Elimination of joint contractures after injuries

Treatment of joint contractures using the Bubnovsky method: restoring mobility without surgery. Learn about modern kinesitherapy methods, rehabilitation time and benefits of the approach. Sign up for a consultation at our centre!

Elimination of joint contractures after injuries using the Bubnovsky method¶

What is joint contracture and how can it be eliminated using the Bubnovsky method?¶

Joint contracture is a pathological condition in which a joint loses normal mobility due to structural changes in the surrounding tissues. It occurs due to scarring, inflammation or atrophy of muscles, ligaments or joint capsule. It is manifested by stiffness, pain on movement, visible deformity and gradual deterioration of limb function. Without treatment, it leads to irreversible stiffness.

Major types of contractures in humans¶

By origin:¶

Congenital (e.g., arthrogryposis, torticollis).
Acquired (post-traumatic, neurogenic, ischaemic, inflammatory).

By type of tissue causing the restriction of movement:¶

Arthrogenic contractures¶

Due to damage to joint structures: capsule, cartilage, ligaments. Often occur in arthrosis, rheumatoid arthritis. They are characterised by ‘starting’ pain, crunching and progressive limitation of movement amplitude.

Myogenic contractures¶

Associated with shortening or atrophy of muscles after injury, hypodynamia or neurological disorders. Lead to an imbalance in muscle tone and unnatural joint position.

Dermatogenic and desmogenic contractures¶

Dermatogenic and desmogenic contractures are caused by scarring of the skin (after burns) or subcutaneous tissue (fibrosis). They are manifested by tightness of tissues, soreness when trying to move.

Neurogenic contractures¶

Neurogenic contractures are caused by damage to the CNS or peripheral nerves (e.g. after a stroke). Characterised by muscle spasticity or, conversely, paralysis.

Direction of movement restriction:¶

Flexion (inability to straighten a joint).
Extensor (difficulty in flexion).
Extensor/extractor (limitation of movement to the side).

Where do post-traumatic contractures most commonly occur?¶

Knee contracture.¶

Most often develops after fractures, meniscus or ACL surgery. It is manifested by the inability to fully extend or bend the leg and limping.

Elbow Contracture.¶

Occurs after burns, fractures or inflammation. Leads to fixation of the arm in a bent position, makes household activities difficult.

Shoulder Contracture.¶

Characteristic of adhesive capsulitis (‘frozen shoulder’). It is manifested by a sharp limitation of mobility, pain when lifting the arm.

Ankle joint contracture¶

Formed after Achilles tendon ruptures or ankle fractures. Causes toe walking, gait disturbance.

Hip Contracture.¶

Develops in coxarthrosis or after endoprosthetic replacement. Causes shortening of the limb, pain when walking.

Causes of joint contractures¶

Joint contractures develop for a variety of reasons, each of which leads to disruption of normal biomechanics and gradual limitation of mobility.

One of the most common causes is trauma - fractures, dislocations, tears of ligaments and tendons. When such injuries heal, scars form in the tissues, fibrotic degeneration occurs, which literally ‘tightens’ the joint, not allowing it to move freely.

Prolonged immobilisation (restriction of mobility), such as wearing a cast after a fracture, also plays a negative role - lack of movement leads to muscle atrophy, tendon contraction and gradual ‘hardening’ of the joint.

Inflammatory processes, be it arthritis, bursitis or tendonitis, cause swelling and then sclerosis of tissues, which also limits mobility.

Other factors are equally dangerous - burns, deep wounds or surgical scars, which mechanically constrict the skin and underlying tissues, preventing the joint from bending or extending.

Neurological disorders, such as spasticity after a stroke or paralysis from peripheral nerve damage, disrupt the natural regulation of muscle tone, causing the joint to either ‘jam’ in one position or, conversely, become loose.

Finally, degenerative processes, primarily arthrosis, gradually destroy cartilage tissue, which leads to bone deformities, osteophyte growth and painful limitation of movement.

All these causes require timely intervention, otherwise the contracture may become irreversible.

