Joint Contractures in Bedridden Older Adults: Causes, Prevention and Safe Range-of-Motion Exercises Families Can Do

Joint contractures in bedridden older adults happen when a joint is not moved and stays in one position for long periods, so the muscles, tendons and other tissue around it shorten and stiffen. The joint can then no longer bend or straighten as far as it used to. The joints most often affected are the shoulders, elbows, wrists, fingers, hips and knees. Families can prevent them with two habits used together: positioning through the day so joints are not left bent for hours, and gentle assisted joint movement done slowly, never pushed past the point of tightness or into pain. If a joint is already stiff, hurts to move, or your parent has recently had surgery or a fracture, ask a physical therapist to assess before you start.

Many families first notice it while changing a shirt: one arm no longer lifts as high as last month, a hand stays clenched so the palm is hard to clean, or both knees stay bent and will not straighten. You are unsure whether to help stretch them, worried it will hurt or make things worse. This guide explains how contractures form, how positioning helps, how to move joints safely, and when to stop.

Quick answer

• Contractures come from joints staying still in one position. The less your parent moves, the weaker and tighter the muscles become, and the less they move again — a cycle best broken early
• Check the shoulders, elbows, wrists, fingers, hips and knees every day
• Position your parent comfortably and as straight as they can manage, with pillows supporting the arms and legs, and change position through the day rather than leaving them curled up
• For assisted movement, hold above and below the joint, move slowly, and stop at resistance, tightness or any sign of pain; never jerk or force a joint. A physical therapist should set the movements and repetitions for your parent
• Skip any joint that is swollen, red, hot or very painful (only that joint; carry on with the others), and do not start on your own after recent surgery or a fracture, or if the doctor has not yet given approval
• If one calf or leg becomes swollen, painful or red, stop moving and massaging that leg and see a doctor today. If there is breathlessness, chest pain, coughing up blood or faintness, call 1669 immediately

1. What is a joint contracture in a bedridden person, and how is it different from spasticity, weakness or joint pain?

A contracture is a shortening and hardening of the muscles, tendons or other tissue around a joint, so that the joint cannot move through its full range, is difficult to move and may hurt when moved. Advice from the NHS in the UK notes that anyone who stops using a joint or keeps it in one position for a long time can develop a contracture. People who spend long periods in bed are especially at risk, and people who sit still in a chair or wheelchair all day can develop contractures in the hips and knees too.

Some conditions raise the risk because they cause weakness or change muscle tone, such as stroke, brain or spinal cord injury, fractures and arthritis. But the main cause families can prevent is not moving. Lying still makes muscles weaker and stiffer; moving then becomes uncomfortable, so your parent moves even less, until the muscles become too short to let the joint move.

Tell them apart before you help

• Contracture: the joint's range of movement is consistently reduced. Even when moved slowly while your parent is relaxed, it goes no further than the same point. Do not try to test it by force yourself
• Spasticity: common after a stroke or other brain conditions. The limb resists more when moved quickly and often eases a little when moved slowly. Spasticity left unmanaged for a long time can turn into a contracture
• Weakness: your parent cannot lift the limb, but when someone else lifts it, the joint moves through its full range without resistance
• Joint pain: movement mainly hurts. If the joint is swollen, red or hot, a doctor needs to see it first; do not stretch it

These need different care, so it is worth having a physical therapist look once before planning long-term joint exercises.

2. Which joints stiffen easily, and the early signs to look for

The joints that most often stiffen in older adults who stay in bed are the shoulders, elbows, wrists, fingers, hips and knees. The first signs usually appear during daily care rather than during a deliberate check.

• Shoulders: the arm will not lift fully into a sleeve, stays pressed against the body, or hurts when you dress it
• Elbows and wrists: the elbow stays bent, the arm rests folded on the chest, the wrist drops, and the arm will not straighten as before
• Fingers: the hand stays clenched, the palm is hard to open and clean, becomes damp or smelly, and nails dig into the palm
• Hips and knees: lying on the back, the knees stay bent up and the legs cannot lie flat; the legs press together so the groin is hard to clean

Contractures are not only a joint problem. NHS guidance lists pain, difficulty getting comfortable or moving, poor hygiene, harder care, more infections and sores, and less independence. Red skin, blisters or broken skin, however, are not caused by too little joint movement; they signal pressure, friction or skin damage in that spot. Relieve the pressure there straight away and ask a nurse to assess it. A red or darkened patch that does not fade when pressed may be an early pressure sore. For skin checks and relieving pressure, see preventing pressure sores at home.

