Contracture Prevention After Spinal Cord Injury

What are contractures?

After a spinal cord injury (SCI), muscles, tendons, and ligaments may shorten. Shortening of a muscle, tendon, or ligament is called a contracture. Contractures result in less movement of a joint, such as your wrist, elbow, shoulder, or ankle. Joints are the places where your bones meet in your arms and legs. Contractures can begin developing as soon as one week after your spinal cord injury. There are things you can do to help prevent contractures.

What causes contractures?

Some of the nerves from your spinal cord to your muscles stopped working completely or partially after your injury. This makes it difficult or impossible for you to move some muscles without help. The nerves to one muscle also may be better than to another muscle. This imbalance can make a muscle on one side of a joint stronger than the muscle on the other side. This causes the stronger muscle to contract or shorten. Spasticity (spas-TIS-i-te) also can cause contractures. Spasticity is when your limbs (arms or legs) move without your wanting them to. Your arms and legs may also resist being moved.

What can be done to prevent contractures?

You and your family members will be taught how to do range of motion exercises to help prevent contractures. Splints and other positioning devices may be used to hold your limbs in the correct position. Caregivers will teach you how to sit and lie down in ways that will help prevent contractures. Caregivers will also help you control spasticity.

What are range of motion exercises?

Range of motion is how well each joint can move. These exercises help your joints stay limber so that they can move as well as they did before the SCI. These exercises cannot make your paralyzed muscles move on their own, but can help prevent problems like contractures. You may need someone else to perform the range of motion exercises if you are unable to do them yourself. Most people have to perform range of motion exercises one time each day. You may need to do it two times if you are developing contractures. Ask your caregiver for more information about doing range of motion exercises.

What is functional electrical stimulation?

Functional electrical stimulation (FES) is a treatment used to stimulate a muscle with electricity to make it move. Depending on the type of spinal cord injury that you have, you may not be able to use this treatment. Ask your caregiver whether FES is a treatment that is right for you.

Are there medicines I can take to help prevent contractures?

Caregivers may give you anti-spasm medicine to decrease muscle tone. This makes it easier to move your joints in their full range of motion.

Can anything be done if a joint has started to contract?

Serial casting is a treatment that may be done to help your joints extend more. It may also stop your muscles from getting shorter. Casts are applied over joints. The casts will be applied, removed, and re-applied over several weeks. Each time the casts are removed and re-applied, caregivers will help your joints extend further. Serial casting may be an option to help reverse a contracture. The goal is that every three to five days caregivers are able to extend the joint a little more until the contracted joint returns to its correct length. Ask caregivers if serial casting can work for you if you already have a contracture.

Where can I go for support?

  • Having a spinal cord injury is life-changing for you and your family. Accepting that you have a SCI is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with a SCI.

  • You may want to join a support group. This is a group of people who also have a SCI. Ask your caregiver for the names and numbers of support groups in your town. You can contact one of the following national organizations for more information:
    • Paralyzed Veterans of America
      801 Eighteenth Street NW
      Washington, DC , 20006
      Phone: 1- 800 - 424-8200
      Web Address:
    • National Spinal Cord Injury Association
      1 Church Street, Suite 600
      Rockville , MD 20850
      Phone: 1- 800 - 962-9629
      Web Address:
    • American Spinal Cord Association
      2020 Peachtree Road, NW
      Atlanta, Georgia , 30309-1402
      Phone: 1- 404 - 355-9772
      Web Address:

Contact a caregiver if:

  • You see that a joint is beginning to contract.

  • You have trouble performing your range of motion exercises.

  • You are having problems with spasticity.

  • You have problems that may be caused by a splint or positioning device, such as:

    • Change in feeling, such as numbness, pain, or burning.

    • Color changes, such as fingers turning blue, red, or white.

    • Edema (swelling).

    • Signs of a pressure sore, such as redness, blisters, or skin breakdown.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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