Range of Motion and Contracture Prevention
Keeping joints loose so they keep working for you.
What is it?
A contracture is a permanent shortening of a muscle, tendon, or joint capsule from being held in one position too long, plus pulling from spasticity, plus scar tissue building up. Once a joint is fully contracted, it is very hard to fix. Prevention is much easier than treatment.
The highest-risk joints after SCI:
- Shoulders (especially in C5–C6 — the deltoid pulls)
- Hips (flexor tightness from sitting all day)
- Knees (flexor tightness from sitting)
- Ankles (plantarflexor tightness — drop foot)
- Fingers (claw hand without intervention in tetraplegia)
How you might notice
- A joint that does not open as far as it used to
- Pain at the end of motion that did not used to be painful
- New skin breakdown from a joint pressing against itself
- Trouble fitting clothing (a tight shoulder will not fit a sleeve)
- A caregiver having to push harder to move a limb
What to do — daily
- Range each joint through its full motion at least twice a day. Active where you can. Passive (a caregiver moves it) where you cannot.
- Stretches — slow, sustained, 30–60 seconds. Shoulder flexion, abduction, external rotation. Hip flexion, abduction, external rotation. Knee flexion, knee extension. Ankle dorsiflexion. Finger extension.
- Stand or use a tilt table for 30–60 minutes a day if cleared. The single best thing for hip and knee extension contractures.
- Use splints if your team prescribed them — resting hand splint, AFO, knee extension splint, abduction wedges.
- Treat spasticity well. Spasticity that is uncontrolled defeats stretching.
💡 Tip
Range of motion is boring and the consequences of skipping are invisible — until they're not. Build it into a routine attached to something you already do (after morning coffee, before evening TV) and it sticks.
What helps
- Heat before stretching — relaxes muscle.
- Casting or serial casting for early contractures.
- Botulinum toxin injection to a tight muscle (especially calf for foot drop, biceps for elbow flexion contracture).
- Surgical release as a last resort — Achilles, hamstring, hip flexor.
📞 Call your doctor if
- A joint suddenly will not move as far as last week.
- Skin is breaking down where two body parts press together (between fingers, in armpit, behind knee).
- New pain at a joint that did not used to hurt.
At your next clinic visit
Bring photos of any joint that looks tighter, your stretching log, and questions about whether your splints still fit. You may have grown out of one or need a different style.
Education only. Not medical advice. If you have a clinical question, talk to your rehab team. For emergencies call 911.