Contraindications of joint mobility training

Severe osteoporosis, acute onset of chronic joint pain, failure to obtain permission from the surgical team for rehabilitation after joint surgery, uncorrected coagulation abnormalities, vertebral artery type cervical spondylosis/severe cervical disc herniation and large movements of the neck, pregnant women without obstetric evaluation before lumbosacral and hip training.

The young man I met at the outpatient clinic last month stepped on a contraindication and sprained his foot while playing basketball. The X-ray did not reveal an obvious fracture that day, so I thought nothing was wrong. He went home and followed a short video to do ankle range of motion training, cracked his ankle and jumped on his feet. On the third day, he was so swollen that he couldn't wear shoes and went back for a CT scan. There was a small avulsion fracture and displacement. He could walk normally after wearing a cast for 2 weeks, but in the end he had to undergo a minor surgery and put in two steel nails. In fact, in the first 72 hours after an acute injury, the soft tissues and capillaries around the joint are in a state of damage and leakage. Forced movement at this time will only tear the small blood vessels that can heal on their own, and may also displace the unstable tiny fractures, which is a typical loss outweighing the gain. Oh, by the way, if there are wounds around the joints that have just been stitched but have not been removed, you must try to avoid large movements, otherwise the wounds will collapse, which will be unnecessary trouble.

Some people will definitely ask at this point, isn’t it said that “it will stick if you don’t move it for a long time”? This is actually a point that the rehabilitation community and traditional orthopedics have been arguing about for many years - traditional orthopedics pays more attention to structural repair. The previous recommendation was to rest until the callus is fully grown after the injury. However, the modern sports rehabilitation view is that as long as absolute taboos such as fractures and vascular and nerve injuries are eliminated, very mild muscle isometric contraction can be done 48 to 72 hours after the injury. It will not affect healing, but can reduce the probability of subsequent adhesions. But there’s a big premise here: you have to find a professional to rule out absolute taboos first, and you definitely can’t try it out by yourself at home in front of a short video.

Let’s talk about the relative taboos that many people easily confuse. It doesn’t mean that you can’t move at all if you touch something, but you can’t move blindly. I once had a 68-year-old aunt with severe osteoporosis. She heard from sisters in the community that stretching can open her shoulders and cure periarthritis. She went to a health center to have a coach perform hard compressions. She was so painful that she was sweating and gritted her teeth. She said, "The pain is effective." She couldn't lift her arms the same day she got home. A X-ray was taken and it was discovered that she had a stress fracture in the proximal humerus. She had to lie down for more than three months before she could barely dress herself. In fact, for this kind of people, joint mobility training can only be done through active activities that they can control, and stop when they feel a slight stretch. They must not let outsiders use violent pressure, let alone pursue the so-called "clicking" feeling of reset. The sound is most likely an alarm sent by the cartilage or ligament being forcibly pulled, and is not a sign of "effectiveness" at all.

There are also some contraindications that are particularly easy to miss. For example, people with vertebral artery stenosis and vertebral artery type cervical spondylosis must not do cervical spine activity training such as shaking the head quickly or tilting the head up and turning the head at the maximum angle. I met a patient who was a copywriter before. His neck hurt every day. He followed the short video to do the "rice-shaped exercise". After doing it twice, he fainted at his work station and was sent to the emergency room. After a check, it was found that one side of his vertebral artery was 80% blocked. When he turned his head greatly, it directly pressed on the blood vessel, and he fainted due to insufficient blood supply to the brain. If there are unexplained lumps in the joints or uncontrolled malignant tumors, you should never move the joints casually. If the tumors are stimulated to metastasize or rupture, you will be in big trouble.

In fact, to put it bluntly, the contraindications of joint mobility training are never strict rules. There are two core judgment criteria: whether it will cause additional damage, and whether it has been professionally evaluated. If you are not sure whether you can do it, first go to the hospital and ask a doctor in the orthopedics or rehabilitation department. Spending more than ten minutes to get a call is much more cost-effective than trying to figure out the problem and then spend tens of thousands of dollars on treatment.