A phase-by-phase guide to restoring wrist flexion and extension from your earliest weeks of healing through full recovery.
Hands On Therapy-Miami, FL
March 22
If you’ve fractured your distal radius, whether you had surgery or were able to manage without it, wrist stiffness is one of the most common and frustrating parts of recovery. Not being able to bring your wrist up and down can feel defeating. The good news: there are evidence-informed techniques I use with my patients every day that make a real difference when applied at the right time.
Here is what to do, organized by where you are in your recovery timeline. Always check with your doctor or therapist before beginning any of these exercises, since healing timelines vary by injury severity and individual factors.
A note on timing
The phases below reflect general clinical guidelines. Your specific timeline may differ. When in doubt, confirm with your treating physician or therapist whether you have achieved clinical healing before advancing.
Phase 1
Active range of motion
Approximately weeks 1–4 while bones are still healing
In the early weeks, the bones are still knitting together. That means no pushing, no forcing, just gentle, active movement where your own muscles do the work. The goal is to keep the joint mobile and prevent scar tissue from locking things down.
Start by propping your forearm on a surface so your shoulder and elbow stay still. Isolating the wrist is harder than it sounds when everything is swollen and guarded a prop prevents your body from compensating.
Exercise 1: Flexion and extension with fingers open
With your forearm supported, let gravity bring your wrist down into flexion, then actively lift it up into extension. Do this with your fingers spread open and your thumb extended outward.
Here is why that matters: the muscles that open your fingers originate at the elbow, cross the wrist, and are among the most powerful wrist extensors in your arm. Your thumb muscles cross the wrist, too. By opening your hand fully, you recruit three major muscle groups instead of two essential ones when everything feels weak and stiff. Flexion (the downward direction) will feel easy because gravity is helping you. Extension (lifting up) is the hard part. Focus your effort there.
Exercise 2: Flexion and extension with a fist
Now make a fist and repeat the same motion. With the finger flexor tendons no longer crossing the wrist joint, you may actually find you can pull farther into extension, but it will feel noticeably weaker. That is completely normal. You are now training two muscle groups rather than three, and this variation helps each work in isolation.
Exercise 3: Dart throwers.
Hold a pen as though you are gripping a dart. Pull your wrist back toward your thumb side (radial deviation), then move it forward and down toward your pinky side (ulnar deviation) as if releasing a throw. This moves the wrist side-to-side in a safe, low-load arc.
A note on range: movement toward the pinky is naturally larger for everyone. Check your uninjured hand, and you will see the same asymmetry. Actively focus on pulling back toward the thumb side, since that direction has more anatomical structures in the way and needs extra attention.
Phase 2
Assisted stretching
Approximately weeks 6–8, once clinical healing is confirmed
Once your doctor or therapist confirms clinical healing, you can begin applying a gentle external load to the wrist. This is the phase where we introduce stretching, and the keyword is gentle. These techniques create a sustained stretch rather than a forced push.
The prayer stretch
Rest your elbows on a table, and place both palms together with fingers pointing upward. Slowly separate your elbows and let your hands slide downward, keeping your palms flat together the entire time. Hold for about 10 seconds. This is called the prayer stretch, and it is very effective for improving wrist extension.
From there, slide your elbows back together, let your wrist drop into flexion, and give a gentle push with the opposite hand. Hold for 5 seconds. Alternate: 10 seconds extension, 5 seconds flexion, repeat.
The biggest mistake with this stretch is letting the palms come apart, which eliminates the stretch. It is easy to cheat without realizing it, which is why I have moved away from making it my primary recommendation. But if it is your only option, it works well when done correctly.
Cleaning the wall (my favorite)
Place your palm flat on a wall and slide your arm upward until your armpit opens towards the wall. Hold for 5–10 seconds. This stretches both your wrist and your shoulder simultaneously. When you fractured your wrist, you fell on your whole arm, and the shoulder stiffened too. This stretch addresses both at once.
Then slide your hand back down the wall, keeping your palm flat against the surface the entire time. As your hand descends, the wall creates natural wrist extension without you having to push into it. Your bodyweight does the work. Hold for 5–10 seconds, then slide back up. Repeat.
I prefer this over the prayer stretch for most patients because the wall limits compensation; your body cannot quietly cheat its way around the stretch the way it can at a table.
Phase 3
Weight-bearing
12 weeks minimum, three months post-fracture
Your wrist needs to tolerate load not for fitness, but for everyday function. Pushing yourself up from a chair, a bed, or the floor requires a wrist that can bear weight through its full range. Without this final phase, end-range movement stays painful and restricted.
Table or floor weight-bearing
Start with your hands on a table, arms straight, and fingers and wrists extended. Slowly lean forward into your palms to get a wrist extension stretch. Then rock gently backward for wrist flexion. Alternate between the two directions, letting your own body weight create the stretch gradually.
As you build tolerance, progress to a hands-and-knees position on the floor, which increases the load. You can also alternate hands, one stretching while the other rests, since your non-injured hand has been compensating for months and will benefit from the movement too.
Beyond the wrist
Restoring wrist flexion and extension is only part of the picture. Full recovery also requires good finger mobility, full forearm rotation (supination and pronation), and shoulder mobility. When you fell and fractured your wrist, the impact traveled through your entire arm. Every part needs attention.
Don’t stop at 80%
Most people reach about 80% recovery, feel good enough, and stop. In my experience, that remaining 20% catches up with them eventually, often years later, as stiffness or weakness resurfaces. Full recovery is achievable for the vast majority of distal radius fractures. Work with a therapist who can guide you all the way there, and know that 100% is a realistic goal based on the type of injury you have.
Meet the team at Hands On Therapy.
Our clinicians are occupational therapists with specialized certifications dedicated to helping you recover without pills, injections, or surgery whenever possible.
Hoang “Juanita”
Owner & Founder · OT, CHT
Hoang is the owner of Hands-on Therapy Services and the force behind its founding vision, a therapy-owned practice where people with injuries can get real, hands-on help. Whether you’ve had surgery and want the best possible outcome, or you’re searching for a way to avoid pills, injections, and surgery altogether, this practice was built for you.
As an occupational therapist and certified hand therapist, Hoang is also the author of all the free guides offered on the site and the internationally sold book The Hands-on Approach: How to Get Rid of Hand and Shoulder Pain Without Pills, Injections, and Surgery.
Carole
Occupational Therapist · CLT
Originally from France and based in Miami for over 25 years, Carole is an occupational therapist and certified lymphedema therapist. Her background as a licensed massage therapist and yoga instructor gives her a distinctly holistic, patient-centered approach to care focused on helping each person regain their independence and quality of life.
Carole is trilingual in English, French, and Spanish. Outside the clinic, she teaches and practices yoga, volunteers at a local animal rescue, and enjoys time with her family, her dog, and two beloved cats.
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