By the Meglio Editorial Team
Meglio is an established UK supplier of physiotherapy, rehabilitation and clinic essentials — NHS supplier, latex-free across the range, with QIMA accredited-lab durability testing on the resistance-band core range and 1,415 verified reviews on Judge.me. This guide is written and reviewed against the cited UK clinical guidelines (NICE, Cochrane, NHS, CSP, BAHT and BOAST 11 where applicable).
This hand therapy putty protocol after distal radius fracture sets out a clinically structured, BAHT-aligned progression for UK occupational therapists, physiotherapists, ESPs and NHS outpatient hand-therapy teams. It maps putty grade and exercise dose to each phase of post-fracture rehab — from immobilisation through return-to-function — and is anchored to BOAST 11, NICE NG38 and consensus BAHT pathways.
The hand therapy putty protocol after distal radius fracture: stage-by-stage
This guide is the working version of the hand therapy putty protocol after distal radius fracture now used in UK clinical practice. Skim the TL;DR for the headline points, or read top-to-bottom for the full protocol, evidence base and procurement spec.
TL;DR
- Stage 1 (Week 0–6, immobilisation): no putty load through the wrist. Tendon glides, adjacent-joint AROM, oedema control, scar prep if surgical.
- Stage 2 (Week 6–8, early ROM post-cast): introduce extra-soft (typically yellow) putty for finger flexion/extension and IP isolation. Pain-free, low-load.
- Stage 3 (Week 8–12, strengthening): progress through soft (red) → medium (green) → firm (blue) grades. Pinch, key-grip, opposition, gross grip, wrap/squeeze. 2–3 sets x 10–15 reps, daily.
- Stage 4 (Week 12+, return-to-function): firm (blue) and extra-firm (black) grades; task-specific loading and return-to-work assessment.
- Procurement note: for shared NHS outpatient clinics, rotate single-patient pack-of-5 colour-coded putty sets rather than communal tubs to maintain infection control.
Context & audience: distal radius fracture in UK hand-therapy practice
The distal radius fracture (DRF), classically the Colles' fracture, is the most common upper-limb fracture seen in UK fracture clinics — and the single highest-volume referral into NHS outpatient hand-therapy departments. Incidence peaks bimodally in young adults (high-energy mechanisms) and post-menopausal women (low-energy falls onto an outstretched hand), with the NHS estimating tens of thousands of presentations per year (NHS — broken arm or wrist).
Management is governed by BOAST 11 (British Orthopaedic Association Standard for Trauma — distal radius fractures) and NICE NG38 (Fractures: assessment and management). Whether the fracture is managed conservatively in a cast or surgically with ORIF, the rehab pathway converges on the same hand-therapy challenge: restore wrist and hand range of motion, rebuild grip and pinch strength, control oedema and scar, and return the patient to functional and occupational tasks.
Hand therapy putty is a low-cost, infinitely-graded, easily-cleaned resistance medium that sits in nearly every UK hand-therapist's kit for exactly this reason. The five colour-coded resistance grades let you progress load in small, defensible increments — something neither dumbbells nor resistance bands manage well at the wrist and finger level. This guide is for the clinicians delivering that progression: HCPC-registered OTs and physiotherapists working in NHS outpatient hand-therapy, ESP / FCP roles, community OT, and private hand-therapy practice. For the broader product-level overview, see our companion piece on hand therapy putty benefits, uses and rehabilitation applications.
The evidence base for putty-led progression
The strongest synthesis of rehabilitation evidence after distal radius fracture is the Cochrane review by Handoll and Madhok (most recently updated as Rehabilitation for distal radial fractures in adults — see the PubMed-indexed Cochrane summary). The review concludes that evidence for any single rehab modality is limited, but supervised, progressive, task-relevant exercise — including resisted hand and wrist work — is consistently recommended over passive treatment alone. Putty progression fits squarely inside that recommendation: graded, supervised, measurable, and adaptable to the patient's pain envelope.
This dovetails with CSP (Chartered Society of Physiotherapy) hand-therapy resources and Royal College of Occupational Therapists standards, both of which emphasise active, individualised loading rather than protocol-rigid time-based progression. The British Association of Hand Therapists (BAHT) articulates this as a 4-stage clinical pathway, and the cross-reference resource on Distal Radius Fracture management at Physiopedia is a useful free-access summary for trainees rotating through the service.
