Muscle Contractures: An Ounce of Prevention is Worth a Pound of Cure

Chronic neuromuscular and musculoskeletal health conditions present an array of challenges to those diagnosed and to their caregivers. Because of the complexity of these conditions, secondary effects or “sequelae” (such as muscle contractures) are often overlooked or may not be considered an immediate priority in their management. As Certified Orthotists, we provide orthopedic bracing for various joints in the body to increase mobility or function, reduce pain, prevent deformity and improve alignment, and muscle contractures are something that we see on a regular basis. 

A muscle contracture occurs when a muscle and its tendon are permanently shortened. They can occur for a variety of reasons including a muscular imbalance around a joint (when one muscle is strong and the opposing muscle is weak) or may be related to immobility of the joint (for example, when moving the joint is painful or from the muscle resting in a shortened position for long periods of time). Contractures reduce the flexibility of the muscle and compromise the function of the joint, resulting in a permanent deformity. 

Muscle contractures can happen to virtually any joint in the body, however there are some that are seen more frequently and are commonly associated with a variety of pathologies. 

• Knee and hip flexion contractures can result from injury, pain or from spending significant amounts of time in a seated position (i.e. wheelchair users).
• Wrist flexion and elbow flexion contractures result in a wrist or elbow that is fixed in a flexed position. Wrist flexion contractures are often accompanied by finger flexion contractures.
• Plantarflexion contractures often occur when the calf muscles at the back of the leg that point the foot down are stronger than the muscles at the front of the calf that lift the foot up. They can also occur when people are on bedrest and their ankle is allowed to relax in a downward position for extended periods of time. The ankle is permanently fixed with the foot pointed downwards, or in a “plantarflexed” position.

Conditions that are prone to developing muscle contractures include cerebral palsy, multiple sclerosis, stroke, drop foot, toe walking, spinal cord injury, acquired brain injury, muscular dystrophy, and rheumatoid arthritis.

Contractures can reduce a person’s overall quality of life by impairing their mobility and function, causing pain, and resulting in further complications such as making the body part more prone to injury or ulceration. It can also make maintaining hygiene and nail grooming challenging, specifically in wrist, hand and finger contractures which can result in a closed fist that cannot be opened. 

The good news is that muscle contractures are often preventable, and these preventative methods can also be used for treatment after a contracture has formed. These include: 

• Physiotherapy to stretch strong, spastic, tight, or shortened muscles and strengthen weakened muscles
• Bracing or casting to maintain a position, prevent further contracture, accommodate a deformity, or to aid in stretching the muscle
• Pharmaceutical treatments such as Baclofen or Botox injections to reduce muscle stiffness in conditions with muscular spasticity such as cerebral palsy, multiple sclerosis or stroke

In cases where severe contractures have developed and conservative treatment methods haven’t been successful, surgery may be considered as an option to improve the joint position. However, in these situations it is possible for the contracture to return if the appropriate interventions (physiotherapy, bracing, pharmaceuticals) aren’t adhered to. 

It is important that people who are at higher risk for developing contractures take measures to prevent them from forming. Regular visits to a doctor (ideally one that specializes in the involved conditions), treatments from a physiotherapist (and completing your exercises at home!), as well as regular use of prescribed bracing for the upper or lower extremities can help to fend off muscle contractures and joint deformity. It may seem that developing a contracture is an unlikely long-term consequence of certain conditions, but preventing them is important to holistic treatment of many conditions and is critical for maintaining quality of life.