Permanent knee contracture?

antiquity · 10-16-2001, 09:33 PM

Is there anyway besides surgery, to stretch shortened tendons in the backs of the knees?

I'm a C7/8 quad with a 35 degree contracture in both of my knees for 10 years. Exercise and ultrasound didn't help.

antiquity · 10-16-2001, 11:35 PM

I found this site while researching, I wonder if this technique can be applied to SCI induced atrophy?

http://www.congo-pages.org/ipvrc/muscle.htm

SCI-Nurse · 10-17-2001, 02:31 PM

Seneca - I am assuming that you were in the described program in a rehab setting whose personnel were familiar with SCI. Were you evaluated by a physiatrist (doctor of Physical Medicine) whose background/expertise is in SCI?

I have looked at the link listed and would suggest that such an approach should be discussed with a physiatrist who does have SCI experience. The use of casting in SCI can be a source of further problems due to the risk of pressure points and skin breakdown under the cast.

The development of contractures unfortunately is a preventable complication. It is so very important that one's daily routine include range of motion of the joints of the paralyzed limbs and stretching of those muscles. CRF

antiquity · 10-17-2001, 07:14 PM

I received therapy in 1978. When I was sent home, I don't think anyone told my mother to make sure my legs spent a couple of hours straightened instead of in the bent position they were always in while sleeping on my side and sitting in my wc. By the time I was 9/10, my knees had significant contracture and no one's recommended anything worthwhile, outside of surgery, since.

SCI-Nurse · 10-17-2001, 08:49 PM

Seneca - I am sure your Mother probably was not given this kind of instruction. I think so little was known and/or identified at that point in time re: management of the spinal cord injured person. The development of the Clinical Practice Guidelines has only occurred in the recent years. Have you been evaluated for the contractures by a doctor with expertise in SCI? If not, I would encourage you to do so. I will do some more searching re: this issue. CRF

SCI-Nurse · 10-21-2001, 02:45 PM

Seneca - With some discussion with another member of the SCI-Nurse team, we offer this additional information. Surgery for the SCI patient with contractures is at best a risky choice as there may be bony involvement as well as tendon involvement with a contracture that has existed for a long time. One may not necessarily regain range of motion (ROM) with surgery but rather end up with the leg in a fixed extended position. As with any surgery, but particularly a risk in this kind of surgery, is the concern about infection and hematoma formation.

A word of caution to all with SCI should include education about the importance of daily ROM, proper positioning, standing (where possible) and periods of time daily during which one lies in a prone (face down) position. This latter activity will stretch the tendons and muscles of the lower extremeties. CRF

Jeremy · 10-21-2001, 04:18 PM

Seneca: Here's some site for range of motion exercises

http://www.rohcg.on.ca/mobile/rom/index.html

http://calder.med.miami.edu/pointis/range.html

"If the wind could blow my troubles away,
I'd stand in front of a hurricane."

SCI-Nurse · 10-21-2001, 05:10 PM

Jeremy - Thanks for posting these sites; both are most helpful. CRF

Curt Leatherbee · 10-21-2001, 09:13 PM

I started getting the same thing too and found it helpful to do leg stretches while sitting in a hottub. I push down on my knees with an even pressure (no bouncing) and slowly the legs go into the extended position. I found that in doing this everyday for about a month, my legs now go into a straight out position fairly easily. Things were getting so bad for a while that I could not even get on my long leg braces, now its no problem.

"Life is about how you
respond to not only the
challenges you're dealt but
the challenges you seek...If
you have no goals, no
mountains to climb, your
soul dies".~Liz Fordred

antiquity · 10-29-2001, 12:39 AM

Thank you everyone for your responses.

ROM is good for preventing contracture but it's ineffective for reversing contracture. All my other joints are fairly lithe and limber.

SCI-Nurse, since surgery is so risky, are you saying that at this point, there's really nothing that can be done.

10-16-2001, 09:33 PM	#1
antiquity Moderator Join Date: Jul 2001 Posts: 14,540	Permanent knee contracture? Is there anyway besides surgery, to stretch shortened tendons in the backs of the knees? I'm a C7/8 quad with a 35 degree contracture in both of my knees for 10 years. Exercise and ultrasound didn't help.

