Contraindications of joint mobility training

Fractures around the joints are not effectively fixed in the acute phase, training movements will directly aggravate the tears of the original important tissues (ligaments, nerves, tendons), there are clear neuromuscular control disorders, and training will induce secondary injuries; relative contraindications cover the acute phase of local inflammation of the joints, severe osteoporosis, early postoperative tissue healing has not reached a stable state, etc.

Last week I met a 52-year-old aunt in the rehabilitation clinic. She sprained her left foot while going down the stairs. On the third day, it was swollen like a water-filled bun. I heard the square dance sisters say, "If your sprained foot is broken, you need to break it as soon as possible or it will become stiff." So I broke it at home. My foot was turned out, and I was sweating in pain. When I came to take an MRI, it was found that the anterior talofibular ligament, which was only partially torn, was completely severed. Originally, it could be cured with a fixation and a brace, but now I had to have surgery to sew the ligament. I suffered for several months.

The first absolute taboo that needs to be mentioned is unfixed acute fractures. For example, if you have just broken the distal end of your radius, and the X-ray shows that the bone has shifted, and you have not put on a plaster or done any internal fixation, if you dare to move your wrist at this time, the bone fragments will easily pierce the surrounding blood vessels and nerves, and what was originally a small matter will become a big deal. Interestingly, there are also a few early functional rehabilitation schools that propose that completely non-displaced intercalated stable fractures can be used for very slight activities under the protection of braces to avoid adhesions. However, this requires extremely high evaluation, and ordinary patients cannot judge for themselves. Mainstream clinical practice still requires effective fixation before engaging in activity training. Don’t gamble with your own bones on a small probability event.

If you have fresh tears in the ligaments and tendons around your joints, for example, if you have just sprained your knee and found out that the cruciate ligament is broken, and you have not yet had surgery, you have to bend your legs to 90 degrees, and the ligaments that could have been repaired and sutured will be torn to pieces. In the end, you can only use your own tendons to reconstruct them, and the recovery period will be extended by more than half a year. Before I do joint range of motion training for a patient, I will always check his imaging report within a week. If he says that the pain has suddenly worsened recently, even if it is an old injury of three to five years, I will first ask him to do an MRI to check whether there is a new tear, and I will never tear it off right away.

There is another type of absolute taboo that is easily ignored by family members, which is that the patient has neuromuscular control disorders. For example, in the soft paralysis stage after a stroke, the shoulder joint is already subluxed. The family members are anxious for recovery and forcefully lift the patient's arm to 120 degrees. This can easily directly strain the brachial plexus and make the hand that has a chance of recovery unable to move. I have seen many such cases in clinical practice, which is a pity.

After talking about the absolute taboos that will cause big problems if you make the wrong mistake, let’s talk about the relative taboos that many people easily confuse - it’s not that you can’t practice, it’s that you can’t practice blindly according to ordinary people’s plans. For example, in the acute stage of arthritis, whether it is rheumatoid arthritis or gouty arthritis, when the disease occurs, the joints will be red, swollen and painful, and the skin temperature will be higher than other places. At this time, if you press hard and angle the joint, the inflammation will only become more irritated and the pain will make you unable to sleep.

There are also elderly people with severe osteoporosis, whose bone density T value has dropped below -3.5. A cough may break their ribs. You must not use brute force when doing joint movement training. For example, when doing lumbar spine exercises for such elderly people, if you dare to press down hard, it is easy to cause compression fractures. I usually tap on the local bone before performing surgery on this type of patient. If it hurts, I first ask him to take a radiograph to rule out microfractures. I will never take this risk.

Patients in the early postoperative period are also relatively contraindicated. For example, in the first three days after knee replacement, the wound is still bleeding and the leg is swollen to the point where it is thicker than before. At this time, don’t listen to what is said on the Internet, "Bend to 90 degrees 24 hours after surgery, otherwise adhesion will occur." I just want to mention here that there is a fierce debate in the industry about whether to use angles in the early postoperative period. Radicals believe that early angles have a lower probability of adhesion and better long-term mobility. Conservatives believe that early tissue is fragile and can easily cause secondary damage. My own experience in rehabilitation for eight years is that there is no one-size-fits-all standard. It all depends on the individual situation of the patient, so don’t follow a rigid strategy.

To put it bluntly, contraindications are never hard-and-fast rules printed in the manual. Everyone’s injury, physique, and recovery situation are different. If you are not sure whether you can practice, don’t force yourself to do it. Find a professional rehabilitation practitioner to evaluate it first. It is much better than trying it out at home. After all, there are only so many joints in the body, and repairing them after they are broken through practice will not be as useful as the original ones.