What does joint mobility training include?

From the perspective of front-line rehabilitation practice, the current mainstream joint mobility training core is divided into two categories: active and passive. Many practitioners also classify active assist training in between as a third category. There is currently no completely unified classification standard in the academic community.

We usually see patients with frozen shoulder slowly touching the wall at home, people recovering from knee arthritis sitting on the edge of the bed shaking their calves without weight, and even wrist and hip circles done before fitness. They are all active joint movement training. They rely on their own muscle strength to drive joint movement without resorting to external forces. It is suitable for people whose muscle strength can support the joints to complete at least a small range of activities. It can not only maintain joint mobility, but also develop surrounding muscle strength.

If the muscle strength is too poor, or if you dare not exert force at all in the early postoperative period, you have to use passive training. For example, in the first week after the cruciate ligament reconstruction surgery, the patient cannot lift his legs at all. The rehabilitation therapist will hold his ankles and slowly adjust the knee flexion angle, or use a CPM (continuous passive motion) machine to lead the joints to flex and extend at a constant speed. The patient does not need to exert force throughout the process. This is mainly to avoid adhesion of the joints due to long-term immobility and to prevent muscle contracture. Many patients grimace in pain when they first do it, but if this step is not done well, it will be even more painful to stretch their legs later.

As for the often-mentioned active assistance training, academic circles are still arguing whether to classify it separately. Some think that it is the transitional stage of active training and does not need to be separated. Others think that its applicable scenarios and effects are different from pure active and pure passive, and should be classified separately. I usually meet many patients after rotator cuff injury surgery in the clinic. They can only lift their arms up to 40 degrees by themselves, and then they have no strength. At this time, I will gently hold their elbows to give them some strength and help them lift to 60 degrees. This half-self-relying and half-relying on external force is a typical active-assist training. It is generally used after passive training, when the patient's muscle strength has not yet reached the transition stage where the patient can move fully autonomously. Once the strength is increased, it can be directly converted to pure active training.

In fact, for ordinary patients or people who exercise daily, there is no need to worry about whether the classification is accurate. When practicing, you only need to control the intensity, don’t bear the pain so much that you can’t help but bear it, and it is consistent with your current physical condition. After all, these classifications are originally used as a reference for rehabilitation practitioners to make plans. The most important thing is to maintain joint flexibility and avoid injury.