Precautions for joint mobility training

Don’t pursue pain, don’t force it, be individualized, and focus on feedback. All other practical details are derived from these four points.

Don’t believe it, I’ve seen too many people fall into the trap of “forcibly chasing the angle”. I recently treated a young man who had undergone anterior cruciate ligament reconstruction. In the 6th week after the operation, he heard a patient say, “The harder you push your legs, the faster your recovery will be.” My mother pressed her leg so hard that she broke out into a cold sweat. The next day, her knee was swollen like a steamed bun. A musculoskeletal ultrasound showed that there was a tiny tear at the insertion point of the patellar tendon. It was supposed to increase by 5 degrees per week, but it stopped for three weeks before it recovered. Regarding the scale of pain, there are actually different views in the rehabilitation circle: the traditional post-operative rehabilitation concept will mention "no pain, no gain" and believe that "tolerable slight pain" must be achieved during training to be effective. ； However, in recent years, the updated consensus on Maitland joint mobilization and the movement control school of rehabilitation practitioners are more inclined to set the pain threshold at 3 points (on a 10-point scale, 3 points is roughly equivalent to the pain of scratching slightly after being bitten by a mosquito). Once sharp pulling pain, stinging, or pain exceeding 3 points occurs, stop immediately, especially for patients within 3 months after surgery. The toughness of the new scar tissue is still very poor, and violent pulling will only cause new injuries and worsen adhesions.

To be honest, the words "individualization" are easy to say, but not many people can actually do it. A few days ago, an aunt with frozen shoulders came over and said that she had been climbing the wall for a month following online tutorials, but she could not lift her shoulders. After an evaluation, it was discovered that she did not have simple adhesive capsulitis at all, but a partial tear in the rotator cuff that caused limited movement. The more she raised her arm, the more the rotator cuff was compressed, and the more she practiced, the more serious the injury. Many people always want to find a "general tutorial" and follow it to get it done, but the reasons for limited joint movement vary widely: some are scar adhesion, some are soft tissue entrapment, some are limited compensation caused by abnormal force lines, and some even have simple muscle tension and do not need to do passive activities at all. After relaxing, the muscle angle will naturally return, and even training is saved. If you practice blindly without understanding the reason, it is really easy to achieve useless results or even have counter-effects.

When I usually lead patients to practice, the first thing I teach is not the movements, but how to read their body's feedback. There is no need to stick to the rigid standard of "today must be 5 degrees warmer than yesterday". Staying up late the day before, walking 10,000 steps that day, or even having joint discomfort due to the recent cooling may temporarily reduce your range of motion by 10 degrees or more. At this time, there is no need to be harsh. I usually ask them to touch the joint to be trained before practicing. If it feels hot to the touch and has obvious swelling, apply ice for 10 minutes before starting to practice. After practice, if the swelling is more obvious than before, apply ice for another 5-8 minutes to avoid accumulation of inflammation. By the way, there is another point that many people miss: don’t just practice range of motion, the strength and proprioception of the surrounding muscles must also keep up. I once had a patient with an ankle sprain, and the angle of the ankle and foot extension has completely returned to normal. However, it is still easy to sprain the foot when walking on uneven roads. It is because you only practice range of motion, and the muscle strength and proprioception of internal and external inversions have not kept up. The joints cannot be stabilized, and no matter how good the angle is, it is useless.

If you have been practicing at home for two weeks, but the angle has not increased at all or even receded, and the pain has become more and more obvious, don't hold on to it. It is better to find a regular rehabilitation institution for an evaluation. Many people just delay the adhesion until it is serious, and finally need surgery to release it, and the suffering is more than ten times more than the initial recovery.

To put it bluntly, joint mobility training is never a matter of competing with angles. You treat your joints as friends, and you can take the feedback they give you seriously, which is much more useful than hundreds of harsh words.