Dominic Stone
Muscle contractures are the result of stiffness or constriction in the connective tissues of the body. They are caused by a permanent shortening and tightening of muscle fibres that reduces flexibility and makes movement difficult. Contractures are commonly caused by inactivity, scarring from an injury or burn, or from overly intense efforts without sufficient warm-up. They can also be caused by neurological input to the muscles from the brain and spinal cord being reduced, as well as from upper motor neuron lesions. The primary intervention for the treatment and prevention of contractures is regular stretching of soft tissues. Physical therapy and occupational therapy are also common treatments for contractures, which help increase the range of motion and strengthen muscles.
| Characteristics | Values |
|---|---|
| Definition | Abnormal contraction of muscle fibres |
| Cause | Stiffness or constriction in the connective tissues of the body |
| Occurrence | Calf, trapezius, adductor, shoulder, lumbar, neck, cervical muscles, wrist, finger flexors, biceps brachii, hamstrings, gastrocnemius, soleus |
| Treatment | Physical therapy, occupational therapy, medication, surgery, massages, hot compresses, de-contracture drugs, pain medication, anti-inflammatory medication, muscle relaxants |
| Prevention | Stretching, exercise, avoiding immobilisation in shortened positions |
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What You'll Learn
Stretching to treat contractures
Stretching is a widely used method for treating and preventing contractures. Contractures are caused by a permanent shortening and tightening of muscle fibres, which results in reduced flexibility and difficulty in movement. The condition is characterised by abnormal contraction of muscle fibres, causing pain in the affected area.
Stretching exercises are recommended for treating contractures, especially when they are first developing. Simple positioning techniques, such as holding the affected limb in a steady, stretched position, can help correct the condition. It is important to hold the stretch for a count of 25, gradually increasing the stretch and repeating the process for 5 to 10 minutes, several times a day. This method is suitable for children, but caution must be exercised to avoid forceful stretching that could cause injury.
For more advanced contractures, stretching must be performed steadily over a long period, using fixed positions, casts, braces, or special equipment that maintains a continuous pull on the affected joints. The recommended stretching time is at least 20 minutes, and in some cases, it may be necessary to stretch for up to 12 hours a day to achieve clinically significant results. Animal studies have shown that continuous stretch can reverse the negative length adaptations in muscles caused by immobilisation. Additionally, interrupting immobilisation with short periods of daily stretch can also help prevent deleterious length adaptations.
While stretching is a common intervention for contractures, its effectiveness has not been conclusively proven through well-designed clinical trials. The available studies suggest that stretching may not be effective for treating and preventing contractures in individuals with non-neurological conditions. However, it is important to note that the studies on this topic primarily focus on the short-term effects of stretching, and the long-term effects remain less understood.
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Contractures caused by inactivity
Contractures are caused by a permanent shortening and tightening of muscle fibres, which results in reduced flexibility and difficulty in movement. This is often due to a loss of elasticity in the muscle, which can be caused by inactivity or immobilisation.
Inactivity can lead to a decrease in satellite cells, which are specialised stem cells that are necessary for muscle regeneration and repair. Without enough satellite cells, other cells like fibroblasts increase, causing muscle fibres to become stiff and fibrotic. This results in the formation of fibrous adhesion, loss of sarcomeres, and a loss of tissue extensibility.
Those who lead a sedentary lifestyle are more prone to contractures when they suddenly exert themselves, as they may struggle to control their efforts. It is important for individuals to move daily and stretch areas such as the fingers, arms, and legs to prevent contractures from developing.
To reverse contractures caused by inactivity, physical therapy is often recommended. This involves performing specific exercises to treat and rehabilitate the affected areas, such as the hand, hip, knee, foot, and limbs. Massage therapy can also be beneficial to relax the muscles. In some cases, a doctor may prescribe medication to treat contractures, such as de-contracture drugs, pain medication, or muscle relaxants.
It is important to note that stretching should be approached with caution, as it can potentially cause further damage to the muscle fibres. Animal studies suggest that prolonged immobilisation in lengthened positions can help reverse the structural and morphological changes associated with contractures. However, the effectiveness of stretching in humans has not been conclusively proven through well-designed clinical trials.
