Different Methods to Correct Contractures

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HealthWiki > Disabled Village Children > Chapter 8: Contractures: Limbs That No Longer Straighten > Different Methods to Correct Contractures

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In this chapter:

 

In this chapter:

• When contractures are just beginning to develop, stretching exercises and simple positioning may be all that is needed to correct them.
• When contractures are more advanced, stretching must be done steadily over a long time, using fixed positions, casts, braces, or special equipment that keep a continuous pull on the affected joints.
• When contractures are old and severe, correction by surgery may be needed.

Even when contractures are advanced, it is usually best to try to correct them as much as possible using simpler, less harsh methods first.

If a contracture is advanced:

First, correct it as far as you can with stretching exercises and positioning.	Second, correct it as much as possible with a series of casts or special braces.

Third, if more correction is still needed, consider surgery.

Surgery often consists of lengthening the tight cords.

Instructions for correcting contractures using plaster casts or braces are in Chapter 59.

CAUTION! Some orthopedic surgeons are quick to recommend surgery. However, we have found that many contractures often said to need surgery can be corrected in the village or home by exercise and casting or braces. In any case, stretching exercises and bracing are often needed for a long time after surgery (or forever) to prevent the contractures from coming back.

Also, some contractures are best left uncorrected (see Chapter 42 and Chapter 56). When in doubt, consult an experienced rehabilitation therapist.

Exercises to correct contractures — stretching exercises

These are similar to the range-of-motion exercises used to prevent contractures, except that steady, gentle but firm stretching is required:

1. Hold the limb in a steady, stretched position while you count slowly to 25.
2. Then gradually stretch the joint a little more, and again count slowly to 25.
3. Continue increasing the stretch in this way, steadily for 5 or 10 minutes. Repeat several times a day.

CAUTION! To avoid damaging the limb, hold it near the joint, as shown. It is acceptable if the stretching hurts the child a little, but it should not hurt him a lot. If you want faster results, do not apply more force. Stretch the limb for longer and more times each day.

In children who do not feel in their legs, take special care not to stretch forcefully. You could cause injuries.

STRETCHING EXERCISE INSTRUCTION SHEETS

Some stretching exercises are done best using specifictechniques. Often they need to be done at home for weeks or months. You will find instruction sheets for the most frequently needed stretching exercises in Chapter 42, “Range-of-motion and Other Exercises.” They include:

Stretching exercise for a tight heel cord.	Stretching exercise for a bent knee.	Stretching exercise for a bent hip.

HOLDING A CONTRACTED JOINT IN A STRETCHED POSITION FOR LONG PERIODS

Chapter 59 discusses the use of casts, braces, and other aids to stretch difficult contractures. These include:

a series of plaster casts and wedges	adjustable braces	elastic stretching devices
	of metal and plastic of wood	bamboo or plastic that works as a spring inner tube
Advantages:	Advantages:	Advantages:
Holds leg in exactly the position you want it. Child (or parents) cannot easily remove it. Especially useful for difficult deformities that bend in different directions.	Can be adjusted by family at home. Can be easily removed to check for sores, for bathing, and exercise.	Same as for adjustable braces, and also: Does not need frequent adjustment because it keeps pulling as joint stretches.
Disadvantages:	Disadvantages:	Disadvantages:
Cannot be easily removed to check for sores, to bathe, and to exercise. (Therefore, casts should usually not be used on children with arthritis or children without feeling in their legs.) Hot in warm weather. Expensive (plaster bandage). Adjustments require trip to clinic or rehabilitation center.	More difficult to make and to fit well. Difficult to use on child with various deformities that go in different directions. Child (or parents) may remove and not use it.	Clumsy—gets in the way. Difficult to make so they work well. Often not good with spasticity.

This page was updated:04 Apr 2024