Muscle Protection and Orthotic Devices

Evidence Against Splinting for Muscle Protection

Serial casting for fixed functional dystonia has been associated with worsening symptoms and the onset of complex regional pain syndrome in patients with functional neurological disorders, highlighting the potential harms of splinting 1
Splinting may prevent restoration of normal movement and function through multiple mechanisms, including increasing attention and focus to the area, increasing accessory muscle use, promoting compensatory movement strategies, causing immobilization leading to muscle deconditioning, and leading to learned non-use, ultimately exacerbating symptoms in patients with muscle overactivity and abnormal posturing 1
Learned non-use is a significant concern with splinting, as it can lead to long-term muscle dysfunction and decreased mobility, emphasizing the need for alternative strategies that encourage normal movement patterns and resting postures 2
Increasing pain is a potential harm of splinting, which can further complicate the treatment of patients with functional neurological disorders, underscoring the importance of careful consideration before using orthotic devices 1

Positioning and passive mobilization should be used to preserve joint mobility and skeletal muscle length in patients unable to move spontaneously, as recommended by the Intensive Care Medicine guidelines, to maintain muscle function and prevent deconditioning 3
Muscle stretching combined with positioning is recommended to maintain muscle length, not through rigid orthotic devices, but rather through gentle and controlled movements that promote normal muscle function, as suggested by the Intensive Care Medicine guidelines 3
Strategies that reduce muscle overactivity, such as muscle relaxation techniques, supporting the affected limb when at rest using pillows or furniture, and avoiding postures that promote prolonged positioning of joints at end of range, can help alleviate symptoms and improve outcomes in patients with functional neurological disorders, as recommended by the Journal of Neurology, Neurosurgery and Psychiatry guidelines 1

Ankle-foot orthoses (AFOs) should be used for ankle instability or dorsiflexor weakness in stroke patients, showing favorable impact on walking disability and balance, as recommended by the Stroke guidelines, highlighting the importance of targeted orthotic use 4
Thumb base orthoses for osteoarthritis provide symptom relief when used long-term (at least 3 months), but this is for joint support, not muscle protection, as noted by the Annals of the Rheumatic Diseases guidelines, emphasizing the need for clear indications for orthotic use 2

The key distinction is that orthoses may help with joint stability and structural support, but they do not protect muscles from overstretch and may actually harm muscle function, as highlighted by the Journal of Neurology, Neurosurgery and Psychiatry guidelines, underscoring the importance of careful consideration before using orthotic devices 1
If removable splints are issued, patients should be monitored regularly and feel empowered to discontinue use in the event of adverse effects, as recommended by the Journal of Neurology, Neurosurgery and Psychiatry and Stroke guidelines, to minimize potential harm 1, 4

Positioning, passive mobilization, and muscle stretching to preserve joint mobility and skeletal muscle length are recommended as alternative strategies to orthotic protection, as suggested by the Intensive Care Medicine guidelines, to promote normal muscle function and prevent deconditioning 3
Active or passive mobilization and muscle training should be instituted early to promote normal movement patterns and muscle activity, as recommended by the Intensive Care Medicine guidelines, highlighting the importance of early intervention 3
Encouraging optimal postural alignment and even distribution of weight to normalize movement patterns and muscle activity can help alleviate symptoms and improve outcomes in patients with functional neurological disorders, as recommended by the Journal of Neurology, Neurosurgery and Psychiatry guidelines 1
Grading activity to increase time that affected limbs are used with normal movement techniques can help promote muscle function and prevent deconditioning, as recommended by the Journal of Neurology, Neurosurgery and Psychiatry guidelines, emphasizing the importance of gradual and controlled progression 1