What are contractures?
A contracture is a condition in which there is a permanent tightening of the muscles, tendons, skin, or nearby tissues that causes a joint to shorten and become very stiff, causing a distortion or a deformity which limits normal joint function. There are different types of contractures, they can occur in muscles, joints and skin.
Types of contractures
Muscles
A muscle contracture involves the shortening and tightening of the muscles, including tendons and ligaments.
Skin
Skin may contract where it’s been scarred from an injury, burn, or past surgery. This will limit your child’s ability to move that part of your body.
Joints
If there’s contracture in the joint capsule where two or more bones connect, your child will experience limited range of motion in that area of your body.
Some individuals are at more risk of developing contractures. For example, children with less mobility are at risk of reducing their ability to mobilise their joint or muscle as the soft tissues surrounding a disused joint can become shorter and tighter. Other risk factors include, hypertonia, hypotonia and muscle weakness.
How to reduce the risk of developing contractures?
- Supporting or prompting your child to reposition frequently.
- Passive range of motion (ROM) exercises. This involves assisting another individual by manually supporting their affected area such as their wrist of fingers through normal range of motion.
- If your child has the ability to move their muscles independently then encourage them to move their muscles as often as possible, especially by bending at their joints within normal range.
- Occupational therapy and Physiotherapy intervention.
- Splinting – The assessment and prescription of splints can be beneficial for some individuals who do not have the ability to move independently and are observed to rest in a flexed position. Splints can support an individual to maintain a neutral range of motion when usually in a fixed flexed position. Splinting is commonly used as part of treatment and management of risk of contractures but the effectiveness of splinting as a stretch intervention for contractures remains the subject of ongoing debate. It is recommended splints to be assessed and prescribed by a treating practitioner.
How can Occupational Therapists provide support?
Occupational Therapists can support a child at risk of developing a contracture by:
- Assessing their joint and muscle function
- Form a passive ROM exercise plan.
- Identify the need for and prescribe splints.
- Providing car er and parental information and coaching
- Referral to physiotherapy and specialist intervention if required.
Stretch is widely used for the treatment and prevention in contractures, however the evidence base to support the best treatment for contractures is limited. The aim of stretch is to maintain or increase joint mobility through active or passive exercises. Contractures are formed when muscles or joints remain immobilised and too tight for extended periods of time, causing the muscle to shorten and not function normally. Research suggests once a contracture deformity has developed, it cannot be reversed by stretching. However, when there is spasticity or reduced range of motion, stretching can ensure we maintain range, this can enable joint and muscle movement and reduce time spent in one fixed position further reducing the risk of muscle, skin, tendon and tissue shortening. Therefore, range of motion stretching exercises are considered a great treatment for reducing the risk of a contracture deformity.
If you have any questions or want to know more about how we can support a child, please feel free to contact us!
