Burn Challenge: Physiotherapy, Key to Preventing Contractures and Restoring Mobility

Burns are devastating injuries that affect not only the skin, but also functionality and quality of life. Beyond the acute healing phase, one of the greatest long-term challenges is the prevention of skin contractures, scars that can severely limit movement and cause pain. This is where physiotherapy becomes a fundamental pillar of recovery.

What Are Skin Contractures and Why Are They a Problem?

When skin is burned, the healing process involves the formation of scar tissue. This tissue, rich in collagen, is initially flexible, but over time it can become dense, shorten, and contract, pulling the surrounding skin and underlying tissues with it. These contractions are called skin contractures. Their impact is significant: they can restrict the range of motion of joints, make daily tasks like eating or dressing difficult, and cause deformities, chronic pain, and body image issues. Understanding their nature is the first step to effectively combatting them.

Early Physiotherapy: The Battle Begins Soon

The prevention of contractures doesn't wait for the wound to be completely closed; it begins as soon as the patient is stable. In the initial phases, the physiotherapist works on:

• Therapeutic Positioning: Placing limbs and trunk in positions that stretch burned tissue and prevent vicious postures that favor contracture. This helps guide the formation of new tissue.
• Gentle Mobilization: Performing passive and active-assisted range of motion exercises to maintain joint flexibility and gently stretch the healing skin. It's a delicate balance to avoid damaging fragile tissue.
• Splints and Orthotics: Using personalized devices (splints or braces) to maintain joints in functional stretching positions for extended periods, especially during sleep, preventing shortening and deformities.

This early intervention is crucial for guiding the formation of scar collagen in a more functional and less restrictive way.

Long-Term Strategies: Keeping Skin Flexible and Functional

Once wounds are closed, physiotherapy intensifies to optimize scar quality and recover maximum functionality. This includes:

• Scar Massage: Specific and progressive massage techniques to soften scar tissue, increase its elasticity, break adhesions, and improve circulation.
• Stretching and Strengthening Exercises: Personalized and progressive programs designed to increase joint range of motion, restore muscle strength, and improve endurance and coordination, adapted to the patient's individual needs.
• Compression Therapy: The use of custom-made compression garments or elastic bandages is fundamental. They help modulate collagen formation, reduce scar thickness, redness, and itching, and significantly minimize the risk of contracture.
• Therapeutic Silicones: Silicone sheets or gels applied to the scar can improve its hydration, softness, and elasticity, complementing other therapies.
• Education and Self-Care: It is vital to educate the patient and their family about the importance of self-care, adherence to daily exercises, consistent use of compression, and sun protection for long-term success.

Conclusion

Burns are a long journey, but physiotherapy is an indispensable companion every step of the way. By actively preventing skin contractures from the outset and throughout recovery, physiotherapists not only help preserve mobility, reduce pain, and improve scar aesthetics, but also empower patients to regain their independence and significantly enhance their quality of life. Do not underestimate the power of specialized and committed physiotherapy intervention.