Muscle contracture is a condition in which muscles tighten as a result of pathology or some outside injury, resulting in shortening of the muscle that is unable or difficult to be reversed. Normal function of muscles requires them to change their length to generate force and produce movement by pulling on bones. The classic double-bicep pose in bodybuilding is an example of muscular shortening as the result of movement, which in that case produces bunching of the bicep muscles. Muscular contractures occur when the shortening that is necessary to produce movement is maintained over time by neurological factors, is more difficult than normal to reverse, or which resists normal movement.
Because muscles need to change their length in order to produce movement, the inability of a muscle to lengthen causes changes in function that can result in difficulty in balance, walking, or interacting with the outside environment. Severe cases of contracture can be extremely painful and can pull joints and bones out of position as the result of sustained and un-managed muscular action. Sustained muscular contracture can result in changes in or damage to the structure of joints, being either the bony or soft tissues, and can cause damage to the skin as well.
Muscle contracture can be caused by a damaging event or other factor that causes change in way in which the brain and the nerves control the muscle. An example of this is a contracture that occurs following a stroke or spinal cord injury, which causes changes in the muscle tone as a result of damage to the parts of the nervous system responsible for the control and coordination of the muscles in a part of the limb. Another example of muscle contractures being caused by a neurological condition is the increased muscle tone common in cerebral palsy, wherein the increased tone or inappropriate contraction of a muscle can lead to abnormal positioning which, if sustained, may eventually cause shortening of the tissues. Muscle contractures can result from congenital or medical events that occur across the lifespan and which affect a person's neurology, but can also result from non-neurological factors as well.
Muscle contracture can occur and develop following decreased or changed use of a muscle. The most common example of this is the development of muscular shortening in the splinted or protected limb. Following a fracture, dislocation, or other structural injury that requires immobilisation of a limb, muscles may be stiff and resistant to movement that is driven either by the patient or by their therapist. This is an example of muscular contracture that does not have a neurological cause. Another example of this kind of muscular contracture is the contractures and shortening which occurs in patients with arthritis and other bony conditions that develop with age. When bones and joints aren't moved through their regular ranges of motion for extended periods of time, the soft tissues that usually provide that flexibility become stiff and shortened, and attempting to move the limb beyond it's shortened range of flexibility can be painful and unpleasant.
Physiotherapy management of muscular contractures differs based on the cause of the condition as well as the context of the person. Managing a muscular contracture that occurs in a young adult with cerebral palsy will require a different approach and progression compared with managing a muscular contracture that occurs in an older adult with other age-related conditions or other diagnosed issues. Regardless of the manner in which the condition is managed, physiotherapy intervention has been demonstrated to be effective in the management of the problem and in controlling the risks that may occur. Such treatment may include soft-tissue work like stretching, massage, and manipulation of stiff joints and muscles, movement re-training if the contracture is occurring within the context of stroke or brain damage, coordination with other management such as botox injection or surgery, and liaison with other clinicians as needed.
Managing discomfort depends on its underlying causes, how it varies throughout the day, what makes it better or worse, and how long you’ve been experiencing it. These factors are reviewed during your initial consultation, which is the first step toward easing and controlling pain. From there, your treatment plan is customised to address the cause, aiming to reduce pain, restore comfortable movement, and prevent future flare-ups.
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