Hesperian Health Guides
Different Methods to Correct Contractures
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- 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.
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:
- Hold the limb in a steady, stretched position while you count slowly to 25.
- Then gradually stretch the joint a little more, and again count slowly to 25.
- 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.
STRETCHING EXERCISE INSTRUCTION SHEETS
Some stretching exercises are done best using special techniques. 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
bamboo or plastic that works as a spring