Welcome back again to the ThreeSpires Physiotherapy blog. In the last blog we began looking at joint contractures, what they are and began to consider how they may affect patients. In this blog post I thought we would look at why contractures are a significant problem.
So, in the last blog post we determined that contractures generally affected patients who have become immobile or have significant tone in a particular joint e.g. a stroke patient who has developed muscle tone in their forearm may find that they develop a contracture at the wrist unless they have a regular program of stretching. A reasonable question for anyone who is not a physiotherapist and is one of the areas that we covered in our recent training session is: “are contractures a problem?” The short answer to this is yes! Joint contractures are a significant problem for a number of reasons for patients who have become immobile:
· Pain!! If you keep a joint e.g. your arm in a fixed position for a long period, it will in general hurt. Now for some patients who have become immobile (especially patients with dementia) they may have difficulty clearly expressing this but as a physiotherapist I think it is pretty reasonable to assume that this joint will not be comfortable for them.
· Rehabilitation and returning to previous mobility: Some patients will become ill and bed bound for a significant period or possibly they will have had an operation (such as a joint replacement) which has made for a very slow recovery and an extended period in hospital and in bed. For these patients it is vital that they do not develop any secondary complications such as joint contractures which then hinder their return to independence. For example if a patient spends 6 – 8 weeks in bed with a serious infection but during this period keeps their knee mostly bent, then it is very likely that they will develop a contracture at the knee that will stop them being able to effectively mobilise and return to their previous levels of independence. To my mind this is a preventable tragedy. Simple daily stretches and movements of the leg and other joints could easily have prevented this and when the infection was over the patient would most likely have been able to begin mobilising (albeit with help) and would have had a good chance of regaining their previous independence.
· Dignity and quality of life: As a physiotherapist who visits patients in a range of nursing and care homes across the area, I really do feel quite strongly that making sure patients who ae immobile and in bed have full range of motion in their limbs a basic quality of life/dignity issue. Seeing a patient in bed with significant joint contractures and unable to stretch out their arms or legs fully is a very sad thing, especially when we know that most of these issues are preventable with a good assessment and stretching routine.
· They are preventable: there are a series of other reasons such as ease of care and hygiene but to my mind one of the main reasons that we should view joint contractures as a problem is that in most cases they were easily preventable. A program of once a day gentle range of motion exercises at each joint would keep most patients with all their joints fully mobile (or at least with a good functional range). The reason that patients develop joint contractures is simply that they haven’t been properly assessed and they do not have a regular stretching and joint maintenance program.
Okay, I think that is enough for one blog. In the next blow we will have a look at which joints are most likely to be affected and the consequences that this has for patients.
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 email@example.com
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