3. Positioning through the day so joints are not left bent

Positioning works around the clock, because your parent spends far more hours lying or sitting still than being exercised. NHS positioning guidance explains that poor positioning leads to contractures because muscles are held in a shortened position for long periods, and that people who are weak often curl into a bent position because it feels more comfortable. The goal is a comfortable, pain-free position, supported with pillows and as straight as your parent can manage.

Full lying positions and turning schedules are in turning and positioning a bedridden parent. This section focuses on the joints.

Arms and hands

• Rest the arm on a pillow that supports its whole length; do not leave it hanging or folded on the chest all day. NHS guidance warns that holding a weak arm in against the body can shorten the muscles around the elbow
• After a stroke, the weight of a weak arm hanging down can pull the shoulder joint loose and cause pain, so support it with a pillow or armrest both lying and sitting
• For a hand that is starting to clench, clean and dry the palm daily and keep the nails short, because nails can dig into the palm when the hand stays closed. Use palm protectors or wrist splints only when a physical therapist recommends them

Hips and knees

• When your parent lies on their back, include periods with both legs straight, not knees bent up all day
• A pillow under the knees can be comfortable for a while, but left there day and night it keeps the hips and knees bent for long periods. Alternate with times when the knees are straight, and ask the physical therapist which pillow setup suits your parent
• When lying on the side, place a pillow between the knees so the legs are not twisted or pressed together for long

Ankles can stiffen too if the toes are left pointing down all the time. But do not prop a pillow or anything firm against the soles yourself: in some people this makes the foot clench downward more, and it puts pressure on the heels. Instead, place a pillow along the length of the calves so the heels float clear of the mattress, keep blankets from pressing on the toes, and gently bend the ankles up and down each day. Foot supports and ankle braces should be chosen and fitted by a physical therapist, especially once an ankle no longer bends upward.

Change position during the day

Help your parent sit out in a chair or wheelchair during the day as able, especially at mealtimes — but not in one position all day, as sitting still for hours also stiffens hips and knees. When seated, feet should rest flat on the floor or footrests, with a pillow under the arms.

How often to change position has no single number for every home; it depends on the skin, the mattress and how much your parent moves on their own. Ask a nurse to help set the right schedule, then see the step-by-step guide to turning schedules and lying positions.

When a joint is already stiff and the hand is clenched or the thighs press together: skin care

Do not force the joint straight to clean it. Let it ease open slowly only as far as it will go, then slip a thin cloth dampened with clean water into the palm, between the fingers or into the groin, and pat completely dry every time. Keep the nails short. If you want to place something in the fold to let air through, ask the physical therapist or nurse what to use first. If the skin in the fold is red, soggy, smelly or broken, have a nurse assess it.

4. Assisted joint movement (passive range of motion): 7 principles

Passive range-of-motion exercise means the carer moves your parent's joint along its normal path for them, for people who cannot move it themselves. An NHS hospital leaflet explains that moving joints regularly helps prevent or reduce stiffness and pain, improves circulation and reduces swelling, and keeps enough movement to allow dressing and sitting properly. Remember these principles:

1. Check first. Ask whether anything hurts today, and look for swelling, redness, heat or wounds where you will hold. If you find any, skip that joint and tell the nurse or physical therapist
2. Get comfortable. Have your parent lie on their back on a stable bed, raise the bed so you do not have to bend your back too much, and tell them each time before you move any part of their body
3. Hold above and below the joint. For the arm, hold at the elbow and wrist; for the leg, under the knee and at the heel. Never pull on the hand or fingers alone, and never pull on a weak arm
4. Slow, steady and rhythmic. The Faculty of Physical Therapy at Mahidol University advises carers to move the person slowly and continuously; if there is spasticity, move slowly within the range that is possible
5. Go to a gentle stretch, then stop. Stop when you feel resistance or your parent becomes uncomfortable. Do not push further to bend or straighten the joint more — forcing can injure the joint or muscles
6. Watch the face, not only the joint. Many older adults cannot or will not say it hurts. A frown, clenched teeth, held breath or pulling away means reduce the range or stop
7. Let your parent help as much as they can. If they can move a little, let them work with you and assist only with the rest; using their own muscles is more valuable than being moved

If your parent has dementia and stiffens or pulls their arm or leg away, it is often from fright or not understanding what is happening. Do not use force. Speak slowly, explain one step at a time, touch gently before you take hold, and choose a time when they are calm. If they still resist, stop and try again later, and tell the physical therapist so they can adjust the approach.

On repetitions, one NHS leaflet for people who cannot move themselves suggests aiming for around 5–10 repetitions of each movement daily, moving slowly without overstretching. Treat this only as an example: the right movements, repetitions and frequency for your parent should be set by a physical therapist for their condition and joints.

