Is immobilisation always the key to healing injuries or reducing pain? The answer is no!
Immobilisation can be an important part of tissue healing. For example, when we fracture our wrist, a plaster cast is typically applied in order to prevent movement of the fracture fragments and to allow the bones to heal in the correct position. Immobilisation can help reduce sudden onsets of inflammation in our soft tissues as well, however there are times when immobilising our joints does more harm than good.
Our joints, and particularly those in the upper limb and hand, are designed to be moved. Movement keeps the fluid around our joints loose and smooth, and keeps our muscles active and strong. Prolonged immobilisation causes a disruption to how our bodies normally function and can have serious negative effects. Some of these effects include:
- Muscle atrophy – we can lose up to 40% of our muscle mass within 2 weeks of immobilisation. Unfortunately our muscle mass is very easy to lose, and then harder to get back
- Stiff joints – immobilisation causes increased production of fibrofatty connective tissue in our joint spaces and adhesions in the fluid that normally keep our joints smooth and free to move. This can lead to reduced range of motion and joint contractures
- Cartilage atrophy – when our joints are not moved, the cartilage between our joints can thin which increases the chances or rate of degenerative change in our joints, aka. arthritis
- Weakened ligaments – immobilisation causes a disorganisation of the cellular composition of our ligaments and their attachment to bones, causing the ligaments to be weakened and at a higher chance of injury or rupture
- Reduced bone density – Putting force and weight through our limbs helps our bones to increase in density and become stronger. Keeping our joints immobilised and reducing the stress placed through bones causes our bones to weaken and increases the risk of osteopenia or osteoporosis
- Reduced cortical representation – Our hands are incredibly specialised, and as such we have a large section of our brain dedicated to our hand function alone. When our hands/upper limbs are immobilised, this cortical representation becomes reduced within as little as 9 days. The result is a feeling of incoordination, a sense that you can’t get your hand or arm to move as you want it to, or a greater sense of pain or dysfunction in your hand, which can lead to an increased risk of developing conditions such as Chronic Regional Pain Syndrome.
Given the many negative effects of keeping our joints still, immobilisation should be used only at appropriate times and not prolonged for any length of time than what is necessary. A common misconception, and a somewhat natural reaction, is a feeling that sudden or prolonged pain in the hand or arm should be immobilised in order for the pain to settle down, however in many instances this is not the case, and keeping your limb still can actually be contributing to the problem. Appropriate mobilisation and strengthening exercises are typically the key to restoring normal, healthy function back to a limb and is more effective at reducing pain. ‘Motion is lotion’ is a great phrase that emphasizes the benefits of movement in our limbs and the rejuvenating effect of mobilising our joints!
Written by Emily McMaster
Practitioner of Hand Therapy