69.14 Active movements means active movements!

All fractures need some exercises from the first week onwards, if not before. Fractures must thus be firmly associated with exercises in the minds of everyone—including the patient. The decision to treat fractures by non–operative methods is thus not a decision to do nothing! Enthusiasm for exercises is a critical part of this method. Exercises are usually necessary for the injured joint itself, and are always important for the normal joints on either side of it. If these joints are not used, even for a few days, they soon become stiff. Encouraging, cajoling, and even bribing and bullying all have their place.

Who is to encourage the patient to move his joints? Few district hospitals have a physiotherapist, and even the elements of physiotherapy are not yet part of any nursing curriculum. So the responsibility is yours, as you go round the ward, to make sure that the patients do their exercises. Your staff must see the patients doing their exercises, and really care that they are done. Exercises are no less important with out–patients. Teach the exercises using examples of each kind of injury, and let your staff see you demonstrating them. Merely telling your nurses and medical assistants to get the patients exercising is not enough. Show them just how much trouble you are prepared to go to yourself.

Here are some exercises which all ward staff should know and teach patients. Carefully supervised walking is an important leg exercise and is discussed in Section 8.1. Active movements may be painful, especially to begin with, so ease the patient’s pain with plenty of aspirin and persist in your persuasion.