How to Improve Joint Contractors with Serial Casting
Serial casting is a non invasive technique that has the potential to reduce muscle tightness and increase joint range of motion. Individuals with limb loss are at a higher risk of developing joint contractures as they heal secondary to prolonged positioning and surgical changes to muscle length/tension. Research has shown that mild stretching over a prolonged period of time has better benefits that intensive stretching over a shorter period of time. In other words, it would be better for a patient to maintain a light stretch for several hours that have a physical therapist "crank" on a joint in a painful position for 20 minutes during a clinical session.
Physical therapists can use serial casting on problematic joints to improve overall function in the long term. If you are a physical therapist that did not learn this technique in school, or are no longer comfortable with the application, multiple continuing educations courses are available to assist with competence.
Serial casting it aptly defined in it's name; meaning that the patient will undergo a series of casts that will progressively increase the available range of motion in the joint. In general, the physical therapist will work with the joint at the beginning of the session to include joint mobilizations, passive range of motion techniques, and proper positioning to prepare the joint to be casted. After the physical therapist has achieved the greatest available joint motion, the limb will be casted above and below the joint. When the casting material has hardened, the joint will be casted to combine the sections of the cast and maintain that stretched position until the cast is removed. Typically, the cast remains in place for 48-72 hours and is removed at the next session where the joint is stretched and casted again. This process can last from 4-12 weeks in general, with results visible in as little a few sessions.
The casting should remain dry, making cast covers imperative for showering and/or bathing. The cast does limit mobility and hinders fun, summer water activities; therefore, the patient has to be compliant with the schedule and agree with the plan. Despite the cumbersome cast, this serial technique has the potential for amazing results and should be considered an important piece of the physical therapist tool box.