Indications for joint mobility training

The first is people with limited mobility due to organic disease in the joints themselves; the second is people with neuromuscular system damage leading to joint linkage disorders; and the third is people with joint adhesion and stiffness caused by long-term immobilization after surgery or trauma.； As long as absolute contraindications such as acute joint infection/inflammation, fractures that have not reached clinical healing, malignant tumors infiltrating the joints, and untreated vascular and nerve damage around the joints are excluded, the above-mentioned groups can carry out joint activity training of corresponding intensity after professional evaluation.

I have been in the rehabilitation clinic for almost eight years, and the highest proportion of patients I receive are from the third category - to put it bluntly, they are "sticky after lying down for a long time." Last year, I met a 22-year-old basketball boy. His anterior cruciate ligament reconstruction surgery was particularly successful. The surgeon praised the graft for being firmly fixed. However, the boy was afraid of the pain and could not get out of bed except to go to the toilet for three weeks after the operation. When he came for a follow-up examination, his knees could not bend 80 degrees, and he needed help from his mother to even put on socks. In fact, there is another point that has been debated in the industry for a long time: European and American rehabilitation systems generally advocate starting a small range of passive joint movements 1-2 weeks after surgery. In the early years, the concept in China was conservative and they were afraid of moving too early to loosen the graft. In recent years, it has been slowly liberalized. However, when to start training and how intense the training should be, in the end, it all depends on the individual's fixation and tolerance. There is no one-size-fits-all standard. To put it bluntly, joint adhesion is like a door shaft that has not been used for a long time and is rusty. Using hard prying will only break the door shaft. You have to slowly apply lubrication and shake it a little before it can be opened smoothly.

In addition to this "lying out" limitation of movement, it is not uncommon for problems with the joints themselves. Not long ago, there was a 48-year-old senior class teacher who suffered from pain in his right shoulder for more than three months. It was difficult to lift his arm to write on the blackboard. At first, he thought it was cervical spondylosis. After half a month of acupuncture, it didn't work. When he came for evaluation, he found that he had frozen shoulder, severe adhesive capsulitis of the glenohumeral joint, and he couldn't even abduct his arm to 90 degrees. There are two opinions on whether activity training should be done in this kind of situation: some scholars believe that complete immobilization and rest should be done in the acute stage of pain, otherwise it will aggravate the inflammatory reaction. ； Another group of people advocate active joint movement within a painless or mildly painful range, which can reduce further adhesion of the joint capsule. Nowadays, most clinical practice will use the middle value. Anti-inflammatory treatment should be performed first in the acute stage. When the pain drops below 3 points, you can start small-scale activities, so as not to suffer from the adhesion until it is stuck.

There is another type of situation that is most likely to be misdiagnosed. There is no problem with the joint itself, but the nerves and muscles that control the joint are "on strike" and they still cannot move. You are just like many stroke patients with hemiplegia. During the recovery period, the flexor muscles of the upper limbs have high tension, and their arms are curled up like hooks and cannot be bent. This is a mobility disorder caused by abnormal muscle tone caused by nerve damage, and is also an indication for joint mobility training. There are also different schools of training logic for this type of patients: the traditional idea is to completely reduce muscle tension to normal before doing activity training. Now more clinical practitioners will choose to lower tension while performing function-oriented joint activities, such as stretching the biceps while guiding the patient to reach for a cup. On the contrary, the recovery of range of motion is faster than practicing alone. I have been in contact with a 62-year-old cerebral infarction patient before. When he was discharged from the hospital, his left hand clenched and he could not open his fist. After practicing this method for two weeks, he was able to hold a spoon and drink porridge by himself.

Of course, don’t start practicing as soon as you see that your joints can’t move. I encountered a big pitfall when I first entered the industry: an uncle said that his knees hurt and he couldn’t squat down. I wanted to do an assessment on his knee joint mobility, but the uncle stopped me and said, wait a minute. I have gout. I just ate seafood and drank beer last night, and now I am swollen like a steamed bun. Harmful, you see, during an acute inflammation of the joints like this, it hurts even if you touch it, let alone doing activities. It is definitely a contraindication. You have to wait for the inflammation to subside before you consider training. There are also people with fractures that have not healed properly or tumors growing in their joints. You cannot do these exercises blindly, otherwise problems may arise.

In fact, after all, the indications for joint mobility training are never dead entries printed in textbooks. Just like knee adhesions, the training intensity and training methods of a 20-year-old young man and an 80-year-old old lady are definitely very different. If you really want to judge whether you can practice, the easiest way is to find a professional rehabilitation practitioner for an evaluation. It is much more reliable than practicing blindly based on online tutorials. After all, if the joints are broken and then repaired, it will be troublesome.