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What are contractures and how do they develop?
Contractures are shortening of muscles, tendons or ligaments that have a limiting effect on movements of the joints. They occur when muscles and joints are not stretched or moved often enough. If, for example, the knees are permanently bent, the muscles that are responsible for extending the knee joints will shorten. As a result, the legs cannot be fully extended any more. The cause for contractures may also be previously existing restrictions on movement of the joints that are necessary for recovery (e.g. a plaster cast) or other health conditions (e.g. arthritis).

Where can restrictions in movement caused by contractures be seen most frequently?

- Shoulder joints
- Elbow joints
- Wrists

How can contractures be avoided?
Contractures can be avoided by moving (if possible autonomously) arms and legs actively and by changing the body position frequently:
- lying - sitting
- bent - extended

Why is it important to avoid contractures?

  • Movement restrictions in arms and legs make everyday life more difficult and decrease autonomy considerably, e.g. eating, personal hygiene, dressing oneself, transferring oneself, etc.
  • Contractures can lead to pressure sores.


If positioning measures are not performed consistently and correctly, contractures may develop quickly and treating them might take a long time.


After being released from the hospital, do I need to go on with the equinus foot deformity prophylaxis?
Normally not. If the feet are in the right position (min. 90° angle of the ankle) during mobilization (more than 6 hours) and upright training is done (30 min per day), no drop foot prophylaxis is necessary in bed.
However, should the situation change, e.g. through increased spasticity, it needs to be reassessed whether prophylaxis against foot drop becomes necessary.

What happens if I rarely wear shoes in the wheelchair or not at all?
The footrests on the wheelchair are normally too narrow for the toes to be supported so that they are hanging down if you are not wearing shoes. This may cause the development of claw feet which may cause problems when wearing shoes (pressure sores). Moreover, shoes offer protection against injuries, e.g. when striking the walls.

What is the best position in bed in order to avoid contractures in the hip and knee joints?
The best position is the prone position since this stretches the joints.

About the author:
Christa Schwager is a specialist in movement science in the Department for Nursing Development and Education at the Swiss Paraplegic Centre in Nottwil/Switzerland, where she has worked since 1994. She is co-author of the key publications in the field of spinal cord injury "Paraplegie. Ganzheitliche Rehabilitation" (eds. Guido A. Zäch & Hans Georg Koch) and "Pflege von Menschen mit Querschnittlähmung" (ed. Ute Haas).

updated: December 2013