Cross-education after forearm fracture: a randomised controlled trial

This study aimed to examine whether isokinetic exercises applied to the intact wrist could reduce muscle strength loss and prevent the development of Complex Regional Pain Syndrome (CRPS) type I in adults with distal radius fractures.

Forty-two patients with distal radius fractures were randomized into two groups: a Cross-Education (CE) group (n = 21) and a control group (n = 21). Both groups received a standard home exercise program. In addition, the CE group performed 12 supervised sessions of isokinetic wrist strengthening exercises on the non-fractured side during the immobilization period. After cast removal, isometric muscle strength of the fractured wrist was evaluated, and patients were monitored for the development of CRPS type I.

The CE group showed significantly higher isometric muscle strength in wrist flexors and extensors compared with the control group (wrist flexors: d = 0.73, p = 0.024; wrist extensors: d = 0.87, p = 0.008). Furthermore, the incidence of CRPS type I was significantly lower in the CE group (p = 0.03).

Cross-Education training applied during immobilization can prevent muscle weakness and decrease the risk of CRPS in fracture rehabilitation.

These findings highlight CE as a safe and effective early intervention strategy that may enhance functional outcomes and reduce complications in patients with distal radius fractures.