be scar tissue and bone that needs to heal well. If neglected, scar tissue can become thick and painful and can even restrict your movement.
On a cellular level we’re able to accelerate tissue healing using dry needling, laser and ultrasound. As healing takes place, we want to see improvement of your pain, and improvement in your ability to move your shoulder and arm muscles.
4th Phase: Soft tissue, bone and joint stress
During this phase of collarbone fracture treatment we will evaluate to see if your collarbone, shoulder joint and shoulder and neck muscles are able to handle tensile, elastic and compression forces. Your collarbone and shoulder joint should get used to the load when lifting the arm away from the body and then also when lifting a heavy object. And your shoulder and neck muscles should be able to contract adequately to give your shoulder the necessary stability.
We start with small steps and minimal weight bearing and gradually get you used to more. We will use isometric muscle contractions with your initial exercises. During this phase of your treatment, you should be able to lift the injured arm with a straight elbow away from your body to the side or front to at least shoulder height. Be able to use the injured arm for light activities below shoulder height with no pain for example eating or writing.
5th Phase: Full range of movement
To regain full range of motion of your shoulder, will be a very important component of collarbone treatment. Your shoulder joint should be able to stretch to the end of its range in all directions.
Scar tissue can cause restrictions and irritation to the surrounding soft tissue. So, it must be lengthened and orientated to allow a smooth shoulder joint movement and smooth contractions of the muscles around your collar bone. We will help you to stretch more, move further and work into your pain. For this we use massage, stretches and joint and nerve mobilizations to achieve full range of movement.
Now, you should be able to lift the injured arm with a straight elbow away from your body to the side or front beyond shoulder height. Even if you need some assistance to achieve this range, you should be able to put the room’s light switch on, or be able to comb your hair.
6th Phase: Muscle strength
This phase of collarbone fracture treatment will focus on strengthening shoulder, back and neck muscles. Repeated contraction of muscles, improves their strength. Stronger muscles have the capacity to work harder and can help to carry the load while keeping your shoulder stable.
Reaching for an object on a shelf above your head, throwing a ball, pulling a car door open and reaching for the seatbelt are some of the basic activities that you will want to get back to. To do these activities with ease, you will need the necessary strength. We will progress your exercises by adding resistance, doing more repetitions and using functional movements as part of your strengthening program. At the end of this phase you should be able to hang the washing, throw a tennis ball and reach for a book on the top shelve.
7th Phase: Shoulder stability and arm movement
It is one thing to feel your muscles get stronger, but another thing to feel like you have control when you move. This is an extremely important component of treatment after your collarbone fracture. To ensure that you don’t overload your collarbone or shoulder joint in the future, you need to have good balance and stability.
Addressing and improving the way you move your arm is a good way to get you to it with more confidence and strength. With time you should be able to bounce a basketball on the floor. You should also be able to lower a fairly heavy object for example a lever arch file from the top shelf without one arm feeling weaker than the other.
8th Phase: Testing for return to activity
A big part of your recovery is to gradually return to your normal routine again. Now, we can determine if you are ready return to work or start exercising again. Your physiotherapist will guide you to re-engage in safe increments, and make adjustments where necessary. At the end of this phase your physiotherapist performs screening tests and medically clears you for return to work and sport.
9th Phase: Speed and power
Now that you’ve worked through the different phases of treatment after your collarbone fracture, we want to improve the power and speed of your movements. Certain activities like throwing and catching will require precise co-ordination, high power and speed. We need to ensure that your collarbone and shoulder muscles are able to keep up with the demands of your body.
Your physiotherapist will challenge you past your normal boundaries to determine how your body reacts to different forces. Ultimately you need to be able to throw a ball through a hoop, lift a kettlebell overhead, do a push up or even do a handstand again. All of this needs to happen in preparation for your return to your sport.
10th Phase: Sport specific training
This is the final stage of treatment in your recovery. Depending on your sport, your physiotherapist will tailor specific exercises to further improve your strength, endurance and technique.
A successful outcome is when you understand your condition, know how to prevent flare-ups and can participate at full power and speed, not to mention the benefits of minimizing your chance of future re-injury.