Question for Post tendon repair - why does stiffness set in so fast after joint mobilization-
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[00:00:00] Hey, so I got a question from a therapist asking about post tendon repair. Why does stiffness set in so fast after joint mobilizations, whether it's passive or active? My name is Wong. I'm an occupational therapist and certified hand therapist. And my goal at hand therapy secrets is to help occupational therapists develop their clinical skills and business skills.
And if you have questions, then I'm going to be answering them through this series of videos. Ask me anything questions. I might answer them for you and tell you my perspective. So this question is about post op tendon repair. I don't know about you, but my patients ask me the same exact question all the time.
Why do when I wake up, it feels so stiff? Why do I, when I do my exercises and afterwards it gets so stiff. So regardless of whether you do passive range of motion or active range of motion, um, why does the stiffness set in? After a period of time, let's say within three hours or so. So in order to [00:01:00] understand why the symptom sets in, you have to understand the nature of injuries and the nature of surgery.
So anytime you have an injury, um, your body, Like sends like I always say it sends the construction workers to come in and repair it, right? And then when you have the surgery to repair the broken tendon or any any broken structures, let's talk specifically about tendon Tendons have to be repaired, right?
So we're talking about flexor tendons or we're talking about extensor tendons The muscle starts out here ends in here. When you cut it, the muscle retracts back, right? So it retracts back and it has to be sewn down together so that it can reattach and then do its job of being able to cross the joint and move the joint.
Let's talk about flexor tendon. So in order for flexor tendons to to work. There's all these other structures that also support and surround those flexor tendons to allow it to fully work. So when there's a cut and [00:02:00] there's an injury, and then on top of that, there's a surgery. You have to almost think about it as if you have two injuries, right?
First from the injury itself and second from the surgery itself. And that requires your body to send these extra cells to come down there and to heal. And it's healing process. It creates edema. It creates scar tissue. So if you study the nature of scar tissue, the fibers of scarring are like jumbled up.
If you think about, um, dropping a box of spaghetti noodles and then you're like jumbling it up together and it's all, instead of laying like in fine, Lines, it's all meshed together, right? And so it's through stress, right? It's through continuous Stress that those fibers start to like get realigned So you try to realign it and then it gets bunched up again and it gets realigned through movement and it gets bunched up again So that's why stiffness sets [00:03:00] in so fast No matter if you're doing joint mobilizations, if you're doing scar, you're working on edema, you're working on passive range of motion That's why the therapy process takes a while.
So the injury doesn't take a long time, but your body's ability to one heal itself, but to the outside surgery to also support that healing is what's going to help someone be able to get more motion and stiffness just sets in really, really fast because the nature of the injury, the body is constantly sending, um, it's construction workers.
It's sending those cells to that area to then scar down and heal. So as long as you're continually stressing it. Um, it's sending, it's sending those cells to continue to heal it. And after a certain amount of time, it starts to dissipate. It starts to not send so much. And then the fibers that are there, um, start to get [00:04:00] realigned and realigned.
So one thing that I always teach my therapist, my, my students, my, my patients themselves is, you know, when we're as therapists, when we're working with some, we're not just looking at quantity of movement, right? Quantity of movement is how much range of motion they have. We're also looking at quality of movement, right?
So quality of movement is something like how long does your stiffness last? Like how long does your looseness last for, right? So if you passively move someone at the beginning stages of them working with you in the first two weeks, four weeks, you know, it's going to take, you know, there's their looseness will last only 30 minutes.
But after about a month or two months, their stiffness will, um, Their looseness will last even longer. It's going to last for hours and and then as [00:05:00] they Continually get better their looseness will last for four days, right? the other quality of Movements at a quantity is you know how you're working with someone and it takes you all day to loosen them up, right?
It takes all hour. You're like, dear Lord, this finger is going to take me forever. Well, as you progress, one way to measure how they're progressing through the quality is you'll get the looseness faster. So where it might take you an hour, the first, you know, a couple of times or the first two weeks or three weeks, um, with, as they get better, it will only take, 30 minutes to get loosened up and then it'll only take 15 minutes to get loosened up, right?
So you're looking for quantity, which is the amount of movement. And then you're looking for quality, which is, um, things like how fast does someone [00:06:00] loosen up? How long do they stay loose? Things like that and then the quality of their movement. So the quality of their movement is between active and passive, right?
So at first they can only get so much passive, right? Only so much passive and the quality that you're looking for is wow They're getting all their passive range of motion in a shorter period of time Let me know if that makes sense. And if that makes sense to you what I'm describing, you know Leave me a comment below and let me know like This totally makes sense, right?