Why is it important to rehabilitate contractures in a timely manner?¶

Timely rehabilitation of contractures is not just a matter of restoring mobility, but of preventing a whole cascade of serious complications.

If the limitation of movement in the joint is left unattended, the process will steadily progress: scar tissue will continue to thicken, joint surfaces will fuse, and eventually ankylosis - complete immobility of the joint - may develop.

But the problem is not limited to the affected joint - due to the forced change in biomechanics begins to overload the neighbouring joints and spine, which leads to their premature wear and degeneration.

Other consequences of untreated contractures are no less dangerous.

Prolonged lack of full movement causes muscle atrophy - they decrease in volume, lose strength and the ability to function normally.

Constant tension and incorrect position of the limb provoke chronic pain syndrome, which only increases with time.

All this together sharply reduces the quality of life of a person - the ability to self-care, professional activity is lost, and in severe cases can lead to permanent disability. That is why rehabilitation should be started as early as possible, while the changes are still reversible.

The Bubnovsky Method: principles of eliminating contractures¶

Dr Sergei Bubnovsky has developed a system of kinesitherapy (movement therapy) which includes:

Diagnosis - determining the type of contracture, condition of muscles and joints.
Active work through pain - performing special exercises on simulators or with elastic rubbers.
Decompression approach - eliminating axial load on the joint.
Cryotherapy - cold to relieve inflammation after exertion.
Breathing techniques - pain reduction.

Each technique is integral in the comprehensive restoration of joint mobility, and additional techniques are available to address the underlying causes and already acquired effects, in the case of a lingering problem.

1. Diagnosis¶

Stage Goal

Accurate determination of the nature and degree of contracture, assessment of the state of the musculo-ligamentous apparatus and articular surfaces.

Diagnosis according to the Bubnovsky method is a comprehensive approach to assessing the condition of the joint and surrounding tissues.

At this stage, the specialist carefully analyses the nature and degree of restriction of mobility, identifying specific biomechanical disorders - from the amplitude of movement to the state of the muscular corset.

During 1-3 diagnostic sessions (and in case of scarring changes - up to a week of observation), the doctor identifies areas of muscle hypertonus or atrophy, assesses microcirculation by such indicators as skin temperature and the presence of edema, which allows to draw an accurate picture of pathological changes and develop an individual rehabilitation programme.

This stage is critical, as it determines the further treatment strategy and avoids complications.

2. Active working through the pain¶

Stage Goal

Gradual restoration of mobility through overcoming the pain barrier without tissue damage.

The Bubnovsky method fundamentally differs from the traditional approach in that it involves active work through the pain barrier, but without the risk of tissue damage.

During 3-6 weeks of regular exercise (and in case of fibrotic changes - up to 3 months), the patient under the supervision of a specialist performs special exercises that cause moderate pain, but at the same time trigger important recovery processes: there is a gradual stretching of scar tissue due to the reorganisation of collagen fibres, sarcoplasmic reticulum in muscles is activated, the quality of synovial fluid in the joint is improved.

In this case, the body naturally responds to the pain stimulus by releasing endorphins, which not only reduces discomfort, but also contributes to the improvement of the general condition.

This stage requires strict adherence to the technique and load dosage in order to achieve restoration of mobility without the risk of complications.

Sarcoplasmic reticulum in muscle.

The Sarcoplasmic reticulum is a special network of tubes inside muscle cells that acts as a ‘calcium storehouse’. When the brain signals a muscle to contract, this ‘storehouse’ instantly releases calcium ions into the muscle fibre - this triggers the contraction. After the contraction, it pumps calcium back in just as quickly, allowing the muscle to relax.

This is a microscopic system of storage and rapid delivery of calcium, without which the muscles simply could not work - neither to contract quickly, nor to relax in time. In the Bubnovsky method, active exercises train this system, improving its function in contractures.

3. Decompression approach¶

Stage Goal

Creation of conditions for joint restoration without destructive axial load.

Decompression approach in the Bubnovsky method is a fundamentally important element of treatment, which is applied throughout the entire course of rehabilitation (from 2 to 6 months, and in arthritis becomes a permanent practice).

