Injury Recovery Part 2: Mobilisation
6th July 2014
Continuing on from ice.
In the last article I spoke about the benefits of using ice as a way to speed up recovery. It seems a little contradictory to say that when the logical mind says cold always slows things down. We use ice for this very reason because it slows down the speed at which the body reacts to the injury. But you would also be right in thinking that other recovery mechanisms could be slowing down too.
When recovering from injury then, it is important that we begin to mobilise the tissues as quickly as possible. For instance, if you were to have a knee replacement the physiotherapists would be stood by your bed almost waiting for the moment you come round from the anesthetic. Their job in this early stage is to encourage you to start moving as soon as possible.
Injured muscle tissue responds well to passive mobilisation early on it the rehabilitation process, allowing the new tissues to form with the length and elasticity they will require when usual function has returned. If the tissues are left in a short position for too long the total length of the repaired muscle will be hindered and full range of motion becomes restricted. It is then a much more difficult job to regain the optimal length in these tissues.
So how can you start to mobilise your injury?
In the first 24 hours post injury it is wise to follow the P.R.I.C.E. protocol by Protecting, Resting, Icing, Compressing and Elevating the injury. See my Cold Therapy article for more detail on this. But after the initial acute phase is over, mobilisation is then key to good recovery. Mobilisation means to move the tissues in the way they were intended rather than keeping them still for too long. To do this you just need to carefully move the joint that has become restricted by the injury itself.
It is important at this point to understand the amount of mobilisation required. As usual it's a simple formula: ‘Only move the joint and effected tissues through your Pain Free Range’.
This pain free range is simply the amount of movement you can achieve without causing pain by over stretching the damaged tissues. It is important to move the tissues as far as you can but be careful not to push too far. Initially within the first 72 hours I would recommend passive movements. A passive movement is one done without your muscle power. So if you’ve injured your calf then move the ankle around with your hands within your pain free range. If there is no pain within the full range of the ankle then try active mobilisation. Active mobilisation means you use your muscle strength to generate the movement. So in this example you would move your ankle around its pain free range with the muscle power of your lower leg that controls that ankle. Simple.
Once you’ve mastered this without pain in the full range of movement then full wait bearing and strength exercises can be started. It is important here to do balance exercises and fine movement exercises to establish good motor control of your muscle again. Once you have adequate control then you can move to more activity specific exercise. And this is where we will continue our discussion. . .