Um, if it doesn't make sense, please also leave me a comment to let me know like what your follow up question is. And, um, maybe your question will be the next, uh, video that I make. Okay. So if you're looking at quantities, if you're looking at quality of how much past they have, you can also then look at quality of active, right?
So at first they, It might just be like, it's such a real struggle to get that amount of [00:07:00] active range motion. And then after a while, they're like, Oh, this part is good, but I can't get the very end part. And injuries itself is a process. Recovery. Sorry, not injury injuries really fast. Recovery is a process that is required.
It's demanded. Uh, we cannot Take a magic pill and all of a sudden poof your stiffness is gone. And I think that most people are looking for that Most people who come to me or they're like I like if I take this anti inflammatory pill Will this help me and my answer to them? This is what exactly what I tell my patients is when you take an anti inflammatory pill, it has to go into your stomach and then it has to get digested through your system and then it sends it to the whole entire body, right?
But you have inflammation here. You know, I'm saying [00:08:00] in that one fingers, always, it's always the middle finger. Um, but so it takes a while to get there. The way you reduce inflammation to the one target area is through movement, right? When you move, right? When you move, you're using muscles to push the fluid out.
Now in the hands, it's not that simple because we don't have big muscles in the hand. We have small itty bitty muscles and then those muscles have small itty bitty tendons. And so things get really stuck in the hand really fast. If you have ever studied the PIP, we have so many structures. of like little strands of tendons here and here and here, um, all around just that one joint.
We have such small strands of structures. They're so small. [00:09:00] They're so delicate, yet extremely strong, right? And so, um, Um, it is one of the reasons that causes stiffness, especially in the PIP, especially in the PIP. We have what's called collateral ligaments, and those collateral ligaments, they're tight all the time.
So they're tight when the finger goes into flexion, and they're also tight when the finger goes into extension, that particular joint. So because the collateral ligaments are always so tight, to give that joint such stability in an injury. It's giving it such stability that it gets really stiff. So that's, you know, it's just understanding the nature of the injury and the nature of the structures that's gonna help you understand and explain why stiffness sits there for so long, right?
And I think when you, [00:10:00] When you study that and you understand that it makes it makes everything so much easier. There's a couple of other reasons, but um, when you understand the nature of the injury, you understand the nature of the tissues, uh, it can help you understand what to do and how to do it better.
And then apply your manual therapy techniques, pick the best exercise to do. in the order in which you're supposed to do it. I tell my patients all the time, if we're doing an exercise and it doesn't help, it's because it's not that that exercise didn't work. It could be that the exercise is in the wrong order, or it could be that we're not carrying that exercise out well enough.
And so you're not seeing the results. So there's, you know, in any kind of injury. right? In any kind of injury, it really does come down to a little technical, critical thinking and then technical skills, um, to really help get rid of that stiffness. But stiffness [00:11:00] lasts for a really long time. And the other reason why stiffness lasts for a really long time is because edema swelling lasts for a long time and it could take, you know, 69 12 months to fully fully get rid of.
Like you'll see it dissipate over time, but to fully get rid of something, it's going to take a year. Like it can take up to a year. Um, so setting that expectation is really important. Can you make progress in the whole time? Absolutely. Do you need to be in therapy the whole entire time? You don't. You don't need to be in therapy for a year.
You don't need to be, but there is a magic window of opportunity for therapy that needs to be consistent and it needs to be early and it needs to be aggressive, you know, aggressive, meaning like that you're making progress. And then you can have what in my clinic we call tune ups. Like, we can follow up every once in a while, you know, so that we get you to your goal of [00:12:00] hitting a hundred percent.
Um, it doesn't mean you have to be in therapy the whole time, it just means that, you know, you need some help, um, to understand it. So, I hope this question, I hope my answer, Helps you to consider what is going on with your patients Why they have such stiffness and then of course to be able to take what i'm explaining And then you as a hand therapist you ask occupational therapists You can go and explain that to your patients so they can know that you know what's going on, right?
Because people are, I promise, people are looking for someone to trust and I think that as an occupational therapist, as a hand therapist, as a certified hand therapist, I think that that you have a lot of possibility to help people with injuries, to help people after surgery specialty tendon repairs are so tough.
Um, they're tough on the patients. They're tough on the therapist because we want to do such a good job [00:13:00] for our patients. But understanding the nature of the tendon of the injury of the surgery is so important. Um, if you found this question and this answer helpful and you Have any other questions? Uh, definitely drop them below because I'm answering your questions through a series I'm doing so that I could help more and more therapists, um, in hand therapy.
And I want to help you develop your clinical skills. So let me know if this helps you. I am going to also include some videos up here that can share with you some other tendon types of videos that can help you with your cases. And then also, don't forget, until next time, like and subscribe the videos.
Alright, I'll see you later.