Putty grades: what each colour means clinically
Meglio's hand therapy putty (and most UK clinic ranges) uses the standard hand-therapy colour code. Match grade to clinical phase rather than to patient preference — patients will routinely under-load themselves if asked to self-select.
| Grade | Typical colour | Clinical use | Stage |
|---|---|---|---|
| Extra-soft | Yellow | Earliest AROM, oedematous hand, very weak intrinsics, paediatric and frail elderly | 2 |
| Soft | Red | Early strengthening; first putty load post-immobilisation in most adult DRFs | 3 (early) |
| Medium | Green | Mid-stage strengthening; manual workers, sports rehab transition | 3 (mid) |
| Firm | Blue | Late-stage strengthening; manual occupations, return-to-work prep | 3 (late) / 4 |
| Extra-firm | Black | End-stage power and endurance; trades, climbing, lifting roles | 4 |
Stage 1 (Week 0–6): immobilisation phase
While the wrist is in a cast or post-operative splint, putty work through the radiocarpal joint is contraindicated. The clinical priority is keeping the rest of the upper limb mobile, controlling oedema, and preventing the stiff-finger / shoulder-hand syndrome that creates the worst long-term outcomes after DRF.
What to prescribe in Stage 1
- Tendon glides (straight, hook, fist, table-top, straight-fist) — 10 reps, every waking hour.
- Finger AROM within the cast — full composite fist and full extension. Most patients lose this within 48 hours of casting if not coached.
- Shoulder, elbow, neck AROM — 2 sets of 10 each, twice daily. This is where hand therapists routinely under-prescribe.
- Oedema control — elevation above heart, retrograde massage, light cohesive bandage wrap where appropriate.
- Patient education — red flags for compartment syndrome, CRPS / complex regional pain syndrome (intense disproportionate pain, vasomotor changes, allodynia).
Putty itself stays out of the protocol at this stage. If the patient asks for "something to squeeze," issue an extra-soft tub only for finger-only work with the wrist supported and explicitly de-loaded — and document that decision.
Stage 2 (Week 6–8): early ROM post-cast
Cast removal is the highest-yield window in DRF rehab. Stiffness, pain, and weakness are all maximal; the patient's motivation is usually maximal too. This is the right moment to introduce putty — but only the extra-soft (yellow) grade, and only for finger-led drills. Wrist loading remains submaximal and pain-guided.
Stage 2 putty exercises (extra-soft / yellow)
- Finger extension against putty wrap — wrap putty around the dorsum of the fingers and extend MCPs/IPs into it. 2 sets x 10 reps.
- IP isolation flexion — small ball of putty in the palm, isolate DIP and PIP flexion of each digit. 1 set x 10 each digit.
- Thumb opposition pinch — small bead of putty, tip-pinch to each fingertip. 2 sets x 10 reps.
- Gentle composite fist into putty — large soft ball, slow fist closure to tolerance. 2 sets x 10 reps.
Run putty alongside, not instead of, wrist AROM (flexion, extension, radial/ulnar deviation, supination/pronation), scar mobilisation (if ORIF), and continued oedema management. Pain at 2–4/10 during exercise is acceptable; pain that persists more than 30 minutes after a session indicates the load is too high.
Stage 3 (Week 8–12): strengthening phase
This is the phase where the colour-coded progression earns its keep. Most patients will move from soft (red) through medium (green) to firm (blue) across 4–6 weeks. Progress on objective measures — typically grip dynamometry, pinch meter, and pain-free ROM — rather than on the calendar alone.
Core Stage 3 putty exercises
- Gross grip squeeze — full-fist closure into a putty ball. 3 sets x 15 reps, slow eccentric on release.
- Pinch (tip / pad / lateral / key-grip) — three-jaw chuck, pulp-to-pulp, and key-grip variations. 2 sets x 12 reps each.
- Finger spread (intrinsics) — wrap putty into a "donut" around all five digits and abduct. 2 sets x 10 reps.
- Thumb opposition + adduction — bead of putty pinched between thumb and each fingertip in succession. 2 sets x 10 reps.
- Finger flick / extension burst — putty resists individual digit extension from a flexed MCP. 2 sets x 10 reps per digit.
- Wrap / squeeze with wrist neutral — putty ball in palm, gentle wrist deviation drills layered in. 2 sets x 12 reps.
Frequency: daily home programme of approximately 15–20 minutes, plus supervised clinic session 1–2x per week. Step up to the next colour when the patient completes 3 sets of 15 reps with good form, no compensatory wrist or shoulder hike, and pain < 3/10.
Concurrent kit that pairs well at this stage includes graded grip work with Meglio Hand Massage Eggs for sustained grip endurance, and proximal loading with light-resistance bands — see our resistance band exercises for back and shoulders guide for the scapular and rotator-cuff drills most DRF patients also need.
