Stretching
exercises

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Stretching the eyelids

1. Close the eye
2. Fix the lower eyelid with the index finger
3. With the index finger of the other hand, pull the scar downwards (perpendicular to the eye).
Hold the stretch (pull of the index finger of the other hand) for at least 30s,  maximum 2 minutes, the eye must not open during the procedure.

Stretching the eyelids

For both sides of the face or one alternately, hold for a minimum of 30s, maximum 2 minutes

Stretching the face and mouth using fingers

Open the mouth and stick a thumb or two in one side of the mouth;
stretch the face as far as possible with the fingers and hold for 30s

Stretching the face and mouth using fingers

1. Close the eyes and open the mouth
2. If the patient is unable to keep the eyes closed, fix the lower eyelids with the index finger for 30s

Neck stretch by bending the neck

active head tilt, hold for min. 30s, max. 2 minutes, can also be passively stretched; sleeping/lying without pillow with slight head tilt

Neck extension with sideways rotation

1. Fix the lower side of the neck with one hand (at the beginning of the head lift), place the other hand on the forehead
2. Slightly tilt the head and rotate to the side, apply slight pressure to the forehead, hold for min. 30s, max. 2 minutes, then repeat the stretch in mirror reverse on the other side (see next page, Figs. 3 and 4)

Stretching the back of the hand

1. Try to set the affected limb in a fist
2. With the other hand, help the affected limb to make a fist and hold it for a minimum of 30 seconds, maximum of 2 minutes

Stretching the area between fingers

1. The patient tries to spread the fingers of the affected limb as far as possible
2. With the other hand, gently push the muscles between the fingers of the affected limb to the right angle and hold for a minimum of 30s, maximum of 2 minutes

Stretching called praying

Push hands against each other, try to keep fingers and wrists stretched as far as possible to the right angle, hold for min. 30s, max. 2 minutes

Stretching the axilla (armpit) to the upper arm – front view

1. Place the affected limb against the wall, with the palm and elbow against the wall
2. Try to tighten the arm by sliding the palm of the hand up the wall (try to keep the palm and elbow in contact)
3. Stretch to the maximum range – the patient always stretches to the maximum range (regardless of whether the range is as in figure 1 or 3) and stays in this position for at least 30s preferably 60s, repeats the movement 6 times, each time attempting a greater range than the previous attempt

Stretching the axilla, dorsal view

Stretching of the axilla and thorax into horizontal abduction with rotation of the thoracic spine

1. Rest the affected limb on the corner, elbow as far away from the body as possible in contact with the wall (shoulder ideally at right angle)
2. Push the elbow into the wall while rotating the head and chest to the opposite side to maximum thrust, hold for min. 30s, max. 2 minutes

Stretching the groin

1. Lying on the back, bend the knee
2. Lean the heel on the other knee and move the bent leg sideways to the extreme position, hold for 30s, max. 2 minutes

Stretching the outer thigh

Option A: lying on your side, catch your ankle with a towel and stretch your bent knee
Option B: lying on your side, grasp your ankle with your hand and stretch your bent knee, always trying to reach the maximum possible range for both, hold for 30s, max 2 minutes

Stretching the Achilles

1. Catch the sole of the foot with a towel
2. Stretch the Achilles to the maximum possible extent, hold for 30s, max. 2 minutes

Extension of the ankle and shin

1. Lying down or sitting, stretch the leg
2. Stretch the toe to the maximum range, hold for 30s, repeat the movement 6 times

ITCHING

Itching is an uncomfortable and bothersome sensation that leads to compulsive scratching and accompanies the scar maturation process, most commonly in burns. It is related to the release of local factors that irritate peripheral nerves. It peaks around the sixth month after healing and its origin is multifactorial. Itching can limit quality of life, especially in children.

Treatment is based on routine measures, topical and general preparations. The available methods often need to be combined.

  • Routine measures

    • Dietary modification (no irritating foods)
    • cotton underwear
    • more frequent ventilation of the room
    • minimise overheating and sweating
    • limit bathing, prefer showering with lukewarm water (no more than 35 °C), use non-irritating soaps and cotton towels

  • Topical treatment

    • is based on intensive moisturizing (dry skin is more itchy), products with aloe vera are preferred
    • in acute cases cooling will help
    • massage also helps by reflex mechanism

  • Systemic treatment

    • Antihistamines and other medications (psychopharmaceuticals) prescribed by a specialist

    Manifestations of neuropathic scar pain are common and are related to chaotic nerve ingrowth into the scar. Treatment is usually pharmacological and should be carried out by a specialist. Common analgesics (e.g. ibuprofen) usually have little effect on reducing pain.