Basic principles of joint mobility training

There are no universal standardized guidelines for joint activity training. The core essence is to "take the individual's current injury status and functional needs as the core, and gradually expand the pain-free range of motion of the joints without causing new injuries, ultimately serving the realization of daily or sports functions."

Last week, I received two patients after knee surgery in the outpatient clinic. One was 3 weeks old after anterior cruciate ligament reconstruction, and the other was just 14 days old after meniscus suture surgery. The first words they said when they came in were, "Can I practice knee flexion at 90 degrees now?" ”, the answers I gave are completely different: the former has passed the strictest braking period, and the surrounding muscle strength is not bad, and you can slowly try to touch the 90-degree threshold. The sutured part of the latter is still in the critical period of healing, and you will have to stop when you bend the knee to 30 degrees at most.

Don’t underestimate the premise of “no new damage”. 90% of people who fall into this trap fall into these six words. I have seen too many young men with acute sprained ankles. They were in a hurry to return to the court just two days after the swelling subsided. They held their ankles and forced them to break off every day. It turned out to be just a strained ligament, which caused new bleeding in the surrounding soft tissues. The swelling did not go away for two weeks, and the recovery progress was delayed by a month compared to the original schedule. To put it bluntly, joints are like old wooden doors. You can't just kick them in. You have to oil the hinges first (relax the tense muscles, ligaments, and fascia around them) and then slowly swing them open. If you kick hard, the door shaft will break.

When it comes to pain control during training, there have always been two different views in the rehabilitation circle: conservatives insist on "pain-free first" and stop immediately as long as tingling or numbness occurs, believing that soreness is a sign of injury.； Radicals believe that "joint mobility training will inevitably be accompanied by moderate soreness. As long as the pain does not exceed a VAS score of 3 points (a full score of 10, which is roughly the level at which you can speak normally without gritting your teeth), and it completely subsides within 24 hours, it is within the normal range." In fact, both statements are correct, but the applicable groups are different: in the early postoperative period, the elderly with fragile bones, and patients with acute injuries must follow the pain-free principle. If they are just fitness enthusiasts who have stiff shoulders and necks after sitting for a long time and want to improve their sports performance, it will be more efficient to carry some acid appropriately.

Don’t believe the nonsense on the Internet about “training full-angle shoulders in 7 days” and “returning to normal squats in half a month”. Functional needs are different, and training goals are very different. For ordinary office workers to exercise shoulder mobility, it is enough to be able to raise their hand to touch the opposite shoulder blade and put on and take off a pullover without getting stuck. There is no need to insist on the overhead angle of the arm to the ear. ； But if you are a weightlifting or CrossFit enthusiast, overhead range of motion is a must-pass level. Otherwise, pressing heavy weight will directly cause acromion impact. I once met a girl who practices Jiu-Jitsu. She specializes in practicing the passive range of motion of the wrist joint in order to perform cross-body movements. Ordinary people think that pressing the palm of the hand to the forearm is the limit. On this basis, she also has to bear the pressure of the opponent's weight. The training intensity is not at the same level as ordinary people.

After doing rehabilitation for so many years, I feel that the most easily overlooked principle is "mobility training must be bound to function." Many people do wrist and ankle wrestling at home. They can reach all angles when practicing with bare hands. However, they are still stiff when holding a cup or walking. This is because they only practice passive range of motion and do not combine it with movement patterns. For example, when training ankle joint mobility, don't just sit and do it. Hold the wall and do forward and backward movements. At the same time, you can practice the control of the calf muscles. After practicing, you can use it for walking and going up and down stairs. It is much more effective than sitting and doing it for ten minutes. Now there are schools of thought that do not need to do passive movement training alone, but directly expand the range of activities slowly in dynamic movements. This is indeed more efficient for ordinary healthy people. However, post-operative patients with severe adhesions still need to do targeted release first.

If you really want to practice at home, the criterion for judging whether you have over-practiced is very simple: don’t stare at the angle. If the pain disappears after you sleep and the joint movements are easier than the day before, then you have practiced correctly.； If the pain makes you unable to walk the next day and your joints become even stiffer, don’t hesitate to reduce the intensity immediately. If you are really unsure, ask a professional rehabilitation practitioner for evaluation, which is much more reliable than guessing on your own.

To put it bluntly, joint mobility training is never about gathering KPIs. It is not about a certain degree that equals victory. All principles are ultimately for your own comfort and ease of use - wearing clothes without getting stuck, walking without pain, and being able to play freely when you want to exercise are more important than any standardized angle value.