Joint activity training content

The core content of joint activity training can be summarized into three categories: passive activities, active activities, and assisted activities. The core goal is to maintain or restore the normal range of motion (ROM) of joints and prevent soft tissue adhesions and muscle atrophy. The applicable scenarios cover almost all sports-related fields such as orthopedic postoperative rehabilitation, chronic disease joint care, daily fitness warm-up, and sports injury repair.

I tore my anterior cruciate ligament while playing amateur basketball two years ago. On the third day after the operation, the rehabilitation therapist held my calf and pushed it down. This was the most typical passive joint movement. I didn’t use any force during the whole process and relied entirely on external force to move the joint. In the past, there was a consensus in the industry to "start passive activities as soon as possible after surgery", for fear that adhesions would require a second surgery if it was too late. However, in recent years, many evidence-based medicine studies have pointed out that if the soft tissue swelling is severe and the surgical internal fixation is not strong enough, it is easy to cause secondary injuries. Nowadays, clinical practice basically adjusts the time according to the specific situation of the patient, and there is no absolute "golden 72 hours".

Don’t think that you only need to practice this after surgery. The cervical vertebrae exercises that office workers do every day, the hips that aunts twist before square dancing, and the shoulder circles before fitness are all active joint movements - they all rely on your own muscle contraction to drive the joints, without the help of external forces. Regarding the training standards for active activities, the rehabilitation circle has been arguing for many years: one group advocates that the maximum range of motion must be achieved every time, and it is effective to stop for 3 seconds if you feel obvious stretching or even slight soreness. The other group insists on repeated activities within a completely painless range, giving priority to activating muscle proprioception to avoid muscle protective spasms caused by pain. I have met a 50-year-old patient with frozen shoulder before. At first, he followed the online tutorial and he was in tears. After practicing for half a month, he could lift his arm even lower. Later, he changed to turning his shoulder within the painless range every day when nothing happened. He turned it a total of two to three hundred times a day. In two weeks, he dared to lift his hand to reach the box on the top of the wardrobe.

The one between the two is power-assisted activities. To put it bluntly, you can move a little by yourself, but not to the maximum range. You rely on elastic bands, the hand on the healthy side, and the help of family members to help you, just like your parents holding the back seat when you are learning to ride a bicycle. When your muscle strength increases, you will slowly withdraw the force. This is generally used in the middle stage of recovery, such as when muscle strength has returned to level 2-3 after surgery and you can lift yourself a little, but still far away. I usually ask patients with wrist sprains to use the unaffected hand to pull the affected wrist and slowly draw circles. It is much more acceptable than completely passive lifting.

Oh, by the way, there is another branch that ordinary people don’t have much contact with but has particularly good results, which is joint mobilization. It is an advanced version of passive movement. It must be performed by a certified rehabilitation practitioner, who pulls or slides along the direction of movement of the joint surface. The two mainstream schools now are Australian Maitland and American Kaltenborn. The former focuses on rhythmic slow swings and should be used gently when joint pain is in the acute stage. The latter focuses on directly pulling the joint surface apart and has a quick effect on old adhesions. No one is better than the other. It depends on the specific situation.

Many people have a misunderstanding about joint mobility training. They think the more painful it is, the more effective it is. It is not until you grin and grin. This is not true. Except for cases of particularly severe adhesion, you will generally feel a slight pulling sensation at most during training. If the pain exceeds 4 points (out of 10 points), you have to stop. Carrying it hard will only arouse inflammation, and the more you practice, the stiffer it becomes. Some people think of practicing for half an hour at a time instead of not moving for three days. In fact, a small amount and many times are more effective. For example, if you have a wrist sprain, taking 2 minutes every hour to move is much better than practicing for 20 minutes at a time when you get home from get off work.

To be honest, there has never been any unified and standardized content in joint mobility training. Whether you are a professional athlete warming up before a game to activate the joints, or an old man doing knee exercises to prevent degeneration, or you are stretching your legs to restore the angle after surgery, the content is very different. The core is nothing more than following the normal direction of movement of the joints, don't force it, and don't stay frozen. Find the intensity and frequency that suits you. It is much more useful to follow online tutorials.