How can I prevent joint contracture after amputation?
A contracture is a joint that has stiffened in one position, so it can no longer move through its full range. It can make a prosthesis harder — sometimes impossible — to wear. The basics of prevention are keeping your hip and knee straight and not staying bent for long periods. Always agree when and how much to stretch with your doctor or rehabilitation team.
What is a contracture, and why does it matter?
After surgery it is natural to settle into whatever position hurts least. But spending long hours with a knee bent or a leg turned outwards can shorten the muscles and tissue around the joint, until the joint stiffens in that shape. This is called a contracture.
A contracture stops a joint from fully straightening or bending. A prosthesis is fitted on the assumption that your joints move reasonably well, so a severe contracture can limit how the prosthesis is worn — and in some cases make it impossible to wear at all. That is why paying attention to posture from the days after surgery matters.
For arm amputations, the focus is usually on moving the joints of the affected side. For leg amputations, the muscles used for walking also need strengthening, so exercise for the other leg is often recommended as well.
Positions to avoid, and what to do instead
| Situation | Avoid | Aim for |
|---|---|---|
| Lying down | A pillow under the residual limb, leaving the hip and knee bent | Hip and knee straight, on a firm mattress |
| Leg position | The residual limb turned out to the side | Both legs side by side |
| Sitting in a wheelchair | Long periods with the knee bent | Ask your care team how to keep the knee straight |
| Other habits | Crossing your legs; resting the residual limb on a crutch handle | Less time spent bent |
In short, cut down the time you spend lying or sitting with your knee or hip bent. Joints kept bent for long periods tend to have poorer circulation and shortening muscles.
Three approaches commonly used in rehabilitation
What follows is general information. When to start, how hard to work, and for how long should come from the doctor or rehabilitation specialist who can see your wound.
1. Resting in the right position
- Lying on your back — on a firm surface, hip and knee straight, no pillow under the residual limb, and the leg not turned outwards.
- Lying on your front — no pillow under the pelvis, hip and knee kept straight.
- Lying on your side — keep the hip and knee of the residual limb in a straight line, with a pillow between your legs if needed.
2. Slow, gentle stretching
Stretches usually target the front of the hip, the back of the thigh (hamstrings) and the front of the thigh (quadriceps). They can be done sitting, lying on your back or front, or with someone helping you. The key rule is never to force it: stretch slowly and in a controlled way rather than pulling hard through pain.
3. Desensitisation: getting the residual limb used to pressure
Wearing a prosthesis puts pressure and body weight on the skin of the residual limb. Desensitisation activities help the skin gradually get used to this.
- Gentle massage — once the wound has healed, lightly rub sensitive areas using an unscented lotion.
- Rubbing, tapping and friction — help the skin adapt to different kinds of touch.
- Light weight-bearing — when ready, press a folded towel against the residual limb to get used to pressure, then, standing, rest it on a padded support and gradually add weight.
Massaging before the wound has fully healed can reopen it. Always check with your care team beforehand.
If you are planning a prosthesis
Joints that move well and a residual limb that is used to pressure can make fitting and getting used to a prosthesis easier. Tell us about your joint movement and rehabilitation progress during your consultation, and we will plan the fitting schedule and the way the prosthesis is worn around it.
Frequently asked questions
If I already have a contracture, can I still wear a prosthesis?
It depends on how severe it is. Whether a prosthesis can be worn needs an in-person look at the joint, so speak to your care team and mention it during your consultation with us.
Is it a problem to rest my residual limb on a pillow?
It may feel comfortable, but it keeps the hip and knee bent and can lead to stiffness, so rehabilitation guidance generally advises against it.
When should I start stretching, and how often?
There is no single answer — it depends on your wound and your situation. Follow the timing and intensity your doctor or rehabilitation team sets.
Does this matter after an arm amputation too?
Yes. Arm joints can stiffen as well, so exercises that keep the joints of the affected side moving are recommended. Ask your rehabilitation specialist for specific exercises.
