From the Guidelines
Prolonged mobilization of a joint is not typically associated with significant complications, but prolonged immobilization can lead to several issues, including joint stiffness, muscle atrophy, and circulatory changes. When considering the potential complications of joint mobilization, it's essential to distinguish between mobilization and immobilization. The provided evidence primarily discusses the risks associated with immobilization rather than mobilization. Key points to consider include:
- Joint stiffness and decreased range of motion due to the formation of adhesions and contractures within the joint capsule 1
- Muscle atrophy, with strength decreasing rapidly during immobilization, as muscles adapt to their shortened position 1
- Cartilage degeneration, as joint immobilization reduces synovial fluid production and nutrient delivery to cartilage, potentially leading to osteoarthritis 1
- Ligament and tendon weakening, resulting from collagen fiber disorganization and decreased tensile strength, increasing injury risk upon return to activity 1
- Bone demineralization (disuse osteopenia), as mechanical loading decreases, with bone density potentially decreasing weekly 1
- Circulatory changes, including reduced blood flow and possible deep vein thrombosis in lower extremity immobilization 1 To minimize these complications, current treatment approaches favor early controlled mobilization, progressive rehabilitation exercises, and the shortest effective immobilization period necessary for healing. It's crucial to note that the evidence provided does not directly support the notion that prolonged mobilization of a joint leads to significant complications. Instead, it highlights the importance of avoiding prolonged immobilization to prevent associated risks. In clinical practice, the focus should be on balancing the need for immobilization to allow healing with the necessity of early mobilization to prevent the complications associated with prolonged immobilization, as evidenced by the guidelines for perioperative care and the management of adults with ischemic stroke 1.
From the Research
Complications of Prolonged Mobilization of a Joint
Prolonged mobilization of a joint may lead to several complications, including:
- Joint instability: Prolonged mobilization can cause joint instability, particularly in individuals with pre-existing joint hypermobility 2.
- Soft-tissue rheumatism: Repetitive joint mobilization can lead to soft-tissue rheumatism, such as bursitis or tendonitis, due to inflammation and irritation of the surrounding tissues 2.
- Muscular tension pain: Muscular imbalance and tension can occur as a result of prolonged joint mobilization, leading to pain and discomfort 2.
- Chronic pain: Prolonged mobilization can also lead to chronic pain, particularly in individuals with underlying conditions such as osteoarthritis 3, 4, 5.
- Reduced joint mobility: Paradoxically, prolonged mobilization can also lead to reduced joint mobility, particularly if the joint is not properly stabilized or if the surrounding tissues become inflamed or scarred.
Factors Influencing Complications
Several factors can influence the risk of complications from prolonged joint mobilization, including:
- Underlying joint conditions: Individuals with pre-existing joint conditions, such as osteoarthritis or joint hypermobility, may be more susceptible to complications from prolonged mobilization 3, 2.
- Mobilization technique: The technique used for joint mobilization can also influence the risk of complications, with some techniques being more likely to cause joint instability or soft-tissue irritation 6.
- Duration and frequency of mobilization: The duration and frequency of joint mobilization can also impact the risk of complications, with prolonged or frequent mobilization being more likely to cause problems 3, 6.