What are the next steps in my rehabilitation as a patient with a forearm injury, currently using a sling to keep my wrist extended and able to perform finger movements with ease?

Next Steps in Forearm Injury Rehabilitation

You should now transition away from the sling and begin active wrist extension exercises combined with resistance training for your fingers, avoiding prolonged wrist extension positioning that the sling creates. 1, 2

Immediate Action: Discontinue Prolonged Sling Use

• Stop keeping your wrist continuously extended in the sling, as prolonged positioning of joints at end ranges can exacerbate symptoms and impede recovery 1, 2, 3
• The Journal of Neurology, Neurosurgery and Psychiatry explicitly warns that splinting and prolonged immobilization may prevent restoration of normal movement, increase accessory muscle use, lead to muscle deconditioning, and promote learned non-use 3
• Your ability to perform finger opening and closing with ease indicates you have sufficient motor recovery to progress beyond passive positioning 1

Core Rehabilitation Protocol

Task-Specific Wrist Practice

• Begin intensive task-specific training focusing on wrist extension and flexion movements through functional activities that progressively challenge wrist control 1, 2
• Progress from supported (table-based) to unsupported wrist movements as your motor control improves 1
• Engage in tasks that promote normal movement patterns with good alignment during functional activities, such as placing your hand on a kitchen counter while standing to prepare food rather than letting it hang by your side 3

Resistance Training Protocol

• Start with low-intensity resistance at 40% of your 1-repetition maximum with 10-15 repetitions 1, 2, 4
• Progress to moderate intensity (41-60% of 1-RM) with 8-10 repetitions when 15 repetitions become only somewhat difficult (Borg RPE 12-14) 1, 2, 4
• Perform resistance training 2-3 times per week to allow adequate recovery between sessions 1
• Do not progress resistance too quickly—starting with very low intensity during initial sessions prevents muscle damage 1

Flexibility Training

• Perform static stretches held for 10-30 seconds with 3-4 repetitions for each stretch 1, 2, 4
• Continue flexibility training 2-3 times per week in conjunction with resistance work 1, 2

Adjunctive Therapy Option

Functional Electrical Stimulation (FES)

• Consider applying FES to your wrist and forearm extensor muscles if you have demonstrated impaired muscle contraction 1, 4
• FES should be used as an adjunct to motor practice, not as standalone treatment, to enhance motor control and reduce motor impairment 1, 4
• The World Stroke Organization and American Heart Association recommend FES specifically for patients with wrist motor impairment when combined with task-specific training 1

Expected Timeline and Monitoring

• Continue this rehabilitation program for 9-12 months depending on your return-to-work or functional goals 1, 2, 4
• Most motor recovery gains occur within the first 6 months, making this a critical window for intensive rehabilitation 1
• Rapid symptom relief typically occurs within 3-4 months with structured rehabilitation, with maintenance of gains over 12 months 1
• If you experience unremitting pain during follow-up, you should be reevaluated immediately 3, 4

Critical Pitfalls to Avoid

• Never rely on passive range of motion alone—active motor practice is essential for recovery 1
• Avoid nursing or protecting the affected limb; instead, use it actively in functional tasks to prevent learned non-use 3
• Do not use compensatory movement strategies or allow accessory muscle overactivity 3
• The absence of motor function beyond what you currently have will not spontaneously improve without structured resistance training and task-specific practice 1