Seven Recommendations to Ensure Safe and Effective Stretching Exercises for Burn Rehabilitation
- Vita Yu-Hsien TU
- Apr 8
- 4 min read
Vita Yu-Hsien TU, Occupational Therapist and Project Manager
Sunshine Social Welfare Foundation
Stretching exercises play a vital role in burn rehabilitation, primarily targeting the stretching of scar tissue and improving joint mobility to enhance movement and functional performance. These exercises are critical for preventing contractures and optimizing recovery outcomes, making them an indispensable tool for therapists working with burn patients. In previous posts and videos, we shared example of techniques using elastic bandages and triangular wedges to effectively stretch dorsal scars of the hand. We also discussed the importance of assessing contraindications before initiating stretching exercises.
This article builds on those foundational concepts by offering therapists seven practical recommendations to ensure stretching exercises for burn rehabilitation are performed safely and effectively in a clinical setting.
By understanding and applying these principles, therapists can enhance patient comfort, minimize risks, and achieve better functional results during stretching exercises in burn rehabilitation.
Seven recommendations for stretching exercises for burn rehabilitation
When performing stretching exercises, the following points should be noted:
1. Start with Low Intensity
The intensity of a stretch is determined by the tensile load applied to soft tissues to elongate them. This can be assessed subjectively based on the patient’s sensation or objectively by measuring the passive resistance of tissues during joint motion. Both clinicians and researchers generally agree that low-intensity stretching, achieved with a low load, is preferable.
Low-intensity stretching offers greater comfort and tolerance for patients. By reducing the likelihood of voluntary or involuntary muscle guarding, it enables patients to stay relaxed or actively participate during the stretching process. Additionally, low-intensity techniques minimize the risk of tissue damage and post-exercise soreness often associated with high-intensity stretching.
2. Set a Safe Duration of the Stretch
Based on the patient’s situation, the therapist must choose a duration of stretch that will be safe, effective, practical, and efficient. Duration refers to the time the stretch force is applied and the tissues are held in the elongated position. If multiple stretch cycles are performed in one session, the cumulative time is considered the total elongation time.
The intensity of the stretch impacts its duration. High-intensity stretching can cause significant discomfort, reducing the amount of time a patient can tolerate the stretch. This is why a “low load, prolonged stretch” is prioritized.
3. Move Slowly and Gradually
Muscle activation refers to the involuntary contraction of muscles during stretching, which can occur as a protective response to prevent perceived overextension. This reaction, often tied to the stretch reflex, can hinder the effectiveness of the stretch and increase discomfort for the patient.
To reduce muscle activation, as well as the risk of tissue injury and post-stretch soreness, stretching should be carried out in a slow and controlled manner. Gradual stretching minimizes the tension placed on connective tissues. This method also improves the viscoelastic properties of the tissues, enhancing their flexibility over time. Additionally, a low-velocity approach is easier to manage for both the therapist and the patient, providing a safer and more comfortable experience.
4. Tailor Intensity to Patient Tolerance
Stretching exercises should be customized to match the patient’s individual tolerance levels to ensure they can sustain the stretch for the required duration. Instead of focusing on achieving an ideal stretch range of motion, the priority should be on realistic goals that balance the stretch intensity and duration to maximize effectiveness. This patient-centered approach allows for gradual progression while minimizing discomfort and the risk of adverse effects.
5. Ensure Correct Posture
Therapists must monitor the patient’s posture during stretching to prevent compensatory movements. Compensatory movements reduce the effectiveness of stretching and, if persistent, may lead to habitual incorrect movement patterns. For example, during shoulder flexion stretching, patients may lean backward as compensation; when stretching finger joints, compensatory wrist flexion movement might occur. Such compensations often indicate excessive pain or that the stretch has exceeded the joint's range of motion. Adjustments in intensity or target range of motion may be necessary.
6. Make Sure to Follow-Up
The intensity and duration of stretching should be adjusted based on improvements in joint mobility, requiring regular assessments. Abnormal reactions such as joint or muscle pain, blisters, or skin tears may not appear immediately but rather after the patient returns home. Therefore, follow-up is essential to monitor outcomes and address any issues.
7. Enhance Patient Engagement
Explaining the purpose and benefits of stretching exercises to patients beforehand can help them understand their necessity, reducing fear or resistance. If therapists teach patients to perform self-stretching exercises, thorough explanations can increase their willingness and consistency in practice.
Looking Ahead
These are key considerations for performing stretching exercises. However, must stretching exercises always be carried out one-on-one through manual therapy by a therapist? In situations where manpower is limited, are there alternative methods to achieve the same effects? Future articles will introduce ways to use equipment to facilitate effective stretching exercises.
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