IMMOBILISATION… (and Inactivity)
After musculoskeletal injury it was often thought that immobilisation was the best action to promote healing. With the exception of fracture healing, most soft tissue injury is now treated with frequent low-strain movement to endorse correct repair and remodelling.
What happens if soft tissue repair and remodelling is done in immobilisation? Here are the most worrying:
1. A decrease in tissue fluid which allows collagen fibers to approximate (increasing abnormal cross-linkage formation).
2. Abnormal vascularisation (due to a lack of direction gained by the strain movement provides).
3. Stasis of oedema and blood (movement assists blood perfusion and interstitial fluid flow)
4. SYNOVIAL MEMBRANE ATROPHY (leading to reduced joint nutrition)
5. Contracture formation (adhesions + cross linkages + sarcomere loss)
In ACL rehabilitation Continuous Passive Motion is a great example of how motion improves the healing process and mechanical tissue ability (pictured below).
So putting immobilisation on a spectrum with high activity being on the other far end… what do you think the consequences are of inactivity? Do you think a degree of the above happens in the tissues? Even undamaged tissues replace themselves regularly.
Applying this to sport, its of greater understanding now how some athletes have a ‘recovery workout’ which is low intensity, and allows the OPPOSITE of all the above consequences to happen.