A contracture is the stiffening of muscles, tendons, or skin, which causes a joint to become fixed in one position. For individuals who are bedridden, prolonged immobility is a primary cause of this condition because joints that are not moved regularly can lose their flexibility. When muscle fibers remain in the same position for extended periods, they can shorten, leading to stiffness and restricted movement.
The Importance of Repositioning and Support
A consistent repositioning schedule is one of the most effective strategies to prevent contractures. Changing a person’s position at least every two hours helps to prevent any single joint from staying in a flexed or bent position for too long. This frequent movement optimizes circulation to tissues and relieves pressure.
Using supportive devices is an integral part of proper positioning. Pillows, foam wedges, and rolled towels can be used to support the body and maintain neutral joint positions. For instance, when a person is lying on their side, placing a pillow between their knees and ankles helps to align the hips and prevent strain.
A small roll can be placed under the lower back to support its natural curve, and supporting the feet with pillows or a footboard can help prevent foot drop. Arms and hands also require careful positioning. The arms should be kept slightly away from the body, with the wrists in a neutral, straight position, and a small hand roll can be placed in the palm to prevent the fingers from curling tightly into a fist.
Implementing Range of Motion Exercises
Beyond static positioning, actively moving a patient’s joints is a direct way to maintain flexibility. For individuals unable to move on their own, Passive Range of Motion (PROM) exercises are performed by a caregiver. These exercises involve gently moving each joint through its full, natural movement. Changes in joints can begin after just three days of immobility, making it important to start these exercises as soon as possible.
When performing PROM exercises, it is important to move slowly and smoothly, supporting the limb above and below the joint being moved. For example, to exercise the knee, a caregiver would gently bend the knee toward the chest until they feel a slight resistance, hold the position for about 15 seconds, and then slowly straighten the leg. This process should be repeated several times for each major joint, including:
- Shoulders
- Elbows
- Wrists
- Hips
- Ankles
As a person’s condition improves, they may be able to participate more in these movements. Active-Assisted Range of Motion involves the patient doing as much of the movement as they can, with the caregiver helping to complete it. The ultimate goal is Active Range of Motion, where the patient can perform the exercises independently.
Utilizing Splints and Orthotic Devices
In some cases, splints and other orthotic devices may be recommended to provide more rigid support than pillows can offer. These devices are designed to hold a joint in a specific, functional position for extended periods, particularly during rest or sleep. For example, a hand and wrist splint can prevent the fingers and wrist from curling inward, while an ankle-foot orthosis can keep the foot in a neutral, 90-degree position to prevent foot drop.
These devices are particularly useful when a patient has muscle spasticity or a strong tendency to hold a joint in a contracted position. Studies have shown that wearing splints overnight can be an effective part of a contracture prevention plan. The consistent, gentle stretch provided by the splint helps to counteract the muscle shortening that can occur during long periods of inactivity.
It is imperative that splints and orthotic devices are used only under the guidance of a healthcare professional. An improperly fitted or incorrectly used device can cause more harm than good, potentially leading to skin breakdown, nerve damage, or increased pain. A therapist can ensure the device is appropriate for the patient’s specific needs and that it fits correctly, providing instructions on when and for how long it should be worn.
Working with the Healthcare Team
A collaborative approach with healthcare professionals is the best way to develop a comprehensive contracture prevention plan. Physical Therapists (PTs) and Occupational Therapists (OTs) have specialized knowledge and can create a personalized care plan tailored to the individual’s specific condition and needs.
Physical Therapists focus on mobility and exercises for large muscle groups, helping to preserve strength and joint mobility in the legs and trunk. They can design a specific range of motion exercise program and teach caregivers the proper techniques to perform these movements safely.
An OT, on the other hand, focuses on activities of daily living and the function of the upper extremities. This helps patients maintain the ability to perform tasks like eating or dressing. Caregivers should feel empowered to request a consultation with these professionals, as a therapist can provide a detailed schedule for repositioning, a customized exercise routine, and recommendations for any necessary supportive or orthotic devices.