84 chapter 8
DIFFERENT METHODS TO CORRECT CONTRACTURES
• When contractures are just beginning to develop, stretching exercises and simple
positioning may be all that is needed to correct them.
• When contractures are more advanced, stretching must be done steadily over a
long time, using fixed positions, casts, braces, or special equipment that keep a
continuous pull on the affected joints.
• When contractures are old and severe, correction by surgery may be needed.
Even when contractures are advanced, it is usually best to try to correct them as
much as possible using simpler, less harsh methods first.
If a contracture is advanced:
First, correct it as
far as you can with
stretching exercises
and positioning.
Second, correct it as
much as possible with
a series of casts or
special braces.
Third, if more
correction is
still needed,
consider
surgery.
Surgery often
consists of
lengthening
the tight
cords.
Instructions for correcting contractures
using plaster casts or braces are in Chapter 59.
CAUTION: Some orthopedic surgeons are quick to recommend surgery. However, we
have found that many contractures often said to need surgery can be corrected in the
village or home by exercise and casting or braces. In any case, stretching exercises
and bracing are often needed for a long time after surgery (or forever) to prevent the
contractures from coming back.
Also, some contractures are best left uncorrected (see Chapters 42 and 56). When in
doubt, consult an experienced physical therapist.
Exercises to correct contractures —’stretching exercises’
These are similar to the range-of-motion exercises used to prevent contractures, except
that steady, gentle but firm stretching is required:
1. Hold the limb in a steady, stretched position while
you count slowly to 25.
2. Then gradually stretch the joint a little more, and
again count slowly to 25.
3. Continue increasing the stretch in this way, steadily
for 5 or 10 minutes. Repeat several times a day.
CAUTION: To avoid damaging the limb, hold it near the
joint, as shown. It is acceptable if the stretching hurts the
child a little, but it should not hurt him a lot. If you want
faster results, do not apply more force. Stretch the limb
for longer and more times each day.
In children who do not feel in their legs, take special
care not to stretch forcefully. You could cause injuries.
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