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Muscle contractures are a painful condition that results in a reduced ability to move an area of your body. The most common muscles affected by contractures are the wrist and finger flexors, biceps, calf muscles, and hamstrings. The condition is caused by a variety of factors, including inactivity, injury, neurological conditions, and congenital conditions. To prevent muscle contractures, it is important to maintain an active lifestyle and seek regular medical care if you have a condition that affects your mobility. Treatment options include physical therapy, stretching exercises, medication, and in some cases, surgery.
How to Prevent Muscle Contractures
| Characteristics | Values |
|---|---|
| Cause | Lack of use, injury, neurological and neuromuscular conditions |
| Common Causes | Inactivity, scarring from an injury or burn, congenital conditions, muscle imbalances, arthritic conditions, heterotopic ossification, prolonged hypertonic spasticity, ulcers, local trauma, diabetes |
| Muscles Affected | Wrist and finger flexors, biceps brachii, gastrocnemius and soleus, hamstrings |
| Treatment | Physical therapy, occupational therapy, medication, surgery, heating soft tissue structures, hydrotherapy, paraffin baths, low-level laser therapy, local vibration therapy, therapeutic ultrasound |
| Prevention | Regular exercise, stretching exercises, proper positioning, heating soft tissue structures, hydrotherapy, paraffin baths, low-level laser therapy, local vibration therapy, therapeutic ultrasound |
| Surgery | Surgical release of affected muscles, tenotomy or tendon lengthening, joint capsule release, total joint replacement, fasciectomy, fasciotomy with skin flap replacements |
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What You'll Learn
Regular exercise and an active lifestyle
The best way to prevent muscle contractures is to lead an active lifestyle. The most frequent cause of contractures is immobility or a lack of use, so regular exercise is a great way to prevent them from forming.
Exercise and stretching are the primary interventions for the treatment and prevention of contractures. Stretching the soft tissues can help to prevent the shortening and tightening of muscles, tendons, joints, and other tissues that cause contractures. This can be done through daily stretching exercises, physical therapy, or the use of a Continuous Passive Motion (CPM) machine. Stretching for long periods is thought to be the most effective, with some sources suggesting a minimum of 20 minutes per day, and others suggesting up to 12 hours a day.
There are many exercises that can be done at home, which a physical therapist can advise on. For example, to preserve shoulder range of motion, 30 minutes of positioning using a sling attached to the bed can be beneficial. To prevent knee flexion contractures, it is recommended to avoid placing pillows under the knees while supine. Prone lying can also help to prevent hip flexion contractures by forcing the hip into extension.
In addition to stretching, hydrotherapy, paraffin baths, and therapeutic ultrasound can be used to improve the elasticity of the soft tissue structures around the joints.
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Physical therapy
Muscle contracture is the stiffening and tightening of muscles, which can be caused by disease or lack of use. It often occurs after prolonged bed rest, inactivity, or the lack of use of certain muscle groups. It can also be caused by neurological and neuromuscular conditions, such as cerebral palsy, polio, multiple sclerosis (MS), or Parkinson's disease.
To prevent muscle contractures, physical therapy can be used to improve mobility and reduce stiffness. A physical therapist can show you exercises to do at home and provide hands-on therapy. They may also recommend the use of a cast or splint to help stretch the tissues near the problem area. A continuous passive motion (CPM) machine may also be used to keep the affected body part moving.
In addition to physical therapy, doctors may prescribe medication to reduce inflammation and pain. For people with cerebral palsy, botulinum toxin (Botox) may be injected into muscles to reduce tension and spasms. If other treatments are ineffective, surgery may be required to lengthen muscles or repair ligaments, tendons, or bones.
To prevent muscle contractures, it is important to engage in regular exercise and maintain an active lifestyle. Stretching is also crucial, particularly for those at risk of contractures due to underlying conditions. This includes stretching common areas such as the fingers, arms, and legs, as well as specific muscle groups like the soleus muscle.
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Surgery
Surgical release of contracted muscle tissue involves cutting tight muscles to allow for more mobility. Tendon lengthening procedures can also help increase mobility, but there is a risk of overcorrection, as seen in some cases of isolated Achilles tendon lengthening, where patients lost the ability to walk due to overlengthening of the heel cord.
