Hand stiffness is a common challenge following injury, surgery, or prolonged immobilization. Restricted movement can significantly impact daily activities and delay the return to work and meaningful occupations. Even a small injury will affect the entire hand, and each hand responds differently. Overloading healing tissue will lead to more inflammation, further contributing to joint stiffness and soft tissue restrictions. An individualized treatment plan based upon the stage of healing is essential.
Traditional therapeutic approaches often include manual techniques, splinting, and exercise programs. Since connective tissue has elastic properties that result in tissue returning to its pre-stretch length, these techniques have limited success in the stiff hand.
Maladaptive movement patterns form as the brain reorganizes itself after injury. The person unknowingly begins to initiate movement from the loose joints. This pattern repeats itself all day as the patient uses excessive effort to regain motion, leading to changes in the motor cortex. Changes in the motor cortex can occur in as little as 12 hours after initial immobilization.
Casting Motion to Mobilize Stiffness (CMMS) is “an underutilized treatment technique that integrates principles of neuroplasticity, therapeutic exercise and the art of Plaster of Paris casting to simultaneously address poor movement patterning, fibrotic edema, tissue tightness, and joint contractures.” (Traveling Course- CMMS: Changing the Way We Treat the Stiff Hand, Oct 2025). The technique involves analysis of the maladaptive movement pattern(s) that are occurring and structures involved based on a comprehensive understanding of anatomy, then designing and fabricating a cast that constrains only the loose joints. Careful consideration is given to the positioning of joints within the cast to inhibit the faulty movement pattern while optimally facilitating movement distally. Wrist stabilization is crucial to regaining proper hand function, the wrist is always included in the cast.
Repatterning of movement occurs through repeated active motion to the stiff joints while preventing compensatory movements.
Light sustained pressure provided through the circumferential nature of cast helps decrease edema while active motion facilitates lymphatic pumping. A simple yet effective HEP of controlled movements w/in the cast is vital. The application of the cast will be performed by a hand therapist who has undergone specialty coursework and hands-on training. The cast is adjusted and modified as the patient progresses. A few different cast applications or modifications may be required t/o the process. Muscles that have become tight are lengthened as the patient repeats the new pattern of movement w/in the cast. A careful cast weaning process is initiated when appropriate. You will be in good “hands” with your clinician during your journey to regaining function!
Traveling Course-Casting Motion to Mobilize Stiffness (CMMS): Changing the Way We Treat the Stiff Hand. Ann Marie Feretti, Ed.D, OTR/L, CHT and Johanna Jacobson-Petrov, MHS, OTR, CHT. 10/18-10/19/2025.
The Casting Motion to Mobilize Stiffness Course. Created by Robyn Midgley (European and British Accredited Hand and Upper Extremity Therapist) and supported by Judy Colditz, OT/R, CHT, FAOTA.
https://www.robynmidgley.com
Hands in Motion Podcast: Casting Motion to Mobilize Stiffness. 8/29/2023. Judy Colditz, OT/R, CHT, FAOTA.
Hand to Shoulder Center of Wisconsin Podcast: Casting Motion to Mobilize Stiffness (CMMS) with Kantessa Steward, OTR/L, CHT. 2/02/25.
Plaster of Paris: the forgotten hand splinting material. Judy C Colditz. J Hand Therapy. 2002 Apr-Jun;15(2)144-57. Doi: 10.1053/hanthe.2002.v15.015014.
