Contracture
is a term which refers to the inability of a joint to move. Contractures can
occur as a result of muscular, ligament and tendon tightness. However,
contractures most commonly develop due to decreased neural innovation to the
musculature. This means that the signals from the brain to the muscles are
interrupted and therefore stimulation of the muscle to move is lost and muscles
become weak and shortened. With limited movement the muscles become extremely
tight. Contractures are very rarely irreversible.
People at higher risk of developing contractures are those who have no ability
to actively move their joints or who have limited ability to move their joints
through their full range of motion on their own. Conditions which are more
susceptible are neurological in nature. This includes conditions such as
Multiple sclerosis, spinal cord injury, cerebral palsy and acquired brain
injury. Although it is not unusual for contractures to develop after joint
replacement surgery if proper rehabilitation is not followed.
Exercise can help in the prevention of contractures through active and passive range of motion and performing functional tasks. For those who have no control over the movement of their joints, passive range of motion is most suitable. With passive range of motion, the exercise physiologist gently stretches and move the persons limb / joint through its full range of motion. In doing so the muscles, tendons and ligaments can be stretched in a safe environment and the risk of tightness is reduced. Similarly, those who have control and movement of their joints but have decreased function due to strength limitations, active range of motion and performing functional movements is the best intervention as it also encourages maintenance of muscular strength. This involves the person performing exercises such as sit to stands, push ups and step ups, which may require physical assistance from the exercise physiologist. However, depending on the level of movement and function, exercises can be adapted. In addition, It is recommended that these types of management is conducted on a frequent basis under the supervision of an exercise physiologist, to further reduce risk of contractures.
