This article on the value of controlled progressive movement and loading
during rehabilitation may be of interest to readers.
Mel C Siff
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Buckwalter JA Effects of early motion on healing of musculoskeletal
tissues. Hand Clin 1996 Feb; 12(1):13-24
One of the most important advances in the promotion of musculoskeletal
healing has come from understanding that treatment of injuries with prolonged
rest may delay recovery and adversely affect normal tissues and that
controlled early resumption of activity can promote restoration of function.
Experimental studies of the past several decades confirm and help explain the
deleterious effects of prolonged rest and the beneficial effects of activity
on the musculoskeletal tissues. They have shown that maintenance of structure
and composition of normal bone, tendon and ligament, articular cartilage and
muscle, requires repetitive use and that changes in the patterns of tissue
loading can strengthen or weaken normal tissues.
Although all the musculoskeletal tissues can respond to repetitive loading,
they vary in the magnitude
and type of response to specific patterns of activity. Furthermore, their
responsiveness may decline with increasing age. Skeletal muscle and bone
demonstrate the most apparent response to changes in activity in individuals
of any age. Cartilage and dense fibrous tissues also can respond to loading,
but the responses are more difficult to measure. The effects of loading on
healing tissues have been studied less extensively but the available evidence
indicates that repair and remodeling tissues respond to loading and that,
like immature normal tissues, repair tissues may be more sensitive to cyclic
loading and motion than mature normal tissues.
Early motion and loading of injured tissues is not without risks, however.
Excessive or premature loading and motion of repair tissue can inhibit or
stop healing. Unfortunately, the optimal methods for facilitating healing by
early application of loading and motion have not been defined.
Nonetheless, experimental studies and newer clinical investigations document
the benefits of early controlled loading and motion in the treatment of
musculoskeletal injuries, and show that optimal restoration of
musculoskeletal function following injury or surgery requires early
controlled activity.
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Dr Mel C Siff
Denver, USA
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