How to reduce contractures with orthopedic manual techniques

What is a contracture and how can we detect it?

A contracture is a sustained and involuntary contraction of some muscle fibers, which does not disappear with the stretching of the muscle nor limits its capacity of contraction, although this occurs with pain, generating a picture of pain (myalgia), which is exacerbated with daily activities, work, being the pain persistent.

From a biochemical point of view, the muscle suffers an elevation of catabolic products, unable to eliminate it, and which perpetuate the painful picture, as they are irritating products of the nerve endings of the muscle fiber.

From a biomechanical point of view, it represents the inability of the muscle fibers to correctly perform the contraction and relaxation process, remaining in a state of semi-contraction, which increases the catabolism of contractile proteins, altering the normal physiology of the muscle.

The cause of a contracture is, in general, an extrinsic factor, usually overuse, postural alterations that alter the normal cycle of contraction and relaxation of the muscle involved, being very frequent the contractures in muscles that are habitually used in movement patterns of low intensity, but of long duration, such as head fixation (trapezius muscles), posture maintenance (paravertebral muscles).

The affected fibers are palpated hard and painful, known as Trigger Points, as they trigger the pain.

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What orthopedic manual techniques do you perform to reduce contractures?

Orthopedic manual techniques, so called because of the mechanical effects they produce on the muscle, are widely used as the first mode of treatment, based on inhibiting contracture by means of controlled mobilization of the adjoining regions and muscle inhibition techniques, which make it possible to re-establish the normal contraction/relaxation cycle.

A very popular technique such as massage is less and less used due to the advantages of orthopedic manual therapy.

What other treatments are used?

A second level of intervention in dry needling is an invasive technique, since the needles penetrate minimally into the skin; we will only feel a small prick, just a discomfort that lasts a second, and its purpose is to inhibit the permanent semi-contraction of the muscle. As it is an invasive technique, it is usually performed under ultrasound control, for the patient’s safety.

The third very important component is aerobic therapeutic exercise, the purpose of which is to improve oxygenation of all tissues, and which brings general benefits to the patient, since there is a direct relationship between the prevalence of contractures and a sedentary lifestyle.

The last aspect of the treatment is ergonomics, that is to say, the correction of postural errors that the patient may make in professional, domestic or sports activities, since if this correction is not made, the contracture could recur.

How long does recovery take?

The recovery period is shorter the earlier the physiotherapy treatment, which implies that the patient abandons empirical methods of self-treatment, and comes to the physiotherapy center within 48 hours of the onset of pain.

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In chronic cases, the treatment involves addressing the muscle pain as a first intervention, and then acting on the mechanical factors that cause the contracture.

What exercises can we do to avoid contractures?

On the one hand, we have regional therapeutic exercises aimed at normalizing the muscular contraction/relaxation cycle and on the other hand, aerobic physical activity as a fundamental element of health.

You could clarify a debate on the use of heat or cold in contractures

The use of heat (thermotherapy) is useful in contractures as long as it is of short duration, deep, and localized. In my practice we opt for resistive/capacitive therapy, a modern technique that facilitates muscle metabolism and reduces painful spasm.