What does joint mobility training include?

From the perspective of sports rehabilitation and clinical practice, the core of joint mobility training is active and passive. The other common types are basically the extension or combination of these two categories.

I have worked as a rehabilitation practitioner in a community rehabilitation center for five years, and I have met too many patients who are new to rehabilitation and cannot understand the difference between the two. Last month, I met an aunt who had her cast removed after a wrist fracture. She forced her wrists to break at home until they were swollen for three days. She said she thought it was effective because of pain. In fact, she didn't even understand the boundaries of the most basic passive training. The so-called passive training means that you do not use any force yourself and rely entirely on external force to drive joint movement. This external force can be the technique of a rehabilitation practitioner, or rehabilitation equipment such as a CPM machine commonly used after orthopedic surgery, or even family members helping to move, which is generally used after surgery. In the early stage, when nerve damage causes muscles to be completely unable to exert force, the purpose is to "unscrew" stiff joints first to avoid soft tissue adhesion. The joint mobilization and joint traction that are often mentioned now are actually subdivided techniques of passive training, but they are more targeted.

When your muscles can use some strength, you can slowly switch to active training. To put it bluntly, you rely entirely on your own muscle contraction to drive joint movement. Even the isometric contraction of muscles practiced just after surgery - the kind where the joints do not move and only stretch the strength, can be considered the beginning of active training. In fact, not only the rehabilitation crowd, but also the wrist turning, ankle turning, and shoulder circling performed by ordinary fitness enthusiasts during warm-up are also active joint movement training, which is equivalent to "lubricating" the joints, which can reduce friction during exercise and avoid strains.

There are many situations in between. For example, a young man who was treated 4 weeks ago after a rotator cuff injury could only lift his arm to 50 degrees by himself, barely reaching the height of picking up vegetables. I supported his elbow and could lift it to 80 degrees with a little force. This kind of active force-based training with external force filling some gaps is called active-assisted training, which is the most commonly used type in the transition stage from passive to active.

There are a lot of controversies about joint mobility training on the Internet. The most prominent one is "should you endure pain during training?" The radical rehabilitation philosophy believes that as long as the pain is not severe or stinging, training with 7-point pain will have faster results and is more suitable for young people and patients with good recovery ability. However, The mainstream domestic rehabilitation ideas still recommend that pain be controlled within 3 points and no more than 4 points at most. Otherwise, problems such as soft tissue strain and heterotopic ossification are prone to occur, which will slow down the recovery progress. In fact, there is no absolute right or wrong between the two ideas, but they are suitable for different groups of people.

For example, a joint is like a door shaft that has not been opened for a long time. Passive training means that someone else helps you scrape off the rust and twist the door shaft so that it can rotate. Active training means that you learn how to open and close the door smoothly by yourself. Power-assisted training means that it is still a little stuck when you first unscrew it. If someone else lends a hand to help you smooth it a few times, you can use it yourself. Don't just practice blindly. I've seen too many people break adhesions and tear ligaments by themselves. It's best to find a professional to evaluate the joint condition first, and then choose the appropriate type of training. Stability is much more important than speed.