What are the methods of joint mobility training?

At present, the core logic of commonly used joint movement training in clinical and daily life is divided into three categories: passive, power-assisted, and active. The specific choice depends entirely on the actual state of the joint, and there is no unified optimal solution.

I have been coaching sports rehabilitation for almost 7 years. The joint problems I have encountered range from sports injuries in teenagers to degenerative arthritis in 70s and 80s. The premise of choosing a method is always to evaluate the joint condition first. It is easy to cause problems if you practice blindly. Last month, I had a little girl who was 4 weeks after surgery for an ankle fracture. After the cast was removed, she couldn't even hook her foot, and it hurt when touched. At this time, she couldn't exert any force on her own, so I had to use my techniques to slowly help her move the ankle joint, control the angle and intensity of force, and remove the adhesions bit by bit. The loosening of joint capsules and ligaments, which relies entirely on external force and does not require the patient to exert force, is passive training. In addition to the therapist's techniques, the use of continuous passive mobilization equipment and the help of family members to assist activities all fall into this category. It is specially used in the early stage after surgery when the muscles have no ability to exert force at all.

After a period of recovery, when the muscles have strength but are still unable to independently drive the joints to normal range of motion, you can switch to assistance training. For example, there was a fifty-year-old patient with frozen shoulder. She could only lift her arm until it was level with her shoulder, and the pain was so painful that she couldn't use it any higher. So I found her a pulley ring and used my good arm to pull the affected arm up, or I held her arm beside her. With a slight upward force on her elbow, she also used her own force to lift it up. After practicing for less than two weeks, she could touch the back of her head by herself. This kind of training in which she exerts part of her own force and uses external force to make up for part of the gap is called power-assisted training. The recovery efficiency is much higher than that of pure passiveness.

If you have no injuries and just want to maintain joint flexibility in daily life, or if the joint strength has basically recovered in the middle and late stages of recovery, you can do active activities. The neck-turning, chest-expanding, and leg-curling movements we usually do during our free time at work, as well as the joint stretching movements in Baduanjin often done by middle-aged and elderly people, are all active activities. They rely entirely on our own muscles to drive joint movements without the need for any external force. Daily persistence can effectively reduce the probability of joint adhesions and degenerative diseases.

Speaking of this, I have to mention that there is quite a controversy in the industry about the limit of strength of joint movement. Some people think that pain must be felt to be effective, otherwise the adhesions cannot be loosened.； The other group believes that as long as there is obvious tingling and soreness that does not subside for more than 2 hours after training, joint damage has been caused, which will actually slow down the recovery process. My own experience over the years is a compromise. During training, you should at most feel a slight soreness, but it should not be so painful that you can't help but sweat. It is most appropriate for the discomfort to completely subside about 10 minutes after training. If you practice with pain, you may tear the already grown tissues, which is not worth the gain.

In fact, to put it bluntly, joint mobility training is like loosening the shaft of a rusty iron door that has not been opened for a long time. It is too rusty at first, so you have to ask someone to help push the door. When the shaft is a little smoother, you can push half of it and someone else holds the handle. When the shaft is completely smooth, you can open and close the door at will. Finding your own stage selection method is much more useful than blindly following the trend of practice.