Effectiveness of Paraffin and Sustained Stretch in Treatment of Shoulder Contractures Following a Burn Injury

Published:September 25, 2019DOI:



      To examine if range of motion of the shoulder treated with paraffin will be better than that of the shoulder treated with sustained stretch alone.


      Pilot randomized controlled trial.


      Regional burn center.


      Patients (N=23) who sustained a burn injury, with a shoulder active abduction and/or flexion in the +70° to +150° degree range, who were 14 years or older, were receiving follow-up physical therapy after discharge from hospital, and provided a signed consent to participate.


      Group A received sustained stretch and paraffin, and group B received sustained stretch only. Both groups had 6 sessions of treatment over 2 weeks.

      Main Outcome Measures

      Active range of motion (AROM) and active-assisted range of motion (AAROM) for shoulder flexion (SF) and shoulder abduction (SA) were measured before and after each treatment session.


      For pretreatment measurements, only the results for SF AAROM had significant time effects. For posttreatment measurements, SF AROM and SF AAROM had significant effects for time. Session 1 was significantly lower than sessions 2, 3, 4, and 6 for both measures, and additionally, session 1 was significantly lower than session 5 for SF AAROM. For SA AROM, a group-by-time interaction effect was significant, with scores for the paraffin group relatively stable across sessions, and the nonparaffin group had peaks at sessions 3 and 6. There were no significant effects for (1) within-session changes to examine improvement during a session or (2) presession scores across the 6 sessions showing maintenance of motion. Total change from the first session presession measurement to the sixth session postsession measurement for the 2 treatment groups were nonsignificantly different.


      As shown in this study, sustained stretching with paraffin may be a valuable adjunct to range of motion intervention for the shoulder after burn injury.


      List of abbreviations:

      AAROM (active-assisted range of motion), AROM (active range of motion), HEP (home exercise program), ROM (range of motion), SA (shoulder abduction), SF (shoulder flexion)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Goverman J.
        • Mathews K.
        • Goldstein R.
        • et al.
        Adult contractures in burn injury: a burn model system national database study.
        J Burn Care Res. 2017; 38: e328-e336
        • Leblebici B.
        • Adam M.
        • Bagis S.
        • et al.
        Quality of life after burn injury: the impact of joint contracture.
        J Burn Care Res. 2006; 27: 864-868
        • Schneider J.C.
        • Holavanahalli R.
        • Helm P.
        • et al.
        Contractures in burn injury; defining the problem.
        J Burn Care Res. 2006; 27: 508-514
        • Serghiou M.A.
        • Niszczak J.
        • Parry I.
        • et al.
        One world one burn rehabilitation standard.
        Burns. 2016; 42: 1047-1058
        • Schneider J.C.
        • Qu H.D.
        • Lowry J.
        • et al.
        Efficacy of inpatient burn rehabilitation: a prospective pilot study examining range of motion, hand function and balance.
        Burns. 2012; 38: 164-171
        • Carrougher G.J.
        • Hoffman H.G.
        • Nakamura D.
        • et al.
        The effect of virtual reality on pain and range of motion in adults with burn injuries.
        J Burn Care Res. 2009; 30: 785-791
        • Head M.D.
        • Helm P.A.
        Paraffin and sustained stretching in the treatment of burn contractures.
        Burns. 1977; 4: 136-139
        • Richard R.L.
        • Hedman T.L.
        • Quick C.D.
        • et al.
        A clarion to recommit and reaffirm burn rehabilitation.
        J Burn Care Res. 2008; 29: 425-432
        • Holavanahalli R.K.
        • Helm P.A.
        • Parry I.S.
        • et al.
        Select practices in management and rehabilitation of burns: a survey report.
        J Burn Care Res. 2011; 32: 210-223
        • Ward R.S.
        Physical rehabilitation.
        in: Carrougher G.J. Burn care and therapy. Mosby, St.Louis1998: 293-320
        • Ehde D.M.
        • Patterson D.R.
        • Fordyce W.E.
        The quota system in burn rehabilitation.
        J Burn Care Rehabil. 1998; 19: 436-440
        • Miller A.C.
        • Hickman L.C.
        • Lemasters G.K.
        A distraction technique for control of burn pain.
        J Burn Care Rehabil. 1992; 13: 576-580
        • Patterson D.R.
        Nonopiod based approaches to burn pain.
        J Burn Care Rehabil. 1995; 16: 372-376
        • Gross J.D.
        • Stafford F.S.
        Modified method for application of paraffin wax for treatment of burn scar.
        J Burn Care Res. 1984; 5: 394