Joint mobility training includes

Active joint movement training, passive joint movement training, assisted joint movement training, on top of these, special extensions such as joint mobilization, dynamic stretching, and proprioception enhancement will be extended according to the rehabilitation goals and population differences. There is no absolutely unified applicable standard, and all must be adjusted based on the individual's injury situation and recovery stage.

Last week, a young man who had sprained his ankle for three days came to the clinic. As soon as he entered the door, he hurriedly asked if he could take two steps to restore function. I pinched his ankle, which was still swollen and shiny, and told him that he couldn't even tolerate passive activities now. Forcibly exerting force would only pull the ligaments that were still swollen. To put it bluntly, passive activities do not rely on one's own muscles to produce force, but rely entirely on external forces to drive joint movement - it may be the hands of the rehabilitation practitioner, the limb on the healthy side, or instruments or braces. It is generally used in the acute stage of injury, early postoperative period, or in situations such as stroke and myasthenia where the muscles cannot be controlled independently. In fact, there have been different opinions in the industry regarding the timing of intervention of passive activities: Sports rehabilitation schools mostly advocate "early painless passive activities". For example, starting to stretch your legs the day after the anterior cruciate ligament surgery to avoid joint adhesions. ； However, many guidelines in traditional orthopedics still require surgery to be started 1-2 weeks after surgery, fearing that external forces may affect the stability of the fixation or graft. There is indeed no standard answer in the cases I have handled: last month, two patients underwent anterior cruciate ligament reconstruction. The 20-year-old basketball team boy used autogenous tendon fixation, which was strong enough. He was able to passively flex his knee to 90 degrees 3 days after the operation, and he recovered quickly. ； A 52-year-old diabetic uncle in the same ward underwent the same surgery and did not start passive activities until 7 days after the operation. In the end, they both returned to full range of motion in about 3 months. There is no need to follow the progress.

Once the full range of passive activities can be achieved, with only slight soreness and no obvious pain, you can basically transition to the stage of assisted activities. Many people tend to confuse assistance with passiveness. In fact, the difference lies in "inability to exert force on one's own": For example, after the edema of a sprained boy has subsided, he hooks his foot to 10 degrees and is stuck and unable to move. At this time, I gently put an elastic band on the sole of the foot to bring back a little force, or I use my hands to help him slightly stretch the 10 degree margin, and his own ankle muscles are also contracting and exerting force at the same time. This is the correct state of assisting activities. I often encounter patients who are lazy at this stage and rely entirely on elastic bands to move. They don’t have to spend half a dime of their own energy, and their range of motion cannot increase after half a month of practice. In essence, they have returned to passive activities, and their efficiency is not even half a star. Generally, I will watch them first exert their own strength to the limit, and the external force can only be 10% of the total strength.

After practicing power-assisted activities for a week or two, most people can transition to the stage of active activities, which means that they rely entirely on their own muscle contraction to drive joint movement without any external assistance. Many people think that active movement means "moving casually". In fact, there are many ways to do it: patients with rotator cuff injuries practice raising their hands. If they always shrug their shoulders and use their trapezius muscles to compensate, the higher they lift, the more serious the acromion impingement. In the end, the range of motion is not improved, but the shoulder becomes more painful. ； Patients after knee surgery lift their legs straight up. If the legs are swinging back and forth to use force, the quadriceps muscles are not trained much, but instead they add extra pressure to the knees. Active activities are not just about "whether you can move", but also about whether the movement pattern is correct.

As for joint mobilization and dynamic stretching that everyone often hears about, they are actually specialized extensions of the above three basic forms. Many people equate mobilization with "rehabilitation practitioners forcefully breaking the legs." In fact, this is not the case. The first two levels of mobilization in Maitland's classification are small-scale and low-intensity. They are originally used to relieve pain and will not hurt at all. I once met an aunt who had undergone knee replacement. She stretched her legs at home until her knees were swollen like steamed buns. The pain was so painful that she couldn't sleep all night. I performed loosening exercises for her once or twice in three days. Most of the pain disappeared. She didn't exert much force, and her range of motion increased by 20 degrees. Dynamic stretches such as arm swinging, waist turning, and leg raising that ordinary people do before fitness are essentially joint activity training, which is to activate the muscles around the joints in advance, improve activity efficiency during exercise, and reduce the risk of strain.

To be honest, ordinary people don’t have to worry about what kind of training they do. After all, the dynamic warm-up before fitness party exercises, and practicing raising hands while lying on the bed with paralyzed patients may seem out of reach. They are essentially joint mobility training. I have summarized the core principles of my own rehabilitation over the years: if there is only slight soreness and swelling during practice, and if there is no continuous stinging or edema for 24 hours after practice, then it is no problem. If the pain is so painful that you still grit your teeth and still carry it, then you have probably practiced wrongly.