How to improve joint range of motion after surgery.

By June 18, 2017Rehabilitation

How to improve joint range of motion after surgery.

Surgery can leave you with large limits in joint range of motion. If not addressed these limits can lead to further problems down the line.

Knee surgery case study.

The following case study is interesting because it shows exactly why the current approach to these issues is flawed and demonstrates a better way to go about improving them.

Gareth came to me following surgery for a patellar tendon rupture. He was left with a marked restriction in knee flexion which was not improving despite several weeks of physiotherapy. His surgeon informed him he could face a further operation if the limit didn’t improve in 6 weeks.

This was obviously something Gareth was keen to avoid which is why he called me.

When we discussed his current rehab programme it became obvious that the only thing being done to improve this limit was passive mobilisation. In other words he was being advised to simply force his knee into further flexion.

During our first session I recorded his knee flexion limit (see below) and then assessed the ability of his knee flexors to contract on demand. Nearly every muscle failed this assessment.

knee flexion limit

We set about changing this situation by improving the ability of each and every one of his knee flexors to produce an effective contraction. We also looked at the impact his injury had had on his hips, trunk and lower legs.

Six sessions later he was at 90 degrees (see below) and is continuing to improve.

I’m also pleased to say Gareth has also managed to avoid further surgery as a result.

knee flexion improvement

Gareth’s situation is instructive because it illuminates a number of flaws in conventional rehab.

Passive mobilisation.

Firstly passive mobilisation does nothing for the muscular system. Simply cranking somebody into a position will not influence that person’s ability to go there of their own volition.

So why bother?

Even if you achieve improvements in range of motion they won’t hold because your central nervous system will rightly consider these changes unsafe as you have no muscular control of them.

Injury rehab protocols don’t work.

Secondly, operations have consequences for every muscle that acts upon the affected joint and beyond. If you are caught up in applying a protocol, which many rehab practitioners are, then you’ll miss important pieces of the jigsaw.

Gareth had been focused on improving the performance of his quadriceps which were the obvious victims of his injury. Nobody had thought to look on the other side of the axis where the bigger limit was.

Surgery should be the last option.

Lastly and more broadly, how many people are being subjected to unnecessary operations in our cash strapped health service because their muscular systems are not being effectively assessed?

Surely it’s prudent to first optimise the performance of the muscles that move a joint before deciding that the joint isn’t moving correctly and so must require more trauma.

If you’ve been left with a limit in range of motion following surgery, first try improving the performance of the muscles that take you into those limited positions before considering more invasive procedures.

Book your Free Discovery Session to find out exactly which limits are currently holding you back.