Burns: The Essential Role of Physiotherapy for a Recovery Without Limitations

Burns are traumatic injuries that go beyond the skin, profoundly impacting the lives of those who suffer them. While initial medical care focuses on saving lives and healing the wound, there is a crucial long-term concern: the prevention of skin contractures. This is where physiotherapy becomes a fundamental pillar to ensure functional recovery and a better quality of life.

What are Post-Burn Skin Contractures and Why Do They Occur?

Skin contractures are the hardening and shortening of the skin and underlying tissues, a product of scarring. When the skin suffers a deep burn, the natural repair process involves the formation of collagen-rich scar tissue. This collagen, while necessary to close the wound, can organize in a disordered manner, contracting and pulling on the surrounding tissues. The result is hypertrophic or keloid scars that, as they shorten, severely restrict joint movement, cause chronic pain, and deformities, affecting both function and aesthetics. Prevention is, undoubtedly, the best strategy to mitigate these consequences.

Physiotherapy: An Indispensable Ally from the Beginning

Physiotherapeutic intervention should begin as soon as the patient's condition allows, even in intensive care units. This early stage is critical to minimize the risk of contractures. Our primary goal is to maintain maximum range of motion and prevent the formation of contractures. This is achieved through:

• Therapeutic Positioning: Placing the patient in specific postures that keep the burned areas stretched and prevent shortening.
• Splints and Orthoses: Personalized devices that immobilize joints in functional positions, applying gentle and constant tension on the burned skin to prevent contraction.
• Early Mobilization: Passive exercises (performed by the physiotherapist) and active exercises (performed by the patient) of the affected joints, always respecting the pain threshold. This helps maintain tissue elasticity and reduce edema.
• Edema Management: Lymphatic drainage techniques and limb elevation to reduce swelling, which can exacerbate stiffness and pain.

Therapeutic Strategies for More Functional Skin

Once the wound has healed, physiotherapy focuses on remodeling the scar and restoring full function. This is a long-term process that requires consistency and active patient collaboration:

• Scar Massage: Specific massage techniques that help soften scar tissue, increase its elasticity, improve circulation, and desensitize the area.
• Progressive Stretching: Stretching exercises designed to elongate the skin and tissues, gradually gaining lost range of motion.
• Therapeutic Exercises: Personalized programs combining strengthening, coordination, and balance exercises to regain strength and functionality.
• Pressure Garments: Custom-made elastic garments that apply constant pressure on the scar, helping to flatten and mature it, reducing the formation of hypertrophic tissue.
• Silicone Sheeting: Patches placed over the scar to keep it hydrated, soft, and less prone to contracture.
• Hydrotherapy: Water provides a supportive environment that facilitates movement and relieves pain, making it ideal for exercises and stretches.

Conclusion

The prevention of skin contractures after a burn is not just an aesthetic issue; it is a fundamental part of ensuring maximum patient functionality and autonomy. Physiotherapy, with its early and continuous approach, is the most powerful tool to face this challenge, transforming the healing process into an opportunity to regain quality of life and a future with fewer physical limitations.