One of the toughest parts of having an injury or an operation is when you struggle to get the motion back into your joint. Often times, surgeries require you to be immobilized for a certain period of time such as in an ACL tear or a Rotator Cuff tear. This is needed to allow the repairs to heal. Sometimes your joint may get stiff because there was significant trauma and swelling creating scar tissue in the joint such as after an ankle sprain or a total knee replacement. Limited motion in our joints can cause us to compensate in our walking or in our ability to do our every day activities. Limited motion in the joint will also decrease the strength of the muscles surrounding the joint. Stretching and mobility exercises can help but are more effective on muscle and tendons. To stretch the capsule of the joint which is what is causing the stiffness, the most effective method is through Low Load, Prolonged Duration(LLPD) stretching. LLPD is sometimes called TERT which means Total End Range Time. The concept is that you are applying a low load or stretch for a long period of time at the end of the joints current range of motion.
The best way to understand is through this video. Dan had a severe injury to his knee and had to keep his leg straight in a brace for several months. Due to high amounts of scar tissue and stiffness in his joint capsule, his knee will not bend more than 51 degrees. Chuck explains that the best evidenced way to improve joint movement is through performing this Low Load, Prolonged Duration stretch for at least 60 minutes a day. This does not have to be done all at once but can be broken up into several times a day.
Another demonstration of a type of LLPD is in this 90/90 Hip stretch demonstrated by Chuck. This stretch helps to improve hip Internal and external rotation motion. Basically how much your hip can turn in or out. Hip mobility is really important for certain sports such as golf, baseball and running. Limited hip mobility may also be the cause of low back pain and should be assessed by your physical therapist.
If you never regained all of your motion after an injury you may benefit from this type of stretching. Talk with your Physical Therapist to make sure this stretching will be safe and effective for you!
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