Its essence is to create gentle conditions for the joint by eliminating the destructive axial load.

This approach results in a whole range of positive changes: the pressure on the joint surfaces is significantly reduced, which allows the cartilage tissue to receive full diffuse nutrition and regenerate. At the same time, micro-traumas to the subchondral bone are prevented, and special exercises optimise the muscle pump, which ensures normal blood and lymph flow in the affected joint.

This method is particularly valuable because it creates conditions for natural tissue repair without medication.

4. Cryotherapy¶

Stage Goal

Curbing post-inflammatory reactions after exertion.

Cryotherapy in the Bubnovsky system plays a key role in the completion of each treatment session, the recommended duration of which is 5-15 minutes after exertion (up to 20 minutes 2-3 times a day is allowed in acute conditions).

This stage causes important physiological reactions: initial vasospasm is replaced by pronounced reactive hyperaemia, which significantly improves local blood circulation. At the same time, the activity of pro-inflammatory mediators (prostaglandins) is suppressed, and cold exposure naturally slows down the conduction of pain impulses along the nerve fibres, providing a pronounced analgesic effect.

This comprehensive approach helps to minimise post-load inflammatory reactions and create optimal conditions for tissue repair between exercises.

5. Breathing techniques¶

Stage Goal

Control of pain syndrome and optimisation of tissue oxygenation.

Breathing techniques in the Bubnovsky method serve as an important tool for complex influence on the body during rehabilitation.

Performed for 5-10 minutes during or after exercises (and in case of neurogenic contractures - up to 20 minutes), they provide several therapeutic effects at once:

Proper diaphragmatic breathing activates the parasympathetic nervous system, which helps to reduce the release of the stress hormone cortisol and naturally relax spasmed muscles.
At the same time, the venous return of blood is increased through the active work of the diaphragm, which improves tissue nutrition and accelerates the elimination of metabolic waste products.
It is especially important that these techniques help to increase the pain threshold, making the rehabilitation process more comfortable and effective, as proper breathing relieves psycho-emotional tension and helps the patient to better control his/her sensations during the exercises.

Effectiveness of the Bubnovsky method in treating contractures¶

The Bubnovsky method demonstrates high effectiveness in treating contractures due to its complex effect on all elements of the joint.

For example, in post-traumatic contracture of the knee (after a hip fracture), the system of kinesitherapy:

Stretches the scars in the joint capsule through dosed loads on exercise machines
Restores microcirculation in spasmed thigh muscles
Prevents the formation of connective tissue adhesions
activates the production of synovial fluid.

Real case: a patient with a 6-month elbow contracture after a burn injury (flexion only up to 90°) regained full range of motion in 3 months of regular exercise through a combination of decompression exercises and cryotherapy.

Dangers of prematurely stopping treatment for joint contractures¶

Example 1: Premature discontinuation of rehabilitation for shoulder capsulitis¶

When a patient quits exercise after 2 weeks (instead of the recommended 3-4 months), the following processes occur in the tissues:

At the cellular level:
- Incomplete phagocytosis of damaged collagen fibres (macrophages do not have time to ‘clean’ the scar area)
- Interruption of angiogenesis - new capillaries that started to sprout in the first 2 weeks regress.
- Myofibrils return to a state of partial atrophy due to insufficient activation of satellite cells
In connective tissue:
- Type III collagen (young) does not have time to be replaced by the more elastic type I collagen
- Fibroblasts stop producing hyaluronic acid.
- Bridges are formed between individual fibres, creating rigid adhesions.
Clinical manifestations:
After 1 month without loading:
- Decrease in flexion amplitude from 120° to 80-90°
- Crepitation (crunching) on movement.
- Night pain due to the formation of new nerve endings in the scar.