Stage 4 (Week 12+): return-to-function
By 12 weeks most uncomplicated DRFs can tolerate firm (blue) and, where occupationally relevant, extra-firm (black) putty. Stage 4 is where the protocol pivots from impairment-level work to participation-level work. Putty is no longer the centrepiece; it is one input among task-specific loading drills.
Stage 4 priorities
- Task-specific loading — replicate the patient's job, sport, or domestic tasks. Manual handling tests for return-to-work; carrying, gripping, lifting drills.
- End-range loaded wrist — putty work at full flexion and extension, with the wrist taking some load.
- Endurance over peak — high-rep, low-rest putty drills (e.g. 3 sets x 25 reps grip squeeze with 30-second rest) build the staying power most manual workers actually need.
- Power for athletic populations — fast eccentric and ballistic finger extension drills; combine with sport-specific drills.
- Outcome measurement — grip and pinch dynamometry against the unaffected side, PRWE or QuickDASH PROMs, and a job-relevant functional task at discharge.
Concurrent interventions: oedema, scar, splinting, neural mobs
Putty progression sits inside a wider rehab plan that, done well, includes:
- Oedema management — retrograde massage, light compression (e.g. Coban / cohesive bandage), elevation. Bulk cohesive options for clinic stock are covered in our resistance and strapping catalogue.
- Scar management (ORIF cases) — silicone, scar massage from 2 weeks post-suture removal, desensitisation work.
- Splinting — volar wrist support for night-time or activity, dorsal blocking splints in selected cases (e.g. after concomitant tendon repair). The 2025 BSSH / BAHT consensus on splinting after DRF is summarised by the British Society for Surgery of the Hand.
- Neural mobilisations — median nerve glides where the patient has paraesthesia, particularly common in DRFs with significant initial swelling.
- Proximal kinetic chain — shoulder, scapular and even cervical work; a stiff, deconditioned shoulder will undermine any hand-level gain.
Hygiene and infection control for shared-clinic putty
Putty is porous, warm, and inherently a shared resource in NHS outpatient clinics — which makes infection control non-trivial. UK hand-therapy departments generally adopt one of three models:
- Single-patient issue (best practice): each patient is issued their own colour-coded tub, takes it home, and brings it back for progression. The Meglio pack-of-5 colour-coded set is designed for this workflow — one pack progresses a single patient across the full DRF rehab cycle.
- Rotating in-clinic tubs with strict hand-hygiene protocols: alcohol gel before and after, putty replaced on a fixed rotation, and tubs withdrawn if any patient is symptomatic or has open skin lesions.
- Single-use tubs for in-clinic sessions using the 57g single-tub Meglio Hand Therapy Putty — economic enough at clinic procurement pricing to issue and discard if needed.
Whichever model your service uses, document it. Mymeglio supplies hand-therapy putty into NHS outpatient hand-therapy departments and can confirm latex-free formulation and bulk procurement pricing — see Meglio for the NHS for the procurement and account-setup pathway, and Meglio reviews for verified clinician feedback.
Order Putty Pack-of-5 for Clinic
When to escalate back to the surgical team
Hand-therapy outpatient services see the bulk of post-DRF recovery, but the threshold for re-referral to orthopaedics or the hand surgery team should be low. Red flags that warrant same-week escalation include:
- Sudden loss of digital extension (concern for EPL rupture, classically 6–8 weeks post-injury in non-displaced fractures).
- New or escalating median nerve symptoms suggestive of acute carpal tunnel syndrome.
- Disproportionate burning pain, allodynia, vasomotor or sudomotor changes (CRPS — early diagnosis materially changes outcome).
- Visible deformity, gross loss of motion plateau beyond 8 weeks, or palpable hardware prominence.
- Wound concerns, suspected infection, or non-healing scar in ORIF cases.
- Any imaging concern raised at the routine 6-week fracture-clinic review.
Procurement: 57g single tubs vs pack-of-5
The two most common Meglio SKUs in UK hand-therapy practice are the 57g single tub and the pack-of-5 colour-coded set. The right call depends on caseload model:
- Pack-of-5 colour-coded set — best for services that issue putty to the patient at first appointment and progress them through grades on their home programme. One purchase covers the full rehab cycle for one patient and removes the awkward "I've outgrown the soft tub, can I have a green one?" conversation at every session.
- 57g single tub — best for in-clinic-only services, services running rotating tubs, and any setting where you want to top up a specific grade (typically green and blue, the workhorses of Stage 3).
For mixed services — most NHS outpatient departments fit this category — a sensible standing order is a pack-of-5 per active DRF caseload patient plus a buffer of green and blue 57g tubs for the rotation pool. Pricing, latex-free formulation and clinical-grade quality are documented on the product pages linked above; the NHS supplier page covers framework purchase, bulk discounts and ProcureWizard / NHS Supply Chain ordering routes where relevant.