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Contractures caused by injury
Contractures are caused by stiffness or constriction in the connective tissues of the body. They are commonly caused by inactivity and scarring from an injury or burn. Contractures can also be caused by a trivial blow to the back, or by incorrect physical preparation. Those who lead a sedentary lifestyle are at a higher risk of developing contractures when they overexert themselves.
Contractures are a permanent shortening and tightening of muscle fibres that reduce flexibility and make movement difficult. They are caused when a muscle loses elasticity. If a muscle cannot move and be stretched, the nearby joints also lose mobility and become painful. The most common muscles affected by contractures are the wrist and finger flexors, and the biceps brachii.
If you have suffered an injury and are experiencing symptoms of a contracture, you should seek treatment right away. Doctors can treat contractures with medicine, casts, and physical therapy. Physical therapy for contracture caused by injury may include stretches to be administered for at least 20 minutes a day, and perhaps for as long as 12 hours a day. It is important to note that the effectiveness of stretching has not been verified with well-designed clinical trials.
To prevent the development of contractures, information about contractures (patient education) and commitment to good care (proper positioning/passive movements) by patients and caregivers are important.
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Physical therapy
Passive stretching is a technique frequently used to treat muscle contractures. This involves taking the joints through their full range of motion to allow connective tissues to lengthen, increase blood flow, and help decrease joint stiffness. This will improve overall mobility and can also decrease the risk of developing other complications. However, because it can activate the stretch reflex and has little carry-over, it may not be as effective as other modes.
There are four approaches to treating muscle contractures:
- Activation or strengthening of the weak opponent
- Local inhibition of the contracted muscle
- General inhibition of hypertonus
- Passive lengthening
Orthoses, including splints and props, can be used to support and gently stretch the affected muscles and joints. These are often custom-fitted and provided to address hand and wrist contractures by offering optimal positioning and a light, long-duration stretch.
In addition to stretching, physical therapists may also recommend regular exercise and an active lifestyle to help prevent muscle and joint stiffness. Exercise can help maintain proper joint mobility and range of motion, improving blood flow and activating muscles, which helps prevent contractures from forming.
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Surgery to reverse contractures
Surgery can be an effective way to reverse contractures, depending on the underlying cause and severity of the condition. Here is a detailed overview of surgical procedures aimed at reversing contractures:
Dupuytren's Contracture Release Surgery
This procedure addresses Dupuytren's contracture, a common hand condition characterised by the thickening and contracture of connective tissues in the palm. The surgery aims to release the contracted tissue bands in the palm and fingers, improving finger extension and restoring hand function. The surgical technique may vary, but the goal is to enhance finger mobility and flexibility.
Skin Grafting and Flap Techniques
For more severe cases of contractures, skin grafting or flap techniques may be utilised. These procedures involve taking a section of skin or tissue from one area of the body and transferring it to the affected site to promote healing and restore function. Flap techniques, in particular, have been used for lower-extremity reconstruction after the release of post-burn flexion contractures.
Joint Capsule Releases
In some instances, joint capsule releases may be performed in conjunction with contracture release surgery. This procedure targets the joints affected by contractures, releasing the tension and improving mobility.
Post-Surgical Care and Rehabilitation
Proper post-operative care is crucial for optimal recovery. Patients are typically provided with detailed instructions on wound care, pain management, and the use of splints or dressings. Hand therapy and rehabilitation exercises are often prescribed to enhance range of motion, strengthen the affected area, and restore function.
It is important to note that surgery may not be the first line of treatment for contractures. Non-surgical interventions, such as physical therapy, massages, and medication, are often explored before considering surgical options. Surgery is usually recommended when conservative treatments have not yielded satisfactory results or in more severe cases of contractures.
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Frequently asked questions
A muscle contracture is the abnormal contraction of muscle fibres. Instead of relaxing, the fibres remain contracted, causing pain and reduced flexibility.
The symptoms depend on the muscle involved, but can always be traced back to moderate muscle pain spread throughout the affected area. For example, in the case of calf muscle hardening, the symptoms may resemble those of a cramp.
Physical therapy and medication are two of the most common treatments for contractures. Physical therapy can help increase your range of motion and strengthen your muscles. Your doctor may also prescribe medication to reduce inflammation and pain, or muscle relaxants.