10-16-2001, 11:35 PM	#2
antiquity Moderator Join Date: Jul 2001 Posts: 14,540	casting? I found this site while researching, I wonder if this technique can be applied to SCI induced atrophy? http://www.congo-pages.org/ipvrc/muscle.htm

10-17-2001, 02:31 PM	#3
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,333	knee contracture Seneca - I am assuming that you were in the described program in a rehab setting whose personnel were familiar with SCI. Were you evaluated by a physiatrist (doctor of Physical Medicine) whose background/expertise is in SCI? I have looked at the link listed and would suggest that such an approach should be discussed with a physiatrist who does have SCI experience. The use of casting in SCI can be a source of further problems due to the risk of pressure points and skin breakdown under the cast. The development of contractures unfortunately is a preventable complication. It is so very important that one's daily routine include range of motion of the joints of the paralyzed limbs and stretching of those muscles. CRF

10-17-2001, 08:49 PM	#5
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,333	knee contractures Seneca - I am sure your Mother probably was not given this kind of instruction. I think so little was known and/or identified at that point in time re: management of the spinal cord injured person. The development of the Clinical Practice Guidelines has only occurred in the recent years. Have you been evaluated for the contractures by a doctor with expertise in SCI? If not, I would encourage you to do so. I will do some more searching re: this issue. CRF

10-21-2001, 02:45 PM	#6
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,333	knee contractures Seneca - With some discussion with another member of the SCI-Nurse team, we offer this additional information. Surgery for the SCI patient with contractures is at best a risky choice as there may be bony involvement as well as tendon involvement with a contracture that has existed for a long time. One may not necessarily regain range of motion (ROM) with surgery but rather end up with the leg in a fixed extended position. As with any surgery, but particularly a risk in this kind of surgery, is the concern about infection and hematoma formation. A word of caution to all with SCI should include education about the importance of daily ROM, proper positioning, standing (where possible) and periods of time daily during which one lies in a prone (face down) position. This latter activity will stretch the tendons and muscles of the lower extremeties. CRF

10-17-2001, 07:14 PM	#4
antiquity Moderator Join Date: Jul 2001 Posts: 14,540	I received therapy in 1978. When I was sent home, I don't think anyone told my mother to make sure my legs spent a couple of hours straightened instead of in the bent position they were always in while sleeping on my side and sitting in my wc. By the time I was 9/10, my knees had significant contracture and no one's recommended anything worthwhile, outside of surgery, since.

10-21-2001, 04:18 PM	#7
Jeremy Senior Member Join Date: Jul 2001 Location: Canada Posts: 588	Seneca: Here's some site for range of motion exercises http://www.rohcg.on.ca/mobile/rom/index.html http://calder.med.miami.edu/pointis/range.html "If the wind could blow my troubles away, I'd stand in front of a hurricane."

10-21-2001, 05:10 PM	#8
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,333	ROM sites Jeremy - Thanks for posting these sites; both are most helpful. CRF

10-21-2001, 09:13 PM	#9
Curt Leatherbee Moderator Join Date: Jul 2001 Location: Florida Posts: 9,320	Seneca I started getting the same thing too and found it helpful to do leg stretches while sitting in a hottub. I push down on my knees with an even pressure (no bouncing) and slowly the legs go into the extended position. I found that in doing this everyday for about a month, my legs now go into a straight out position fairly easily. Things were getting so bad for a while that I could not even get on my long leg braces, now its no problem. "Life is about how you respond to not only the challenges you're dealt but the challenges you seek...If you have no goals, no mountains to climb, your soul dies".~Liz Fordred

10-29-2001, 12:39 AM	#10
antiquity Moderator Join Date: Jul 2001 Posts: 14,540	Thank you everyone for your responses. ROM is good for preventing contracture but it's ineffective for reversing contracture. All my other joints are fairly lithe and limber. SCI-Nurse, since surgery is so risky, are you saying that at this point, there's really nothing that can be done.

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