by Jaimini Chawda

I realise this is bit of a weighty subject for our Stretch web-site, but prior to working here I was a Physiotherapy assistant to a hospital specialising in Amputees. We spent so much time actually stretching and strengthening as a part of their rehabilitation programme. So I shall be as benign and non technical to our readers as I can.
An amputation is a difficult concept for a person to come to terms with, let alone dealing with all the other fringe problems that come with it like flexion contractures.  A flexion contracture is when a joint is in a bent position due to the tight flexors of the joint.

Contractures develop due to muscle imbalance from the surgical procedure which moves the muscles around a joint.  It can also be due to poor postural habit over a period of time.  The most common joints that a contracture is found are at the hip and knee.  These are seen in Trans-Tibial Amputations, which is one of the more common amputations.

After the first few days of an amputation, patients are started on an exercise programme by a Physiotherapist or an assistant such as myself, to strengthen the muscles that have weakened.  The muscles weaken from disuse from the bed rest after the operation.

An Occupational Therapist is also involved in the rehabilitation and the amputee is given a wheelchair.  For the most part of the day an amputee is encouraged to sit in the wheelchair.  This is because it is good for their chest and allows their muscles to get stronger from the transferring, rather than just lying in bed.  But it also has its downside; even though saving the knee joint increases an amputees rehabilitation potential, sitting in the wheelchair can lead to contractures.  Amputees are encouraged to keep their knee straight but not all adhere to this.  An amputee has a tendency to sit with their knees flexed rather than keep it flat on the stump board. No one finds it natural to do this!

The knee flexion contractures occurs when the flexors of the knee become tight (hence the name) in this sitting position.  To correct the contracture, it is effective to stretch out the hamstrings and also strengthen the quadriceps.  The key to it is maintenance; this advise applies to all of our clients who come and get Stretched with us. Amputees should carry on their exercises to avoid the reoccurance of the contractures

Hip flexion contractures also occur from prolonged sitting in the wheelchair and to treat it, prone lying is usually effective.  But some amputees do not like to lie on their front so stretching in side lying for the hip flexors will decrease the contracture. The best way to stretch is to get the patient to activate the large gluteal muscles to extend the hip to allow maximum release in the hip flexors. A therapist will gently assist or facilitate the Stretch by guiding the muscle through the end range of motion.

The contractures need to be treated before the patient starts the rehabilitation phase in relation to gait re-education.  This is because they can affect the gait pattern when ambulating and ultimately the chances of having a  prosthesis.