Joints are the musculoskeletal areas where two bones connect. The joints have soft tissues around them, like cartilage, tendons, and ligaments. Cartilage is the flexible tissue that covers the ends of the bones at a joint. The tendons are bands between the muscles and bones that connect everything to initiate joint movement. And the ligaments are a kind of bridge that connects the bones of the joints to keep the body stable when in motion. After an injury, the joints need to be worked out, stretched, and massaged to return to proper function and support. A chiropractic personalized rehabilitation program will include exercises that target joint stability.

Joint Injury Rehabilitation

The shoulders, elbows, wrists, knuckles, hips, knees, and ankles are joints. The spine is also made up of joints. The first step for achieving joint stability after a lower-body injury is to assess the joints for:

• Local strength
• Control
• Structural defects

A physician, chiropractor, or therapist will check the joint and test for weakness or deficits in soft tissues, tendons, ligaments, and cartilage.

• Individuals can have conditions, diseases, or injuries that affect the joints, causing dysfunction.
• Correcting deficits may require taping, bracing, exercises, or surgery.
• Joint stability is attained through specific exercises that target balance, proprioception, range of motion, flexibility, strength, and endurance.
• Individuals must participate in their rehabilitation program to fully recover from their injuries.

Proprioception and Neuromuscular Training

Neuromuscular training and proprioception are essential to joint stability.

• Neuromuscular control is an unconscious response to joint motions without awareness.
• It is how workers or athletes adjust to uneven pavement or shift their weight to stay balanced on an incline or stairs.
• Proprioception is the ability to sense the body’s orientation in the environment.
• It allows body movement and responds without consciously thinking about where the body is in space.
• The information signals detect joint position, limb movement, direction, and speed.
• A joint with a high level of neuromuscular control and a trained proprioceptive system can respond appropriately to various forces placed upon it during activity, decreasing the risk of injury.
• Proprioceptive exercises train joint proprioceptors to adapt before initiating a potentially damaging/injurious movement.

Targeted Training

• Specific to the individual’s injury, specific exercises are incorporated to regain/relearn skill sets and reset automatic movement patterns.
• Skills training improves the ability to make adjustments quickly and decreases the potential for worsening or creating another injury.
• Research has found that individuals who participate in neuromuscular retraining have improved muscular activation and reaction to changes compared to those who do not incorporate retraining exercises.
• Trainers and therapists use neuromuscular exercises to prevent and rehabilitate ACL injuries.

Lower Extremities Rehabilitation Exercises Therapy

The following example of an exercise rehabilitation program can be used to rehabilitate the lower extremities. The exercises should be done slowly over several weeks. Therapeutic exercises should be combined with an appropriate and gradual range of motion and strengthening program. Individuals should always work with a chiropractor and physical therapist to develop the most suitable program for specific injuries and limitations.

One-Leg Balance

• Try to stand on one leg for 10 to 30 seconds.

One-Leg Balance with Eyes Closed

•  Stand on one leg for 10 to 30 seconds with your eyes closed.

Balance Board with Half-Squats

• Balance on a wobble board.
• Perform ten slow, controlled half-squats.

Step-Ups

• Step up onto a balance board.
• Place a balance board, soft pillow, or foam pad 6 to 8 inches above the starting point.
• Step up ten times.

Step Downs

• Step down onto the balance board.
• Place a balance board, soft pillow, or foam pad 6 to 8 inches lower than the starting point.
• Step down ten times.

Single-Leg Hops

• Hop forward and focus on landing properly.

Single-Leg Spot Jumps

• Hop from one spot to another spot on the floor.

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References

Akbar, Saddam, et al. “Effects of neuromuscular training on athletes’ physical fitness in sports: A systematic review.” Frontiers in physiology vol. 13 939042. 23 Sep. 2022, doi:10.3389/fphys.2022.939042

Borrelli, Joseph Jr et al. “Understanding Articular Cartilage Injury and Potential Treatments.” Journal of orthopedic trauma vol. 33 Suppl 6 (2019): S6-S12. doi:10.1097/BOT.0000000000001472

Cote, Mark P, et al. “Rehabilitation of acromioclavicular joint separations: operative and nonoperative considerations.” Clinics in sports medicine vol. 29,2 (2010): 213-28, vii. doi:10.1016/j.csm.2009.12.002

Jeong, Jiyoung, et al. “Core Strength Training Can Alter Neuromuscular and Biomechanical Risk Factors for Anterior Cruciate Ligament Injury.” The American Journal of sports medicine vol. 49,1 (2021): 183-192. doi:10.1177/0363546520972990

Porschke, Felix, et al. “Return to work after acromioclavicular joint stabilization: a retrospective case-control study.” Journal of orthopedic surgery and Research vol. 14,1 45. 12 Feb. 2019, doi:10.1186/s13018-019-1071-7

Vařeka, I, and R Vařeková. “Kontinuální pasivní pohyb v rehabilitaci kloubů po úrazech a operacích” [Continuous passive motion in joint rehabilitation after injury and surgery]. Acta Chirurgie orthopaedicae et traumatologiae Cechoslovaca vol. 82,3 (2015): 186-91.