Joint activity training operation procedures and evaluation standards

The core logic of joint mobility training can be summarized as "evaluation first, graded training, and dynamic adjustment." There is no universal standardized action template. The core of evaluation always revolves around the three priority dimensions of "not causing additional damage, meeting functional needs, and long-term benefits" rather than simply pursuing improvement in the angle of activity.

When I first started rotating in the rehabilitation department, I came across a very impressive case: 3 weeks after surgery for anterior cruciate ligament reconstruction, a 22-year-old young man heard a patient say, "The harder you stretch your legs, the faster your recovery will be." This misunderstanding of regarding “activity angle” as the only goal is too common among ordinary patients and even many novice practitioners.

Let’s talk about the core premise at the operational level first: before starting any training, you must first pass the red line of contraindications. If the fracture is not completely healed, the joint is in the acute inflammation stage, there are loose bodies in the joint, or the soft tissue repair surgery has just been performed, you must not move blindly regardless of what others say. This is an uncontroversial consensus in the entire industry. As for the focus of the assessment process, the differences between different schools emerge: traditional neurorehabilitation pays more attention to the baseline value of passive range of motion, believing that passive range of motion is the basis for active exertion; while the functional rehabilitation school that has emerged in recent years will first test the control ability of active activities - even if the passive knee flexion can reach 120 degrees, if the patient can only stabilize at 90 degrees actively, then the focus of training is definitely not to forcefully break the passive angle, but to practice muscle control within 90 degrees first.

I have managed more than 20 patients with postoperative adhesions of the knee joint, and I have found that if the patients are forced to break them off as soon as they come up, the probability of subsequent recurrence of adhesions is more than 30% higher than if they are loosened step by step. Think of a joint as a hinge that has been rusted for a long time. If you use a screwdriver to pry it up, you will definitely break the hinge and deform it. You need to spray some rust remover first, right? When putting it into training, first relax the surrounding tense soft tissues: for shoulder training, first roll the tense pectoralis minor and upper trapezius muscles. For knee joint training, first press and rub the insertion point of the quadriceps and hamstring muscles. Wait until the patient's muscles are completely relaxed before moving slowly, so as to save effort and not cause pain. There is another detail that novices tend to overlook when performing passive activities: the proximal joints must be fixed. For example, when moving the elbow joint, you must press the upper arm firmly. Otherwise, what you will be moving for a long time is actually the shoulder joint, which is purely useless.

The logic of training for special groups is even more controversial. For example, for children with cerebral palsy in the spastic stage, some schools advocate long-term static stretching, holding it for more than 30 seconds at a time to extend the range of motion to facilitate subsequent wearing of orthotics; some schools advocate using rapid stretch reflexes to induce active force exertion, believing that it is useful to mobilize autonomously controlled range of motion. In fact, both options are supported by clinical data. There is no absolute right or wrong. It just depends on the training goal: to solve the problem of wearing orthotics first, choose static stretching; to lay the foundation for subsequent walking practice, it is definitely more appropriate to give priority to inducing activeness.

When it comes to evaluation criteria, there is really no unified numerical KPI. The first bottom line to keep is safety: if the joints continue to tingle or swell for more than 24 hours after training, or even snap or compress, even if the angle increases by 20 degrees, it is completely unqualified. An aunt who had periarthritis of the shoulder had her shoulders stretched at a physical therapy center in the community. She was so happy that she could lift her shoulders above her head. However, the pain kept her awake all night. An MRI scan revealed that she had a torn rotator cuff, which was not worth the loss.

After passing the safety line, the core thing to look at is "whether it can be used." For example, for an old man with knee osteoarthritis, if you force him to bend 130 degrees, but it turns out that he can't get up from squatting and it still hurts, then you might as well practice it to 110 degrees, so that he can go to the toilet and put on socks by himself. After all, the purpose of training for ordinary patients is to live a good life, not to make up the numbers on the rehabilitation record. If the service is for athletes, for example, a gymnast's shoulder joint must be opened to 180 degrees to complete a set of movements, then the evaluation criteria will naturally depend on the specific needs. I met an old man who taught calligraphy before. He had tenosynovitis in his right wrist, and his active range of motion was only 60% of normal people. He said that as long as he could hold a pen and write without pain, we didn't force the angle of his wrist joint. We only trained him on the stability of the angle of holding the pen. After two weeks, he went back to class, and the effect was much better than force-breaking.

To put it bluntly, joint mobility training is essentially a process of dialogue with the body. You have to understand its tolerance bottom line and know the real needs of the user, instead of trying to apply a standardized process to everyone. After all, training that allows people to live a good life is truly effective.