Basic principles of joint mobility training

Pain-free priority, individualized adaptation, function orientation, and gradual loading, if you step on any minefield, your training will be in vain, or it will cause secondary damage.

I have been in a rehabilitation clinic for almost 8 years, and have seen at least hundreds of patients whose problems were aggravated by stepping on pits. What impressed me the most are two extremely contrasting cases: one is a 22-year-old basketball enthusiast who was anxious to return to the court 3 months after the rotator cuff surgery. He followed the tutorials on the Internet and forced himself to break his shoulder. Every time it hurt and broke into a cold sweat, he still had to carry it. A week later, part of the newly grown tendon was torn off, and it took another two months before he could move slowly.； The other is a 70-year-old aunt with knee osteoarthritis. She dares not bend her legs for fear of pain. In half a year, her knees can bend up to 70 degrees. She cannot even use the squat toilet at home. She has to find a place to sit in advance every time she goes out.

You may also be curious, what exactly is "painless first"? Interestingly, this principle is still somewhat controversial in the rehabilitation circle: the traditional conservative view is to use the NRS 10-point pain score (0 is no pain at all, 10 is unbearable pain). As long as the pain exceeds 3 points, you must stop to avoid causing additional pressure on joints and tendons. ； The younger sports rehabilitation school is more inclined to "tolerable slight pain is normal", especially for patients in the adhesion period 4-6 weeks after surgery. As long as it is not sharp and continues for more than 1 minute after stopping the movement, and it is just soreness or slight pulling pain, you can continue. If you blindly pursue complete painlessness, you will easily miss the golden period of adhesion release. In fact, both statements are correct. The core depends on the applicable group: the elderly with osteoporosis and patients who have just had tendon suture surgery less than 4 weeks ago must stick to the 3-point pain line. Young patients with adhesions without bone problems can relax the standard slightly.

Having said this, I have to mention the importance of individualized adaptation. It’s also about the release of frozen shoulder. The 20-year-old boy has good skin and tendon toughness. Every time I help him release it, I use a little more strength. Even if the angle increases by 5 degrees in a single time, there is no problem. ； But last week I saw a 68-year-old grandma with periarthritis of the shoulder. She has thin skin and mild osteoporosis. Every time I loosen it until she feels a little bloated, I stop. The standard is reached after a single improvement of 1-2 degrees. After three months, she can raise her arms to comb her hair and reach the top of the wardrobe. Don’t believe the internet celebrity tutorials like “Unlock shoulder abduction 180 degrees in 7 days” and “Bend legs to 120 degrees two weeks after surgery”. People’s basic conditions are very different. If you use other people’s standards to set yourself up, you are just looking for trouble for yourself.

Many people practice range of motion for a long time without any effect. Essentially, they have not discovered the "functional orientation". I once had a 3-month-old girl with a sprained ankle. The ankle dorsiflexion angle measured while sitting was completely up to standard. However, she felt pain when wearing high heels that were more than 3 cm tall. When running, her ankle always felt wobbly and sprained easily. I stopped her previous training of sitting and pressing her feet, and changed it to standing on a 15-degree incline to do squats. Later, I also added training of standing on a balance mat while wearing high heels. Within two weeks, she said that she didn’t feel any pain after wearing high heels for shopping all afternoon. Traditional rehabilitation may pay more attention to whether the angle of static measurement is standard enough, but current functional rehabilitation pays more attention to whether you can use this angle in daily life: if you practice bending your knees to squat on the toilet, don’t always lie down and bend your legs. Practice more sitting and bending your knees and squatting while holding something. ； The purpose of practicing shoulder abduction is to reach high objects. Don't always lie on your side and raise your arms. Practice standing and raising your hands to reach the cabinet. The angle you practice will be "living".

Finally, when it comes to progressive loading, to put it bluntly, don’t compete with your joints. It's like oiling a rusty hinge. If it can't come up, use brute force to pry it up. You have to spray some lubricant and shake it back and forth for more than ten minutes. Then it will loosen slowly. The same is true for joints. There was a patient who had undergone anterior cruciate ligament reconstruction. The patient group said that he should "stretch his legs very hard". He did it for an hour a day at home, but the swelling became so swollen that he could not bend within a week. When he came for a follow-up examination, he had to drain 20 milliliters of fluid alone, which delayed his progress for half a month. In fact, there is no need to pursue improvement every day. It is enough that the total training time per week and the angle improvement in a single session do not exceed 10%. This week, you can bend to 100 degrees, and next week you can go up to 110 degrees. Being steady is much faster than rushing for quick success.

To be honest, these principles are not that mysterious. The joint has been with you for 20, 30, or even 70 or 80 years. It is the old friend you are most familiar with. You have to follow its temper: don't break it forcefully when it comes up, and don't force it to move at all. Find a rhythm that is comfortable for you. Training that can help you solve practical problems is the best training.