Physiotherapy for Burns and Hypertrophic Scar Rehabilitation

What is burns and scar contracture?

Thermal scalds, electrical injuries, chemical burns, and deep dermal flame injuries are unfortunately prevalent across residential and industrial settings in India. As deep burns heal through secondary intention or split-thickness skin grafting, myofibroblasts cause rapid tissue contraction and thick, pruritic hypertrophic scarring. Without immediate, proactive physiotherapy positioning and splinting ("the position of comfort is the position of contracture"), joints become frozen in fixed deformities. Physiotherapy provides continuous anti-deformity positioning, custom thermoplastic splinting, silicone elastomer contact therapy, pressure garments, and rigorous active stretching.

How physiotherapy helps

• Anti-contracture splinting and positioning
• Custom pressure garment sizing and compliance
• Silicone gel sheet application and management
• Gentle multi-directional scar massage drills
• Active and passive joint mobility exercises

Common signs

• Tight, leathery skin bands restricting joint movement across neck, axilla, elbow, or hand
• Intense itching (pruritus), burning sensations, and pain in maturing hypertrophic scar tissue
• Post-skin graft tightness that resists stretching and feels fragile during daily movements
• Skin redness, elevated raised scars, and lack of skin pliability over healed burn areas
• Loss of functional range of motion and difficulty with personal hygiene or self-care

Clinical rehabilitation framework

Evidence-informed clinical progression and starter exercise targets for burns and scar contracture.

Frequently asked questions

Related conditions & care

Dupuytren's ContractureDupuytren's disease causes progressive fibroblastic thickening and contracture of the palmar fascia, pulling the ring and little fingers into fixed flexion. When a contracture prevents placing the palm flat on a table (table-top test positive), surgical fasciectomy or collagenase release is performed. However, post-procedural rehabilitation determines the ultimate functional outcome. Without dedicated hand therapy, wound contraction, joint stiffness, and aggressive scar formation can rapidly re-bend the fingers. Physiotherapy provides custom night extension splints, scar silicone massage, tendon gliding exercises, and graded grip restoration.

Colles FractureA Colles fracture is a complete fracture of the distal radius bone in the forearm with dorsal displacement of the wrist, typically sustained by falling onto an outstretched hand (FOOSH). It is particularly common among older adults with underlying osteopenia or osteoporosis in India, frequently occurring from slips on wet bathroom tiles or unpaved streets. Following 4 to 6 weeks in a plaster cast or surgical fixation with a volar locking plate, patients invariably experience severe wrist joint stiffness, restricted forearm turning (pronation and supination), finger puffiness, and diminished grip power. Post-immobilization physiotherapy focuses on gentle passive and active joint mobilisations, edema reduction, tenosynovial gliding, and graded resistance training to safely restore independence in carrying groceries, preparing meals, and personal care.

Trigger FingerTrigger finger (stenosing tenosynovitis) occurs when inflammation, thickening, or nodule formation on the flexor tendon restricts its smooth glide through the first annular (A1) pulley at the base of the finger or thumb. In India, repetitive gripping, heavy domestic activities (such as wringing clothes, chopping, and sweeping), manual tool use, and underlying conditions like diabetes commonly precipitate the condition. As the nodule catches within the tightened pulley sheath, the digit snaps, clicks, or locks in a flexed posture. Conservative physiotherapy combines custom MCP joint splinting to prevent pulley irritation, tendon gliding exercises, gentle deep friction massage, and ergonomic utensil adaptations to restore smooth, painless finger excursion.

Repetitive Strain Injury (RSI)Repetitive strain injury (RSI) refers to cumulative musculoskeletal pain and tissue strain affecting muscles, tendons, and nerves in the neck, shoulder, forearm, or wrist. It frequently arises from sustained posture, repetitive typing, smartphone use, manufacturing assembly, or manual instruments. Physiotherapy identifies the mechanical drivers of strain, relieves localised muscle and tendon tension, and corrects workstation ergonomics, movement patterns, and load pacing so symptoms do not keep recurring.

Clinical guides & articles for burns and scar contracture

Evidence-informed articles, recovery timelines, and home care advice from our clinical library.