Complications: Swelling or Edema and Contractures

Rehabilitation Institute of Chicago Brain Injury Team
Complications: Swelling or Edema and Contractures

Swelling in the legs and arms is very common after being unable to move them. This swelling is caused from fluid building up in the legs and arms due to slowed circulation. This fluid builds up when legs hang down as when you are sitting in a chair. The swelling can make your feet too big for your shoes and cause a pressure sore. For this reason it is best to wear shoes that are _ or a full size larger than you used to

How to prevent or manage swelling

  • Wearing elastic stockings that are fit to your legs or arms can help prevent this swelling. The stockings must be applied before you get up and before any swelling is present.
  • Raise your legs for periods of time during the day either by propping them up on a chair or using elevated foot rests on your wheelchair.
  • Always place your arms in an elevated position both while in bed and out


Contractures happen in the joints such as elbows, shoulders, knees and hips. When your arms and legs are not moved around, such as with range of motion exercises, the muscles and tendons can shorten making the joint stiff. If you develop contractures it can greatly limit your ability to do things for yourself. They can be painful and make it hard to be properly positioned in bed. Contractures are much easier to prevent then they are to treat once they occur.

How to prevent contractures

  • The best way to prevent contractures is to stretch your joints on a daily basis. Range of motion exercises makes sure that all the muscles and tendons get maximal stretching. Range of motion needs to be performed at least once a day. If you have a lot of spasms or tone you will need to do it more often.
  • Lying on your stomach (prone) also helps prevent contractures. This stretches the knees and hips. In all other positions except standing, your knees and hips are bent or flexed.
  • If you have a lot of tone or spasms your therapist may make you some splints. If you do not know how to stretch your arms and legs properly, ask your therapist or doctor.

How to recognize contractures

  • When you try to straighten or bend your arm or leg it will begin to get harder to get it all the way straight or bent.
  • Once contractures are bad enough the arm or leg will be impossible to move at the joints.

How to manage contractures

  • You will need to be seen by your doctor and therapist. They may order medicines, stretching exercising, splinting and casting. The only way to improve contractures is to stick to the program developed for you.
Posted on BrainLine November 26, 2008.

From the Rehabilitation Institute of Chicago, LIFE Center. Reprinted with permission.