A fall on the outstretched hand (FOOSH) is a common occurrence and often results in a Colles' fracture, a fracture of the distal inch of the radius and ulna next to the wrist. Treatment is immobilisation in a splinting material such as Plaster of Paris for five to six weeks to allow healing of the bony fragments, followed by a variable period of rehabilitation depending on the severity of the fracture. The hand is extremely important functionally so the period in plaster is kept to a minimum to allow quick restoration of normal hand use, although a wrist splint can be used for a week or so, particularly in cases where there is significant pain on activity.

Once the hand is released from the Plaster of Paris the physiotherapist will check the healing process is progressing normally. Palpation of the fractured area firmly should cause no significant tenderness or pain, hand colour should be normal and there should be no excessive swelling of the area. Muscle wasting is common after immobilisation but should not be too great. The ranges of movement of the limb, while restricted in some planes, should not be severely reduced in many planes. Pain should not be severe or widespread nor come on with all movements of the wrist and hand.

Range of movement exercises are the first line of treatment for a physiotherapist, teaching exercise performance every two hours. Many colles' fractures do very well simply with regular end range exercise practice and do not need more sophisticated treatments. The physiotherapist checks any restrictions in shoulder and elbow movement then records the forearm rotations, supination and pronation, which are important functionally. The physiotherapist will then assess wrist flexion and extension, finger flexion and extension and thumb movements. Most commonly restricted movements are supination and wrist extension.

After the plaster comes off the wrist often feels vulnerable, partly because the plaster is seldom left on until the bone is entirely healed to prevent the onset of complications due to immobilisation. Physiotherapists may give the patient a futura type brace, a fabric brace with Velcro straps and a metal piece for the underside of the wrist to stiffen it. This is not meant to keep the wrist immobilised further but to support the wrist while the patient is performing functional activities and then to be removed for light activities and regular exercise performance.

Joint mobilisations are used commonly by physiotherapists to improve joint ranges of motion if the exercises do not improve this alone. Physiotherapists perform accessory movements, so called mobilisation techniques, whereby they move the patient's joint passively to re-establish the vital gliding and sliding movements. The midcarpal, radiocarpal (wrist) and lower radio-ulnar joints can be treated this way to increase the ranges, the physiotherapist fixing one part of the joint firmly as they move the other half. This can be done with gentle movements or much more strongly, pushing against the resistance of the stiff joint structures which are preventing full movement.

Wrist strengthening is usually accomplished by general use of the arm gradually more in normal daily life but there are occasions where this is not enough and more needs to be done. There are wrists which don't strengthen up and those who need more strength to perform manual jobs or heavy activities. A hand class can provide guidance to practice the many individual hand movements which must be worked to strengthen up the hand. Working at specially designed pieces of apparatus can work harden or strengthen the muscles involved in grasping, gripping, twisting, pulling, turning and fine hand function.

In some cases a pain syndrome can develop in the hand with tight swelling, poor joint motion, high pain and hypersensitivity, at which time a doctor's opinion is needed to exclude complications with the fracture such as non-union. Painkillers and contrast bathing are treatments for the pain, with self massage used for swelling and desensitising techniques for the abnormal sensibility. The patient should be clear that they have to go through significant pain to get their hand better again.