5. Basic joint movements families can help with

The movements below are general principles hospitals use to teach carers, not a personal programme. Work one side at a time and finish each movement by returning the limb to a supported resting position. If your parent has had joint surgery or a fracture, or the doctor has given movement restrictions, follow those first.

Shoulders

1. Holding at the elbow and wrist, slowly lift the arm forward and up as far as is comfortable, stopping at resistance or discomfort, then lower it
2. With the palm facing up if possible, slowly move the arm out to the side as far as is comfortable, then bring it back
3. A weak arm after a stroke: the shoulder is easily injured. Move it only within the range the physical therapist sets, and never pull on the arm or lift it by the hand. Canadian stroke rehabilitation guidelines advise that this arm should not be moved passively beyond 90 degrees forward or out to the side (about shoulder height) unless a physical therapist has first taught you how to position the shoulder blade and upper arm correctly

Elbows, wrists and fingers

1. Holding at the elbow and wrist, bend the elbow to bring the hand towards the same shoulder, then straighten the arm as far as it goes without forcing
2. With the elbow bent, slowly turn the forearm so the palm faces up, then down
3. Support the hand and bend the wrist up and down
4. Make a fist and open the fingers, spread the fingers and bring them together, and move the thumb to touch each fingertip in turn. If the hand is tightly clenched, ease it open gently from the base of the fingers; never pry the fingertips open one by one

Hips and knees

1. With one hand under the knee and the other cupping the heel, slowly bend the hip and knee to bring the knee towards the chest, then straighten the leg back onto the bed
2. With the knee bent and the foot flat on the bed, support the knee and gently move the hip so the knee tips out to the side, one leg at a time, then bring it back to the middle. Do not do this movement if your parent has had a hip replacement or has a hip that dislocates easily, until a physical therapist has assessed them
3. Do one leg at a time, and do not twist or rotate the hip unless a physical therapist has taught you

On tired days, do the highest-risk joints first — hands, shoulders and knees — rather than skipping the day. A good time is after a bath or bed bath, when muscles are warm and relaxed. If your parent can still sit or stand a little, see when an older parent can't walk after hospital.

6. When not to move a joint yourself, or to stop immediately

In short: when movement could cause more injury, or there are signs of another hidden problem, stop and contact a nurse, physical therapist or doctor first.

Do not start until a doctor or physical therapist says so

• Recent surgery, a fracture or a cast
• A hip or knee replacement with movements the surgeon has restricted
• The doctor has said the bones are very fragile, or your parent has broken bones easily before
• A weak shoulder that is already loose or painful
• Your parent's overall condition is not yet stable, or a blood clot in the leg is suspected

Stop immediately during the exercise

• Pain increases, your parent cries out, or their face clearly shows pain
• You feel or hear something unusual in the joint and it hurts
• Spasticity keeps increasing as you go

One leg swollen, painful or red: stop, and see a doctor today

If one calf or leg becomes swollen, painful, red or warmer than the other, it may be a blood clot in a vein, which people who lie in bed for long periods are already at risk of. Stop moving and massaging that leg straight away and take your parent to see a doctor today. If there is breathlessness, chest pain, coughing up blood, light-headedness or fainting, call 1669 immediately.

Tell the nurse or see a doctor promptly

• A joint becomes swollen, red, hot or newly painful, especially with a fever
• A joint loses a clear amount of movement within a few days
• Sudden weakness on one side, a drooping face or slurred speech — call 1669

7. When to have a physical therapist assess your parent

Ask a physical therapist to assess your parent at least once when bed care begins, and again if you see any of the signs below. Contractures that have already formed usually need more than simple movement — for example, specific positioning, splints, or medication and pain review together with a doctor.

• A joint no longer straightens or bends as far as before, or keeps getting worse
• A clenched hand, a bent elbow or bent knees make cleaning or dressing difficult
• Your parent hurts every time a joint is moved, or resists whenever someone helps
• There is spasticity from a stroke, or another brain or spinal cord condition
• Recent surgery, a fracture, or a long hospital stay
• The family is unsure whether the movements or the amount of force are right

A physical therapist works out whether it is contracture, spasticity or pain, plans the movements, teaches the family hand positions step by step, and says which movements to avoid. For older adults who have not had a stroke, see home physiotherapy for older adults.

