Principles of joint activity training sequence

Prioritize the treatment of distal limitations, first perform active activation in the pain-free range, then gradually transition to proximal joint adjustment, passive force generation and weight-bearing resistance, and finally meet the needs of daily or special movements - but this order will be flexibly adjusted according to the type of injury, training goals, and technical characteristics of the school. There are no rules that must be adhered to.

To be honest, many patients who are new to rehabilitation and even novice coaches always want to find a "one-size-fits-all" sequence, and they will not go wrong if they follow it. In actual clinical practice, there is no such thing.

Don’t believe it, I just came across a typical example last week: a young man has been playing with a sprained foot for more than three months. The bone is fine in the X-ray, but he can’t squat down and his foot always feels heavy when walking. Before, he searched for tutorials at home, cracked his ankles and pulled his Achilles tendons every day, and he grinned in pain, but he still didn't feel better. When I evaluated him, I pinched his toes first. None of the ten toes could be bent properly. When he walked, he hit the ground with his whole foot and couldn't grip the ground at all. I didn't move his ankles first, so I asked him to sit on a stool and practice grasping the towel with his toes. He held it for 5 seconds and released it for 2 seconds. I did this for 10 minutes. Then I asked him to squat 3 centimeters lower than before. I was dumbfounded.

This is actually the logic of "first the distal end and then the proximal end" in the mainstream consensus - you can imagine the entire kinetic chain of the lower limbs as a series of springs. If the toes at the end are stuck, the upper ankles and knees will not be able to exert force no matter how hard they are. If you unblock the end jams first, the mobility of the entire chain will naturally be released.

Oh, by the way, this point has actually been controversial in the industry. For example, many rehabilitation practitioners who perform Maitland joint mobilization are more accustomed to adjusting proximal core stability first and then dealing with distal problems. Let’s take the young man with sprained ankle just now as an example. If his pelvis shakes too much when standing and his gluteus medius muscles can’t work hard at all, then no matter how well you adjust the mobility of your toes and ankles, if your center of gravity tilts after taking two steps, the ankle joint will still be stuck back to its original restricted position, which is equivalent to wasting your efforts. I have encountered this type of patient before, and the ankle rebounded after three adjustments. Later, I spent two weeks training the core and gluteal muscles, and then adjusted the ankle once, and it was fine again, and it never happened again. There is nothing right or wrong between the two logics, they just suit different people.

Speaking of this, I have to mention the biggest pitfall that many people encounter during recovery: trying to make progress from a different angle. This is why the mainstream consensus places "pain-free first and then weight-bearing" in a very important position. I had a girl who had a forearm operation 4 weeks ago. She was recovering elsewhere. Every time I adjusted the angle, she cried in pain. Her knee was swollen for three days after the adjustment. After practicing for half a month, the angle was stuck at 90 degrees and she couldn't move. I changed the order of training for her. She didn’t touch the angle. First, she lay down and did isometric contraction of the quadriceps. Then she slowly shook her knee in a pain-free range. When she got tired, she applied ice. As a result, in less than three days, she could bend to 105 degrees while sitting without any swelling.

Of course, this principle is not dead. If you meet a professional athlete who is rushing for the season, the team doctor will most likely quickly adjust the angle within the controllable range of slight pain. After all, competitive sports require efficiency. Ordinary people should not learn this. Pain is the alarm given by the body. Hard carrying will only trigger muscle protection spasms. The tighter and tighter it will be, and in severe cases, it will cause new injuries.

As for "be active first and then be passive", it is easier to understand: the angle that you can control and use to exert force is the "effective angle". The passive range of motion that is forced by others is "virtual" and is not used at all for walking, running and jumping. Of course, there are exceptions. For example, patients with nerve damage such as hemiplegia and spinal cord injury cannot control their muscles at all. They must first do passive activities to prevent joint adhesion, and then gradually practice active control.

I have been doing rehabilitation myself for 6 years, and I have never encountered the exact same training sequence twice. Last time, I had an old badminton player who had been playing badminton for ten years. His shoulder hurt and he couldn't lift it up. As usual, he moved his wrist and elbow first and then adjusted his shoulder. After practicing twice, he made no progress at all. Later, I simply asked him to hold an empty racquet and do slow-motion swing training first, just in the range where he felt no pain at all. After 20 minutes of swinging, his shoulders could be raised to 160 degrees by themselves, which was much more effective than half a day before.

To put it bluntly, these so-called "sequential principles" are empirical references summarized by predecessors, not standard answers that must be copied. If you really want to practice it at home, just remember two core points: first, it won’t hurt, and second, the angle after practice can be used in daily life. If there is no progress at all after practicing for two or three days, and the pain is even getting worse, don’t force yourself to do it. Seek a professional rehabilitation practitioner for evaluation as soon as possible. Don’t turn a small problem into an old injury.