A contracture is what happens when a muscle stays in a shortened position long enough that it tightens, and then tightens more, until the joint can no longer open. The cause is almost always long stretches of immobility, which is why it shows up in a hand after a stroke or in someone living with dementia. And yes, you can slow it down or prevent it at home. It takes two things: short bouts of slow stretching spread through the whole day, and a soft positioning splint that holds the hand or knee open between stretches.
That is the answer Dr. Brandy Archie, occupational therapist and founder of AskSAMIE, gives on this episode of There's an OT For That. Most of what you will find when you search this question is written for clinicians or by splint retailers. This page is written for the caregiver watching a hand close and wondering whether it can still be stopped. It can, and the sooner you start, the more you keep.
What is a contracture, exactly?
In the episode we use the hand as the example because it is the one caregivers see most. Hold your hand out and relax it. It rests slightly curled, because it takes muscles to extend the fingers and muscles to close them, and at rest neither group is working hard. After a stroke, the hand often cannot actively extend or close much anymore. So it sits in that resting curl all day. Over time that curl gets tighter, and tighter, and tighter, until the fingers are drawn into the palm. That is a contracture. It can happen in many muscles, not just the hand. Behind the knee is another common place.
Our ultimate goal is always for the person to get function back in that hand. But even when that is not possible, we want to make sure the hand does not close completely, because a closed hand creates its own problems. The nails pinch into the palm and start cutting the skin. It becomes very hard for anyone to open the hand and clean inside it, and it can get smelly and raw. Tightness is one thing. True shortening of the muscle, where it will not open at all, causes permanent damage. That is what we are trying to prevent.
What causes a contracture?
Immobility, over a long time. The shortening accelerates after a stroke or with dementia because the hand spends so many hours not moving. Here is the math we walk through in the episode. If a caregiver stretches the hand once a day, that still leaves about twenty three hours and thirty minutes where the hand just stays put in its shortened position. One daily stretch cannot win against that. And no one can spend all day holding a loved one's hand open, and if it is your own hand after a stroke, you need your good hand free to live your life. So the question is not "how do I stretch more?" It is "how do I get movement into this hand many times a day without adding a job to my list?"
Where occupational therapy fits
Preventing contractures is core occupational therapy. An occupational therapist's job is to help people stay as safe and independent as possible, which usually means using their hands, feet, and muscles. When the person cannot do that on their own, our job is to equip the caregiver to care for that hand or knee properly. Positioning, range of motion, and choosing and adapting a splint are all things an OT does every day. If you have been searching for "resting hand splint" and found only clinical papers and product listings, occupational therapy is the discipline you were actually looking for.
How do I stretch a contracture at home?
Tag it to something you already do
The trick is to do range of motion in little bits throughout the day, attached to routines that already happen. For a caregiver, that might look like this:
- Every morning, when you wash the hand during a bath or while brushing teeth, do not just open it once to get it clean. Open and close it five to ten times in a row.
- Do the same at every hand washing: before lunch, after meals, any time you are already holding that hand.
If the contracture is your own, in a hand or behind a knee, tag the stretch to something you do several times a day anyway. Every time you use the bathroom, open that hand or straighten that knee as far as it goes and pull it back while you sit. Every commercial break, do it again. What you tie it to does not matter. It just needs to be something you will remember and can repeat consistently, many times a day.
Slow, to the resistance, then hold
There is some skill to a good stretch. Move slowly and consistently. When you feel the resistance, pull to it and hold. Take a few deep breaths and try to let the muscles relax. Often they will open a little more. Then pull a little further and hold again. The number of repetitions matters less than the time you spend holding at each point where it gets tight. One or two reps with a good long hold at the end range does more than ten quick pumps.
Why you also need a positioning splint
Mixing stretches into the day is the goal, and it is still probably not enough on its own. You also want periods where the hand or knee is held in the right position without anyone doing anything. That is what a brace or splint is for. In the episode we show a hand splint and walk through what makes a good one for contractures:
- It bends. A good contracture splint is flexible enough that you can shape it to the position the person can tolerate today. If the hand is already fairly closed, you set the splint to hold it just a little more open than it can manage on its own, and you open the splint a bit more as the hand improves.
- It is soft, with no pinch points. The hand will be in there for hours, so the skin has to be protected. Look for fabric covering the whole thing, zippers that sit on the inside rather than sticking out, no exposed metal, and Velcro that is soft on every edge.
- The person can get it off. If you wear the splint, you must be able to remove it independently. If you cannot hook a finger under the Velcro tab, adapt the splint. We have sewn a small loop onto the tab many times so one finger can catch it and pull. An OT is excellent at exactly this kind of adaptation.
You can browse our collections for the positioning splints we recommend, or get help from an occupational therapist to choose and fit one.
How long should the splint be worn?
Work up to it. Start with about an hour, take it off, and put it on again for another hour later in the day. Grade the time up as it is tolerated. Do not wear it overnight until the person can comfortably tolerate about eight hours during the day. The reason is simple: if the hand can only take an hour or two, and you put the splint on at bedtime, they will wake in pain in the middle of the night.
Once eight daytime hours are comfortable, move the splint to overnight and free the hand during the day. That is actually the goal, especially if there is still some movement in the hand. We want whatever movement exists to be happening during the day, when the person is actively doing things, and we want the splint doing its holding work while they sleep.
Red flags: pain and redness
Pain is a red flag. If the splint hurts, take it off and build up more slowly. Redness is the other one. After you remove the splint, any red mark should fade within about five minutes. If it does not, that is a pinch point. Find where the mark lines up with the splint and figure out the irritant. Sometimes it is as simple as a tag that was left on. Take the tag off, fix the spot, and do not keep wearing a splint that leaves marks that stay.
Get an occupational therapist involved
If this feels like a lot, it is because it kind of is. If you are not already working with an occupational therapist on this, please get one. You do not have to be hospitalized first. Ask the doctor for an OT referral. If the person is homebound, an OT can come to the house through home health. Otherwise there are outpatient clinics, and some outpatient clinics will bring an OT to your home too. You can find an OT near you in our directory, and our payment options page explains how insurance and out of pocket payment work for this kind of care.
If you take one thing from this episode, let it be this: the answer to what prevents a contracture is movement. Stretch it, range it, put it in the position you want it to stay in, and find ways to do that many times a day.
Frequently asked questions
Can a contracture be reversed?
Early tightness responds to stretching and positioning, and the ultimate goal is always getting function back. Once the muscle has fully shortened and the joint will not open at all, that damage can be permanent. That is why starting the stretching and splinting early matters so much.
How many times a day should I stretch the hand?
Many short times beats one long session. Once a day leaves the hand shortened for the other twenty three and a half hours. Tie a few slow stretches to every hand washing, every bathroom trip, or every commercial break. Hold time at the tight point matters more than rep count.
Should the splint be worn at night?
Eventually, yes. Only after the person can comfortably tolerate about eight hours of daytime wear. Until then, wear it in shorter blocks during the day and build up, so no one wakes in pain at 2 a.m.
What if the splint hurts or leaves red marks?
Take it off. Pain means the wear time is too long for now. A red mark that does not fade within about five minutes is a pinch point, and you need to find the cause, such as a tag, a zipper edge, or a rough spot on the Velcro, before wearing it again.
Do I need a doctor's order to see an occupational therapist?
Ask the doctor and they can write one, and you do not need a hospital stay first. An OT can see the person at home through home health, in an outpatient clinic, or through outpatient visits that come to the house. You can also search our directory directly to find an OT near you.
