The use of splints in the treatment of joint stiffness: biologic rationale and an algorithm for making clinical decisions

The purpose of this article are (1) to discuss the rationale for using splints to increase range of motion (ROM) and (2) to describe an algorithm that can guide therapists' clinical decisions when splints are used to treat patients who have limited ROM. The primary rationale for using splints is to apply relatively long periods of tensile stress to shortened connective tissues to induce tissue lengthening through biologic remodeling. The process of remodeling is contrasted with more temporary mechanical phenomena that occur in biologic tissues. The proposed algorithm guides the use of splints based on measurements of pain and ROM. We describe three variables of splint use that may be adjusted: frequency, duration, and intensity. The relative importance of each of these variables is discussed. The algorithm is not joint or injury specific and requires continual modification of splint use based on a patient's response to treatment. Deciding which patients are appropriate for end-range splinting and deciding when to discontinue splint use are also discussed.