Contractures after stroke are characterized by stiff, tight muscles and joints. It most often occurs in the hands, leading to clenched hands after stroke. However, the condition is not limited to the hands.
Contractures can develop in any neglected joint in the body affected by spasticity, like the elbows and shoulders. This condition can impair your ability to take care of yourself (like holding a toothbrush and dressing yourself).
To help prevent and reverse contractures after stroke, it helps to understand why spasticity occurs along with the best rehabilitation methods for treatment.
This article will walk you through all of it. Let’s get started.
Causes of Contractures After Stroke
Contractures are characterized by extreme stiffness in the muscles, joints, or connective tissue that limits your range of motion.
Contractures are an advanced stage of spasticity, a condition where muscles become stiff and tight after stroke. When spasticity is left unmanaged, contractures can develop.
For example, if you had spasticity in your hand after stroke, and things continued to worsen, your hand might curl and clench into a tight fist, resulting in a hand contracture.
Spasticity is best understood as a miscommunication problem between the brain and the muscles. When stroke has damaged the brain’s motor neurons that communicate with your affected muscles, the muscles “clench up” to protect themselves.
Rehabilitation for contractures involves restoring the connection between the brain and the muscles. You’ll learn how next.
Rehabilitation and Treatment for Contractures After Stroke
Contractures develop when spasticity has been left unmanaged. If you suffer from contractures after stroke, there is hope for recovery.
You can reverse contractures after stroke by participating in daily, consistent rehabilitation using the following methods:
To help reduce contractures after stroke, start by gently stretching the affected muscles. If you have hand contractures after stroke, it can help to use a split to prop your hand open. When splints aren’t feasible, you can try using a basketball or other object to stretch your hand on.
2. Range of Motion Exercises
Next you’ll want to move your affected muscles through gentle range of motion exercises. This will help get blood flowing and encourage the muscles to loosen up. However, increased blood flow isn’t the only goal…
3. Massed Practice
To reverse contractures after stroke, the goal of rehabilitation is to rewire the brain through neuroplasticity. Here’s how it works:
When you practice physical therapy stroke exercises, specific neurons in the brain fire. The more these neurons fire together, the stronger their connection becomes. It’s like the popular neuroscience saying: “neurons that fire together wire together.”
The more you practice PT stroke exercises (i.e. massed practice) the more your brain will regain the ability to correctly send motor signals to your affected muscles. As this communication is restored, mobility will improve, and the contractures will slowly be reversed.
4. Passive Exercise
If you have contractures after stroke, you might not be able to practice PT exercises on your own. Does this mean you’re out of luck? Not at all!
Stroke patients with severe spasticity and contractures can still participate in passive exercise where the muscles are assisted through the movement. You can do this yourself by using your non-affected side or enlist the help of a therapist or caregiver.
Although you aren’t “doing it yourself,” passive exercise still helps activate neuroplasticity. It will take time to see results, but if you put in consistent work, your contractures will loosen up and mobility can improve.
5. Electric Stimulation
Electric stimulation is a rehabilitation method used to treat spasticity and mobility issues after stroke. It involves applying electric currents to the affected muscles through the skin. Stroke patients will see the best results by combining electrical stimulation with rehabilitation exercise.
To boost your contracture recovery efforts, you can try spasticity-reducing treatments like Botox. This drug is a nerve-blocker that temporarily relieves spasticity and contractures.
Although the treatment is temporary and requires repeat treatments, you can use the relief as a “window of opportunity” to get rehab exercises done. That treats the root problem, so when the Botox wears off, some of your improvements will remain.
7. Rehab Technology
When stroke patients pursue rehabilitation at home, it can be difficult to stay motivated to exercise daily. Since consistency is key for results, rehab devices can help.
Home therapy tools like Flint Rehab’s FitMi help patients with severe spasticity regain mobility by motivating high repetition of rehab exercises. Even patients with clenched hands have reported remarkable improvement after using FitMi for just a couple months.
Orthoses include splints and props that are custom-fit to support and gently stretch open the affected muscles and joints. They should be recommended and adjusted by your therapist to best suit your needs.
Sometimes contractures are painful and affect your quality of life. If the above treatments don’t help, your therapist may recommend surgery as a last resort.
How to Prevent Contractures in Stroke Patients
The rehabilitation methods mentioned above help reduce contractures in stroke patients. But how can you prevent them in the first place?
The same methods used to reverse contracture can be used to prevent them. Gently stretching the affected muscles and taking them through their range of motion can help prevent contractures from forming.
Most of all, massed practice of rehabilitation exercise can help manage spasticity, reduce contractures, and improve mobility.
We hope this article has inspired you to start moving to prevent and manage contractures after stroke. Good luck!