Upper extremity contractures rarely require surgical intervention. Surgery is typically only indicated if the range of motion is impeding care, hygiene, or skin health, or if the pain is intolerable. For example, a Chinese study from 2019 found that among patients with severe burns, the incidence of contracture was 94%, with about one-quarter requiring corrective surgery.
After surgery, patients undergo rehabilitation to maintain functionality, prevent further scar formation, and enable wound healing.
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Avoid placing pillows under the knees
To prevent muscle contractures, it is important to avoid placing pillows under the knees while sleeping or lying down. This is because placing pillows under the knees can promote knee flexion contractures, a common type of contracture that affects the knees. Knee flexion contractures occur when the muscles, tendons, and ligaments around the knee joint tighten and shorten, reducing the range of motion and making it difficult to straighten the leg fully.
By avoiding the use of pillows under the knees, you can help maintain the natural alignment of the leg and prevent the knee joint from being held in a flexed or bent position for extended periods. This is especially important for individuals who may be at a higher risk of developing muscle contractures, such as those with cerebral palsy, muscular dystrophy, or other neurological or neuromuscular conditions.
Additionally, avoiding pillows under the knees can be beneficial for overall posture and spine health. It encourages a straighter alignment of the legs, which can help reduce pressure on the spine and improve spinal health. This is particularly important for individuals who may have back pain or spine-related issues.
Furthermore, by not placing pillows under the knees, you can promote better circulation in the legs. When the knees are bent or elevated, it can sometimes restrict blood flow and lead to poor circulation. By keeping the legs straight and parallel to the surface, you encourage optimal blood flow and reduce the risk of blood pooling or circulatory issues.
Overall, avoiding the placement of pillows under the knees is a simple yet effective strategy to prevent knee flexion contractures and maintain healthy joints, muscles, and connective tissues. This practice can be easily incorporated into daily routines and sleep habits to promote long-term joint health and mobility.
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Stretching exercises
Stretching is widely used for the treatment and prevention of contractures, which are a common complication of neurological and non-neurological conditions. Contractures are characterised by a reduction in joint mobility, causing muscles to become tight and difficult to move and stretch. The primary intervention for the treatment and prevention of contractures is regular stretching of soft tissues.
To reduce the risk of muscle tightness and prevent contractures from developing, it is important to move daily and stretch common areas like the fingers, arms, and legs. Stretching exercises should be done regularly and intensively, and for long periods (at least 20 minutes, and perhaps for as long as 12 hours a day) to maximise the probability of attaining a clinically worthwhile effect.
Some stretching exercises are best done using specific techniques, and they may need to be done at home for weeks or months. For contractures that are severe or develop from neuromuscular disorders, it is important to seek medical treatment, including physical and occupational therapy, to prevent contractures from worsening and to try to regain as much functional range of motion as possible.
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Frequently asked questions
A muscle contracture is the shortening and tightening of muscles, joints, tendons, or other tissues, causing a deformity and reduced ability to move that area of the body.
Muscle contractures are most frequently caused by immobility or inactivity, but they can also be caused by congenital conditions, muscle imbalances, arthritic conditions, heterotopic ossification, prolonged hypertonic spasticity, ulcers, burns, local trauma, diabetes, or, in rare cases, hypothalamus-pituitary-adrenal axis (HPA) hormone deficiency.
To prevent muscle contractures, it is important to maintain an active lifestyle. Regular exercise and stretching can help prevent muscle and joint stiffness. Specific preventative measures include avoiding placing pillows under the knees while supine to prevent knee flexion contractures and using a sling attached to the bed to preserve the shoulder range of motion.
Treatment options for muscle contractures include physical therapy, occupational therapy, medication, casts, splints, and surgery. Physical therapy and occupational therapy can help increase the range of motion and strengthen muscles through stretching exercises and hands-on therapy. Medication may be prescribed to reduce inflammation and pain. Surgery may be considered as a last resort to lengthen muscles or repair ligaments, tendons, or bones.
The symptoms of muscle contractures include pain, stiffness, and loss of movement in the affected area. The most common muscles affected by muscle contractures are the wrist and finger flexors, biceps, calf muscles, and hamstrings.
