Splints have been used to stretch many a joint in many a direction, with varying degrees of efficacy. In research, as in literature, generally the reasons for good efficacy are:
- the splint is able to be worn for hours every day
- the splint holds at end-of-range
both of these are key to predicting a splint will work – more so in many cases than patient factors of malunion, injury severity, chronicity or hard-end feel and despite therapy plateau. (see our research page).
This needs to be addressed by the therapist from the start.
It’s very common for a patient to wear a splint for less than the required time. This is often the reason for poor results. It’s worth checking with them their wear time. Typical times for such splints are 4-8 hours per day.
A splint which doesn’t hold the joint at it’s end-of-range will never achieve anything. Usually if the patient improves while wearing like this, they would have improved as much without it. This is commonly the reason neoprene or TAP splints are not indicated for stiffness in rotation, and the reason some custom thermoplastic splints fail. This can be tested easily, by donning the splint and seeing if you can passively move the joint further than the splint. If you can, you need to adjust the splint or choose another splint. It is also worth checking that the patient can don the splint in a way which ensures end-of-range positioning – that’s what’s happening at home.
While other variables of therapy for stiffness often need to be addressed, these type of splints generally prove good efficacy alone. If they aren’t, troubleshoot the total-end-range-time. That is – the time they’re wearing it daily and the position at end-of-range. Browse through research to see what is expected in rotation with a good splint.
So, the troubleshooting checklist is:
- Duration: the patient can and does wear for the prescribed duration.
- End-of-range positioning: the splint holds consistently at end-of-range. The patient should feel stretch, and you shouldn’t be able to passively stretch them further.
- Right splint: The wrong choice never holds at end-of-range, for example a neoprene splint for rotation will never hold in firm supination.
- Self donning: The patient should be able to apply the splint so it holds at end-of-range.