FAQs
When can I start a hand therapy putty protocol after distal radius fracture?
Finger-only putty work with an extra-soft (yellow) tub can usually start within 24–48 hours of cast removal, typically around week 6 post-injury. Loaded wrist work through putty waits until pain-free wrist AROM is reasonable, normally weeks 7–8. Earlier finger-only putty (with the wrist explicitly de-loaded) is occasionally appropriate in non-displaced fractures or during in-cast care, but document the decision.
How do I choose putty grade after a Colles' fracture?
Match grade to clinical phase, not patient preference. Start at extra-soft (yellow) at Stage 2, progress to soft (red) once finger AROM is full and pain-free, then to medium (green) and firm (blue) across Stage 3 based on objective grip and pinch measures. Extra-firm (black) is reserved for end-stage Stage 4 patients with manual occupations or athletic demands.
How many reps and sets of hand therapy putty exercises per day?
Stage 2: 1–2 sets of 10 reps per drill, daily. Stage 3: 2–3 sets of 12–15 reps per drill, daily, with a supervised clinic session 1–2x per week. Stage 4: 3 sets of 15–25 reps with shortened rest for endurance, plus task-specific loading. Total daily putty time is typically 15–20 minutes — more than that and adherence drops sharply.
Is hand therapy putty safe for older patients with a fragility distal radius fracture?
Yes, with the same staged approach but slower progression and earlier outcome-checks. Older fragility-fracture patients tolerate yellow and red grades well; many will not progress beyond green. Pair putty with falls-prevention work and a wider osteoporosis review under NICE NG38. Avoid extra-firm grades unless return-to-function genuinely demands it.
What infection-control protocol do NHS outpatient hand-therapy clinics use for shared putty?
Best practice is single-patient issue — each patient is issued their own colour-coded tub (commonly a pack-of-5) and takes it home for the rehab cycle. Where putty must be shared, services typically run a rotating tub system with strict hand hygiene before and after, withdrawal of tubs from patients with open lesions, and a documented replacement schedule. Putty is porous and cannot be wiped down; do not treat it like couch roll or hard-plastic kit.
Can I use hand therapy putty alongside splinting after a distal radius fracture?
Yes, and most patients will. Volar wrist splints for night-time or activity protection are common into Stage 3; putty work happens out of splint, in protected positions, and the splint goes back on after the session. Dorsal blocking splints (e.g. after concomitant tendon repair) impose specific putty restrictions — clear those with the operating hand surgeon. The British Society for Surgery of the Hand publishes consensus splinting guidance.
When should I refer a hand therapy patient back to the orthopaedic or hand surgery team?
Same-week referral for sudden loss of digital extension (possible EPL rupture), new median nerve symptoms (possible acute carpal tunnel), disproportionate burning pain or vasomotor changes (possible CRPS), visible deformity, hardware concerns in ORIF cases, or a motion plateau beyond 8 weeks without progress. BOAST 11 sets out the expected interface between hand therapy and the trauma team.
Conclusion
A defensible hand therapy putty protocol after distal radius fracture is not "give them a tub and see them in two weeks." It is a four-stage progression mapped to the BAHT pathway, anchored in BOAST 11 and NICE NG38, dosed by colour grade and rep scheme, and adapted to the patient's surgical history, occupation and comorbidities. Done well, it gets manual workers back to the trades and older patients back to independent living — and it does so on the cheapest, most adaptable piece of kit in the hand therapist's bag.
For services standing up or refreshing their hand-therapy stock, Meglio supplies the 57g single tubs and pack-of-5 colour-coded sets into NHS outpatient hand-therapy departments and private practice. Latex-free, clinical-grade, and procurement-ready. See Meglio for the NHS for framework and bulk-buy routes.
Clinical disclaimer. This article is intended for qualified healthcare professionals and is not a substitute for clinical training or professional judgement. Always apply evidence-based practice, work within your professional scope, and refer patients to appropriate specialists where indicated. Patient-facing guidance must be individualised and supervised.
About this guide
This guide is written and reviewed by the Meglio Editorial Team against the cited UK clinical guidelines (NICE, Cochrane, NHS, CSP, BAHT, BOAST 11, RCOT and BSI standards where applicable). Meglio is an established NHS supplier of physiotherapy, rehabilitation and clinic essentials — latex-free across the range, with QIMA accredited-lab durability testing on the resistance-band core range and 1,415 verified reviews on Judge.me. For clinical sign-off on bespoke procurement specs, white-label rollouts or tender returns, contact our NHS Solutions team.