Elbow contracture

I was out today and saw something else that I think might be due to a stroke. This is not a gait pattern. It has to do with your arm.

Commonly, after a stroke, the flexor muscles will be for some reason a lot more active. Bending your elbow is flexing and shortening your elbow. Straightening it is extending and lengthening it. And a lot of times after a stroke – and this happened to me -when you try to use one muscle on your affected side, ALL of the flexor muscles on that side of your body will contract in synergy. This is different than spasticity.

Right after my stroke, when I would attempt to walk the entirety of flexor muscles on the upper right side of my body would turn on. Meaning that when I tried to walk, my shoulder would elevate (this is kind of flexion, shortening of the muscles there anyway), my elbow would bend, and my wrist and fingers would curl. Luckily, this went away for me but for a lot of stroke survivors, it never goes away.

What I saw when I was out was a person walking with her elbow bent. It didn’t look natural and you could tell that she was not holding it like that intentionally. This is called a contracture. The tendons of her biceps muscles are permanently shortened causing an elbow contracture. (Again, this is someone I don’t know, I’m just speculating.)

Well, permanent schmermanent I say. If a doctor or therapist has told you that your contracture is permanent, don’t believe it. I don’t buy it. Tendons are a living tissue that can be remodeled. It will take a heck of a lot more work on your part to lengthen them back out than it did to shorten them, but it can be done.

The tendons are not shortened because of something neurological. At first, yes. But right after your stroke, the arm would have been able to be completely straightened out by force because the tissue had not adapted to the shortening effects of the stroke yet. After years, it has adapted to this and can no longer be easily straightened out. The actual tendons have adapted and shortened. The brain is no longer causing the shortening as it did at the beginning.

There is a theory in physical therapy called TERT (total end range time.) This theory claims that the amount of increase in passive range of motion (PROM) of a stiff joint is proportional to the amount of time the joint is held at its end range, or total end range time .”

So spend a lot of time in TERT and the tendons will lengthen. Or even better, take the joint to end range for a ton of repetitions each day. Stretch it. A lot. But don’t believe that it’s permanent.

Categories: Brain stuff, Recovery, Rehab, Stroke stuff

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