How to Stop Pressure Sores & Contractures Before They Start After a Stroke

When it comes to stroke recovery, one of the most overlooked—but critically important—areas is positioning and pressure relief. Without the right positioning, you’re not just risking discomfort—you could be facing serious setbacks like contractures, pressure sores, joint misalignment, and increased pain.

The good news? With a few simple adjustments to how you or your loved one is positioned in bed or in a wheelchair, you can reduce pain, protect the skin, and recover from a stroke more quickly. This article will walk you through bed positioning, wheelchair posture, and essential pressure relief strategies that support healing and mobility.

Why Positioning Matters After a Stroke

If you're going through stroke rehab in Indianapolis or at home, it’s vital to understand that mobility isn’t the only thing that affects recovery. The way you position the body—especially when movement is limited—can either help or hurt your progress.

Without proper positioning:

• Muscles tighten into painful contractures

• Spasticity can worsen

• Joints can shift out of alignment

• Prolonged pressure can lead to dangerous bed sores (pressure ulcers)

All of these issues can slow recovery and even cause long-term damage. But with the right knowledge and tools, they’re preventable.

Bed Positioning: Protecting the Affected Side

If you’re spending long hours in bed after a stroke, especially with hemiplegia, positioning is your first line of defense.

✅ Arm Position

Use pillows to support the affected arm and shoulder. The arm should be gently placed away from the body, palm up if possible, with the wrist straight. This setup helps reduce spasticity and prevents the arm from curling toward the chest.

✅ Leg Position

Place pillows or wedges under the affected leg, especially under the knee and hip, to keep the hip from rotating outward.

✅ Ankle & Foot Support

To prevent a tight calf and drop foot, the ankle should stay in a neutral 90-degree angle. You can use a bed boot or loosely wrap an ACE bandage to support proper alignment.

Wheelchair & Chair Positioning: Sitting With Support

When sitting in a chair or wheelchair, posture is just as important.

🪑 Arm Support

Use a lap tray, arm trough, or small pillow to support the affected arm and prevent it from hanging. This helps prevent shoulder subluxation and pain.

🦵 Leg Support

Make sure the foot is fully supported on the footrest with the knee at a 90-degree angle. A small pillow under the thigh may help prevent sliding forward, especially during longer sitting periods.

Pressure Relief: The Key to Preventing Bed Sores

Even with perfect positioning, staying in one position too long can cause pressure to build up over bony areas like the tailbone, heels, and shoulders. This reduces blood flow, which can eventually lead to open wounds and infections—a major risk in stroke survivors.

In Bed

• Reposition every 2 hours to prevent pressure buildup.

• Use wedges or pillows to slightly shift to one side for an hour, then switch.

• Keep sheets smooth, clean, and dry to allow airflow and reduce friction.

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In a Chair

• Shift weight every 30–60 minutes. Lean side-to-side or forward using your stronger side. Hold the position for 20–30 seconds.

• Use a wheelchair cushion—gel, foam, or air—for pressure relief. Most insurance providers cover new cushions every few years with a prescription.

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Early Warning Signs of Pressure Sores

Catch pressure sores early by checking high-pressure areas for:

• Redness that doesn't fade

• Warmth or tenderness

• Blisters or open wounds

If you notice any of these signs, relieve pressure on the area immediately, keep the skin dry, and contact your healthcare provider right away.

Want to Learn More About Stroke Recovery?

Preventing pressure sores and contractures is just one part of your recovery journey. If you’re looking for the best exercises for stroke recovery, tools to help you recover from a stroke quickly, or access to online stroke therapy, we can help.

🎯 Get a personalized plan: Join our online stroke recovery coaching program for expert 1:1 guidance.

📺 Watch guided videos: Subscribe to our YouTube channel for free exercise videos and education

📘 Start now with our free self-assessment tool: Download the free guide to identify your recovery stage and the right exercises for you.

Indy Neuro Therapy offers online stroke recovery programs and stroke rehab in Indianapolis that support your progress every step of the way—from bed positioning to advanced movement retraining.