OBJECTIVE: To evaluate the effects of cross-education (contralateral effect of unilateral strength training) during recovery from unilateral distal radius fractures on muscle strength, range of motion (ROM), and function. DESIGN: Randomized controlled trial (26 week follow-up). SETTING: Hospital, orthopeadic fracture clinic. PARTICIPANTS: Women over age 50 with a unilateral distal radius fracture. INTERVENTIONS: Participants were randomized to standard rehabilitation (control), or standard rehabilitation plus strength training (train). Standard rehabilitation included forearm casting for 40.4 (+/- 6.2days), and hand exercises for the fractured extremity. Non-fractured hand strength training for the training group began immediately post fracture, and was conducted at home 3 times/week for 26 weeks. MAIN OUTCOME MEASURES: The primary outcome measure was peak force (handgrip dynamometer). Secondary outcomes were ROM (flexion/extension; supination/pronation) via goniometer and the Patient Rated Wrist Evaluation Questionnaire (PRWE) for the fractured arm. RESULTS: Fifty-one participants were randomized and 39 participants were included in the final data analysis. For the fractured hand, the training group (17.3 +/- 7.4kg) was significantly stronger than the control group (11.8 +/- 5.8kg) at 12 weeks post-fracture; p < 0.017. There were no significant strength differences between the training and control groups at 9 (12.5 +/- 8.2kg; 11.3 +/- 6.9kg) or 26 weeks (23.0 +/- 7.6kg; 19.6 +/- 5.5kg) post-fracture, respectively. Fractured hand ROM showed the training group had significantly improved wrist flexion/extension (100.5 +/- 19.2 degrees) than the control group (80.2 +/- 18.7 degrees) at 12 weeks post-fracture; p < 0.017. There were no significant differences between the training and control groups for flexion/extension ROM at 9 (78.0 +/- 20.7 degrees; 81.7 +/- 25.7 degrees) or 26 weeks (104.4 +/- 15.5 degrees; 106.0 +/- 26.5 degrees) or supination/pronation ROM at 9 (153.9 +/- 23.9 degrees; 151.8 +/- 33.0 degrees), 12 (170.9 +/- 9.3 degrees; 156.7 +/- 20.8 degrees) or 26 weeks (169.4 +/- 11.9 degrees; 162.8 +/- 18.1 degrees), respectively. There were no significant differences in PRWE between the training and control groups at 9 (54.2 +/- 39.0; 65.2 +/- 28.9), 12 weeks (36.4 +/- 37.2; 46.2 +/- 35.3) or 26 weeks (23.6 +/- 25.6; 19.4 +/- 16.5), respectively. CONCLUSIONS: Strength training the non-fractured limb after a distal radius fracture was associated with improved strength and ROM in the fractured limb at 12 weeks post-fracture. These results may have important implications for rehabilitation strategies following unilateral injuries.

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