Common mistakes families make

• Forcing a joint straight, thinking more pain means more benefit. Pushing past resistance can injure the joint or muscles and makes your parent afraid to be moved next time. Go only to a gentle stretch and stop
• Pulling on the arm to turn or lift your parent. Especially a weak arm — it can injure and hurt the shoulder. Support at the shoulder blade or waist, or use a draw sheet
• Waiting until a joint is stiff before starting. Prevention is far easier than correction. If your parent's condition is stable and the doctor has not advised against it, start positioning and joint movement from the first day they need to stay in bed (check the restrictions in section 6 first)
• Doing exercises but leaving your parent curled up all night. Positioning matters as much as movement; you need both
• Doing everything for them. If your parent can still move a little, let them try first and help only with what they cannot manage
• Not telling anyone about pain. Pain makes your parent avoid moving, which speeds up contractures. Ask the nurse or doctor to help manage it

When to bring in professional help

If a joint is already stiffening, moving it hurts, or no one at home can move your parent's joints every day, a professional plan saves the family from guessing. Results vary with the condition, how long the joint has been stiff and your parent's overall health.

• Home physiotherapy: a physical therapist assesses each joint, tells contracture, spasticity and pain apart, plans the movements and resting positions, and teaches the family or caregiver to continue daily. THB 1,800 per visit, first visit THB 1,500 until 31 December 2026; packages of 10 visits THB 15,000, 20 visits THB 29,000 and 30 visits THB 42,000. Available in Bangkok and its surrounding provinces only. Call 095-767-6307 (+66 95 767 6307). See home physiotherapy
• Caregiver for daily care: helps with turning, positioning and basic joint movement every day following the therapist's plan (assisting with the plan, not providing physiotherapy in place of a physical therapist). 12-hour shift THB 1,800 per day (minimum 3 days) or THB 30,000 per month, available nationwide. See elderly home care
• Electric home-care bed: makes positioning and adjusting the working height easier. With mattress from THB 4,500 per month, delivered, installed and demonstrated in Bangkok and its surrounding provinces

Many families combine the two: a therapist adjusts the plan periodically while a caregiver or relative helps with the basic daily movements. If you are preparing to bring your parent home for bed care, see the overview in caring for a bedridden parent at home.

Frequently asked questions

What causes joint contractures in bedridden patients?

Joints that are not moved and stay in one position for long periods, so the muscles, tendons and tissue around them shorten and stiffen. Conditions that cause weakness or spasticity, such as stroke, raise the risk, and pain that stops your parent wanting to move speeds it up.

Can a contracture be stretched back to normal?

You should not try to force it. Once a contracture has formed, simple movement often cannot fully restore it, and forceful stretching risks injury. A physical therapist can assess it and may use specific positioning, splints or a referral to a doctor; the aim is to stop it worsening and make your parent more comfortable.

How many times a day should bedridden exercises be done?

There is no single number for everyone. One NHS leaflet gives an example of around 5–10 repetitions of each movement daily for people who cannot move themselves, but the right amount depends on the condition and the joints, so have a physical therapist set it.

My father cries out in pain when I move his joints. Should I continue?

No. Stop straight away and use a smaller range next time. If it hurts every time, or the joint is swollen, red or newly painful, tell the nurse or physical therapist before continuing, as there may be another cause that needs checking.

Can a caregiver do physiotherapy for my parent?

A caregiver does not provide physiotherapy in place of a physical therapist, but can help position, turn and gently move your parent's joints every day following the plan the physical therapist has set. Assessing the joints, telling a contracture from spasticity and designing the programme are the physical therapist's job.

Can I use a hot pack before moving the joints?

For some people, yes, but ask the physical therapist first. Warmth helps muscles relax and makes movement more comfortable, but someone with reduced sensation, or who cannot say when it is too hot, can be burned without noticing. Do not apply heat to a joint that is swollen, red or hot, to broken skin, or to a leg where a blood clot is suspected. If unsure, use the time after a warm bath or bed bath instead.

Can I buy and fit a splint myself?

It is better not to. Wrist and other joint splints need the right size and angle for your parent's joint, and a poorly fitted one can press on the skin and cause a wound. Use one only when a doctor or physical therapist recommends it, and ask them to show you how to fit it and check the skin.

Talk to the KIN HomeCare team

If your parent's arms or legs are moving less than before, or you are unsure how to help move their joints, call and tell us what you are seeing. A short LINE video of your parent lying in their usual position, and of you helping lift an arm or bend a leg, helps the team advise more accurately.

• Home physiotherapy (Bangkok and surrounding provinces): 095-767-6307 (+66 95 767 6307), alternative 061-881-9399 (+66 61 881 9399)
• Caregivers and equipment rental: 061-881-9399 (+66 61 881 9399)
• LINE @KINHOMECARE
• Free consultation; the team helps you work out which service to start with

This information is general guidance for families and does not replace advice from your parent's doctor.

Written by Orrathai Boontuang, RN (licence 5311192883) · Medically reviewed by Dr. Kamolchat Choktanomsup (licence 40854) · Prices as of October 2026; please confirm with our staff before booking.