Recently we ran a series of physiotherapy training sessions at a residential care home called Barrowhill Hall aimed at helping staff identify residents who were at risk of developing a joint contracture and then treating these residents with some stretching. This was a great success and made me think about the importance of integrating physiotherapy and care and also about the impact that joint contractures can have on patients. As such I thought that it could be helpful for regular readers of this blog to have a look at joint contractures, who is at risk, how they affect patients and how physiotherapy can help with them. Despite it sounding like quite a simple topic, there is quite a lot to this and as such we will have to split it up into a few blogs.

As a physiotherapy service seeing a lot of patients with reduced mobility in care and nursing homes we encounter a lot of patients with joint contractures and these can be enormously problematic for patients. However, looking at the problems that they cause for patients is jumping ahead and as such before we carry on discussing the problems that they can cause it is probably a good idea to look at what they are! Well put quite simply a joint contracture is “the loss of range of motion at a joint”. More formally however it could be defined as:

“Contractures are the chronic loss of joint mobility caused by structural changes in nonbony tissue, including muscles, ligaments, and tendons.

They develop when these normally elastic tissues are replaced by inelastic tissues. This results in the shortening and hardening of these tissues, ultimately causing rigidity, joint deformities, and a total loss of movement around the joint.”

(Cristian, Khanna & Kim 2014)

Reading the above definition I think the key points to note are that normally elastic tissues such as muscles, ligaments and the joint capsules are replaced by inelastic tissues. As a physiotherapist when I assess a patient if I find that a particular joint is restricted (such as a knee) and despite a fair amount of stretching I can’t get it to move through a full range then I would say that this was a joint contracture. Research suggests that the primary risk factor for getting a joint contracture is immobility, which makes sense as anyone who can easily take all of their joints through a good range each day is very unlikely to develop a contracture. According to some statistics up to 71% of immobile adults in institutions such as care homes will have some form of joint contracture. Although immobility is the primary risk factor spasticity and tone in limbs can play an important role such as in patients who have had stroke.

The final thing to consider before we leave things for another blog is that contractures develop quickly in anyone that is immobile. Some studies suggest that shortening of muscle fibres begins within 24hrs but certainly my experience as a physiotherapist is that once a patient has become immobile it is vital to begin a daily stretching routine as soon as possible to prevent their joints becoming contracted.

Okay, in the next blog we shall look at why contractures are a problem and some of the common areas that are affected.

 

For anyone reading: we are a home visit physiotherapy service, based in Lichfield but serving anywhere within a 20 minute drive including areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We offer a wide range of services including paediatric physiotherapy, post-operative rehabilitation, neurological physiotherapy and neck and back pain relief. If you need further information or would like to book an appointment we can be contacted on 0788 428 1623 or via enquiries@threespiresphysiotherapy.co.uk