Starting Physical Therapy at 6 Weeks Post-Humerus Fracture
At 6 weeks post-injury, your patient can and should already be doing physical therapy—in fact, she should have started much earlier. For most humerus fractures, PT should begin within days to 2 weeks after injury, not at 6 weeks 1, 2.
Timing Based on Fracture Location
Proximal Humerus Fractures
- Start immediately to within a few days for minimally displaced fractures 3, 1
- Immobilization for only 1-2 weeks maximum, then begin functional exercises 4
- Immediate PT produces significantly better outcomes than delayed rehabilitation: patients starting immediately had 42.8% disability at 1 year vs. 72.5% in those who waited 3 weeks 1
- Even comparing immediate vs. 1-month delay shows no harm from early mobilization 3
- Greatest functional improvement occurs between 3-8 weeks post-injury 5
Humeral Shaft Fractures
- Earlier surgery = earlier PT = better outcomes 6
- When surgery performed early: PT starts at mean 6.5 weeks (range 5-12 weeks) 6
- When surgery delayed: PT starts at mean 10 weeks (range 6-14 weeks) 6
- Delayed PT means delayed recovery and return to daily life 6
- For conservative treatment: immobilization 3-6 weeks depending on fracture type, then begin exercises 7
Critical Clinical Decision Points
Your patient at 6 weeks should be:
- Already doing active range of motion exercises
- Working on functional activities
- Progressing toward full shoulder mobility
Red flags requiring caution:
- Radial nerve palsy (occurs in ~4% of shaft fractures) - still do PT but modify approach 7
- Unstable fracture pattern on exam
- Signs of nonunion (rare before 6-8 weeks) 4
Type of PT Matters Less Than Timing
Supervised formal PT vs. self-directed exercises show comparable outcomes 2:
- A single advice session on gradual return to activities can be as effective as supervised rehabilitation
- Self-training with follow-up control produces equivalent results to conventional PT 5
- This means the barrier to starting PT should be very low
Common Pitfall to Avoid
The biggest mistake is waiting too long. The outdated approach of prolonged immobilization (>3 weeks) leads to:
- Increased shoulder disability that persists for years 1
- Delayed bone union 6
- Prolonged recovery time 6
At 6 weeks, bone union typically occurs around 6-8 weeks for proximal fractures 4 and exercises should continue beyond bone union for optimal functional recovery.
Your patient is already in the window where she should be actively rehabilitating. Start PT now—whether formal supervised therapy or structured self-directed exercises with periodic assessment.