Physiotherapy for Complex Regional Pain Syndrome (CRPS)

What is complex regional pain syndrome (CRPS)?

Complex regional pain syndrome (CRPS) is a disabling condition marked by severe, disproportionate burning pain, swelling, skin colour and temperature changes, and extreme sensitivity to touch (allodynia), most often following a fracture, sprain, or surgery of the wrist, hand, ankle, or foot. Because aggressive passive stretching flares symptoms, evidence-based physiotherapy uses the Budapest criteria and graded motor imagery (laterality training, imagined movements, and mirror therapy) to normalise brain-body cortical maps, alongside gentle tactile desensitisation and functional paced loading.

How physiotherapy helps

• Graded motor imagery and laterality training
• Mirror therapy for sensory cortex calming
• Tactile desensitisation with graded textures
• Gentle active movement avoiding pain flares
• Paced daily functional tasks and limb loading

Common signs

• Severe, continuous burning, stinging, or throbbing pain out of proportion to the original injury or surgery
• Allodynia (intense pain from light touch, bedsheets, or a gentle breeze) and hyperalgesia
• Noticeable temperature asymmetry between limbs, with the affected area feeling abnormally hot or icy cold
• Skin colour changes ranging from mottled red to pale white or purplish blue, accompanied by localized swelling
• Joint stiffness, muscle weakness, tremors, and trophic changes such as altered nail growth, hair loss, or thin shiny skin

Clinical rehabilitation framework

Evidence-informed clinical progression and starter exercise targets for complex regional pain syndrome (CRPS).

Frequently asked questions

Related conditions & care

Carpal Tunnel SyndromeCarpal tunnel syndrome develops when the median nerve becomes compressed as it passes through the carpal tunnel on the palmar side of the wrist. Increased pressure within the tunnel, often linked to repetitive wrist bending, sustained gripping, fluid retention, or inflammatory changes, causes tingling, numbness, and burning pain in the thumb, index, middle, and radial half of the ring finger. For mild to moderate presentations, conservative physiotherapy focuses on relieving nerve compression, reducing flexor tendon friction, and preserving hand function.

Colles FractureA Colles fracture is a complete fracture of the distal radius bone in the forearm with dorsal displacement of the wrist, typically sustained by falling onto an outstretched hand (FOOSH). It is particularly common among older adults with underlying osteopenia or osteoporosis in India, frequently occurring from slips on wet bathroom tiles or unpaved streets. Following 4 to 6 weeks in a plaster cast or surgical fixation with a volar locking plate, patients invariably experience severe wrist joint stiffness, restricted forearm turning (pronation and supination), finger puffiness, and diminished grip power. Post-immobilization physiotherapy focuses on gentle passive and active joint mobilisations, edema reduction, tenosynovial gliding, and graded resistance training to safely restore independence in carrying groceries, preparing meals, and personal care.

Trigger FingerTrigger finger (stenosing tenosynovitis) occurs when inflammation, thickening, or nodule formation on the flexor tendon restricts its smooth glide through the first annular (A1) pulley at the base of the finger or thumb. In India, repetitive gripping, heavy domestic activities (such as wringing clothes, chopping, and sweeping), manual tool use, and underlying conditions like diabetes commonly precipitate the condition. As the nodule catches within the tightened pulley sheath, the digit snaps, clicks, or locks in a flexed posture. Conservative physiotherapy combines custom MCP joint splinting to prevent pulley irritation, tendon gliding exercises, gentle deep friction massage, and ergonomic utensil adaptations to restore smooth, painless finger excursion.

Tennis ElbowTennis elbow (lateral epicondylalgia) involves pain and microstructural tendon changes at the common extensor origin on the outer elbow, most commonly affecting the extensor carpi radialis brevis tendon. It frequently develops from repetitive wrist extension, forceful gripping, keyboard use, kitchen tasks, or racquet sports. Rather than prolonged immobilisation, evidence-informed physiotherapy uses structured tendon loading to build tendon capacity, stimulate collagen remodelling, and modify contributing daily biomechanics.

Clinical guides & articles for complex regional pain syndrome (CRPS)

Evidence-informed articles, recovery timelines, and home care advice from our clinical library.