Treatment of Muscle Contractures

Physical and Therapeutic Measures

The American Geriatrics Society recommends static stretching exercises to be performed daily when pain and stiffness are minimal, such as before bedtime 2
The American Geriatrics Society suggests preceding exercises with superficial moist heat to improve effectiveness 2
Maintaining the terminal stretch position for 10-30 seconds before slowly returning to the rest position is recommended 2
Submaximal and aerobic exercise should be implemented, avoiding excessively strenuous exercise that could worsen the condition 3, 4
Adequate rest during exercise and monitoring of patient response is necessary 5

Correct positioning and appropriate orthotics should be used to counteract deforming forces 1, 5
Specific orthotics should be used according to the affected joint (AFOs for plantar flexion contractures, knee braces for knee flexion contractures, etc.) 5
Adequate support should be provided in all positions, especially sitting and standing 4, 5

The American Heart Association recommends considering tizanidine, dantrolene, or oral baclofen for spasticity that causes pain, poor skin hygiene, or decreased function 1, 6
Avoiding the use of diazepam or other benzodiazepines during the recovery period due to potential harmful effects is recommended 1, 6

For selected cases with incapacitating or painful spasticity, considering the use of botulinum toxin or phenol/alcohol is recommended 1, 6
In chronic patients with severe spasticity, evaluating the use of intrathecal baclofen is necessary 1, 6
Considering neurosurgical procedures such as selective dorsal rhizotomy for spasticity resulting in pain, poor skin hygiene, or decreased function is recommended 1, 6
Orthopedic surgery may be necessary in some cases (such as scoliosis management) when progression goes beyond what is susceptible to conservative management 5

Modifying stretching exercises to avoid pain or when the joint is inflamed (decreasing the range of motion or the duration of the static position) is recommended 2

Coordinating the use of positioning devices, orthotics, and bipedalism with medical specialists due to potential contraindications such as cardiac or pulmonary compromise, osteoporosis, fracture risk, subluxation, or hip dislocation is necessary 5
Prolonged use of orthotics beyond the necessary healing period can cause stiffness and decreased range of motion 7