The Importance of Preventing Contractures | Muscular Dystrophy Queensland

The Importance of Preventing Contractures

The Importance of Preventing Contractures

Contractures are common in people with neuromuscular conditions, particularly those who use wheelchairs.

They develop when muscles and joints become shortened or fixed due to reduced movement, muscle weakness or imbalance. Contractures can cause pain, stiffness and reduced mobility, affecting daily comfort and independence. Early prevention, stretching and postural support are key to maintaining movement and quality of life.

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The Importance of Preventing Contractures

Contractures are a common complication experienced by people living with neuromuscular conditions, particularly those who use wheelchairs. These conditions can reduce joint movement and cause muscular imbalances, leading to joints being held in the same position for long periods. When a joint remains immobilised with limited stretching and use, fibrotic tissue can build up, restricting movement and flexibility.

In neuromuscular conditions such as Duchenne muscular dystrophy, healthy muscle fibres may break down and be replaced by fat or connective tissue. This process, known as muscular fibrosis, can cause the muscle to become fixed in a shortened position, called a contracture. If left unmanaged, this shortening can become permanent, particularly when the joint itself is affected.

Gravity also contributes to contracture development. For individuals with muscle weakness, gravity can pull joints into a fixed position that weak muscles cannot counteract. Over time, this can lead to postures such as rounded shoulders, flexed hips or dropped ankles, which further shorten muscles and connective tissue.

Why Contractures Matter

Contractures can cause pain, stiffness and loss of function, all of which impact quality of life. Long-term effects may include:

  • Pain and deformity
  • Reduced mobility and independence
  • Skin breakdown and pressure injuries
  • Increased risk of osteoporosis
  • Difficulties with sitting, standing, walking breathing and/or digestion

Everyday tasks such as dressing, repositioning in bed and finding a comfortable sleeping position can also become more challenging.

Preventing and Managing Contractures

Contracture management is most effective when supported by a multidisciplinary team including physiotherapists, occupational therapists, and other allied health professionals.

Tips for prevention and management

  1. Stretch regularly: Gentle, regular stretching can help delay or reduce contractures. Your physiotherapist can recommend exercises suited to your needs.

  2. Change positions often: Try to adjust your position every 30–60 minutes to reduce stiffness and pressure.

  3. Maintain neutral joint alignment: Use cushions, wedges or supports to keep joints in a comfortable midline position.

  4. Make use of wheelchair features:

  • Tilt helps redistribute pressure and relieve the effects of gravity through the spine.
  • Recline gently extends the hips, improving comfort and circulation.
  • Elevating leg rests can help stretch muscles and improve posture.

How Physiotherapy Can Help

Your physiotherapist can help minimise the risk of contractures through:

  • Advice on optimal positioning to maintain joint alignment.
  • Designing personalised stretching routines suited to your level of function. Small, frequent stretches are often more effective than occasional long sessions.
  • Recommending splints, orthotics or night positioning aids to support proper alignment.
  • Encouraging the use of day-time splints or supportive footwear when using a wheelchair full time.
  • Monitoring joint range of motion for early signs of stiffness.
  • Providing regular seating and posture reviews to ensure ongoing comfort and function.

Remember: sustained, gentle stretches are safer and more effective than intense or jerky movements.

References

  • UK Physiotherapy and OT Best Practice Guidelines
  • AUSNMD – Duchenne Muscular Dystrophy
  • Skalsky, A.J. & McDonald, C.M. (2012). Prevention and Management of Limb Contractures in Neuromuscular Diseases. National Institute of Health.
  • Choi, Y.A., Chun, S.M. & Shin, H. (2018). Lower Extremity Joint Contracture According to Ambulatory Status in Children with Duchenne Muscular Dystrophy.
  • Martinez-Lozano, E., Beeram, I., Yeritsyan, D. et al. (2022). Management of Arthrofibrosis in Neuromuscular Disorders: A Review. BMC Musculoskeletal Disorders, 23(725).
  • Usher, K.M. et al. (2019). Pathological Mechanisms and Therapeutic Outlooks for Arthrofibrosis. Bone Research, 7:9.
  • Iolascon, G. et al. (2019). Neuromuscular Diseases and Bone. Front Endocrinol (Lausanne), 10:794.