Example 2: Ignoring breathing techniques for spastic contracture¶

When respiratory exercises (5-10 minutes daily) are ignored, a cascade of pathological reactions develops:

Neurological changes:
- Gamma-motoneuron activity increases → increase in muscle tone
- Reciprocal inhibition is impaired (antagonists do not relax)
- Pathological synergies (combined movements) are formed.
Muscle imbalance:
- Lactate accumulates in spasmed muscles (pH decreases to 6.2-6.5)
- Calcium pump activity decreases (Ca²⁺ remains in sarcoplasm)
- A ‘second level’ contracture develops - shortening of sarcomeres
Effects in 3-6 months:
- Appearance of antagonist contractures (e.g., hip flexion-adduction)
- Myofascial triggers in 3-4 adjacent areas
- Increase in energy expenditure for movement by 40-60%

These processes explain why a partial programme has a temporary effect, while a full course creates the conditions for sustained remission.

!!! warning ‘Early withdrawal from treatment is particularly dangerous in the case of’ - Arthrogenic contractures (risk of ankylosis)
- Post-burn changes (recurrence of fibrosis)
- Neurological disorders (aggravation of spasticity)

Critical treatment steps¶

First 4 weeks: Formation of a new motor pattern
6-8 weeks: Capillary sprouting in ischaemic tissue
3-4 months: Final remodelling of collagen fibres

Important!

Missing any of these periods negates the previous efforts. Patients who have completed the full course (4-6 months) retain their results for 5-7 years, whereas with the shortened programme 80% of cases require retreatment after 6-12 months.

Advantages of the Bubnovsky Method¶

Restoration of mobility without medication and surgery is achieved due to the natural mechanisms of adaptation of the body.

Activation of the body's own reserves

Kinesitherapy activates the body's own reserves - with dosed load there is a production of endorphins (natural analgesics), stimulation of cartilage tissue regeneration through improved diffuse nutrition, and gradual stretching of scar structures without surgery.

Clinical studies show that 78% of patients with Grade I-II contractures achieve full restoration of mobility without the use of medication.

The muscles are strengthened and blood circulation is improved thanks to a special exercise regime.

Exercises without axial load on joints

Decompression exercises on multifunctional simulators allow to work deep muscle layers without axial load on joints.

This causes active arterial blood flow (up to 300% of the initial level) and lymphatic drainage, which is confirmed by thermographic studies. At the same time, the muscle corset is strengthened - after 3 months of regular exercise, muscle mass increases by an average of 15-20%.

Individual approach

Individual approach is provided by personalised selection of exercises taking into account the data of myofascial diagnostics.

For each patient a programme with precise dosage of load (in terms of flexion angle, number of repetitions, resistance of rubber shock absorbers) is prepared. This is confirmed by clinical cases - for example, with the same diagnosis of ‘post-traumatic contracture of the elbow joint’ two different patients can be prescribed completely different sets of exercises depending on the condition of the soft tissues.

Prevention of recurrences

Prevention of relapses is achieved through the formation of a correct motor stereotype.

Statistics of Bubnovsky centres show: patients who have completed the full 6-month course have less than 12% recurrence rate within 3 years, whereas with traditional treatment - 45-60%.

This is due to the fact that the method does not just temporarily increase the amplitude of movement, but restructures the work of neuromuscular circuits, creating stable compensatory mechanisms.

Get your freedom of movement back at the Dr. Bubnovsky Centre!¶

If you have experienced joint contractures after injuries, surgeries or diseases and are tired of pain and limitations, we know how to help you!

Our centre offers a unique method of treating contractures without drugs and surgery - through movement, proper loading and comprehensive rehabilitation.

Why come to us?¶

Individual approach - the training programme is tailored to your condition and diagnosis.
Safe techniques - we work through gentle stretching and muscle strengthening, without risk to joints.
Proven effectiveness - thousands of patients have regained mobility and pain relief.
Full cycle recovery - not just temporary relief, but lasting results.

Don't wait until the contracture becomes irreversible! Make an appointment for a consultation and we will find the best course of rehabilitation for you.

Important

Contractures require early and systematic rehabilitation. The Bubnovsky method, based on kinesitherapy, can restore joint function even in complex cases, but requires regularity and adherence to exercise technique.