Effects of Immobilization on the Shoulder
Keeping the Shoulder Mobile is Important for a Healthy Joint
Recent awareness as to the negative effects of immobilization on connective tissue has changed the way injuries are treated. Historically, post-surgical patients and patients with acute injuries were routinely immobilized for days and weeks at a time. Today, the goal is to get the shoulder moving as soon as possible.
Acute and chronic shoulder injuries are common in athletes and in the active population. Getting the shoulder complex moving as soon as possible after an injury is important for the health and quick recovery of the shoulder joint complex.
Physiological Effects of Mobility
Mobility is extremely important for joint health. When a joint is immobilized, many of the structures in and around the joint (hyaline cartilage, ligaments, joint capsule, muscles) begin to experience adverse effects. These effects can occur within as little as three days.
Movement keeps the joint healthy in a number of ways, including:
- providing nutrition to hyaline (articular) cartilage
- lubricating the joint
- preventing adhesions from forming within soft tissue
- strengthening the ligaments and bones
Physiological Effects of Immobilization
Immobility causes a number of adverse effects with all of the various connective tissues within the joints. The tissues that experience adverse effects include connective tissue (joint capsule, ligaments, joint capsule), muscle, and articular cartilage.
Rapid changes occur with immobilization in all of the soft tissues. One of the more damaging effects occurs within the connective tissues of the joint.
When connective tissue within a joint is injured, collagen is laid down within the damaged tissue (normal healing process). However, when a joint is immobilized, this collagen is laid down randomly in and between the different fibers effectively “gluing down” the tissues (Therapeutic Exercise for Musculoskeletal Injuries, 2005). Collagen fibers are not only laid down in the injured area, but also between surrounding tissues including ligaments, joint capsule, and muscle fibers restricting their ability to glide and move.
At the same time that the collagen is restricting movement, inactivity of the muscles because of the immobilization causes weakening of the muscle fibers themselves. The physiological changes include a reduction in the size and number of muscle fibers within the muscle. The end result is that muscles become weaker and smaller (atrophy).
Because the articular cartilage (thin layer of cartilage on the end of long bones) is solely dependent on movement to provide nutrients and lubrication to the joint, immobility causes articular cartilage to become thinner with possible necrosis (death of tissue) with extended periods of immobilization.
The lesson to be learned is that immobilization can play an important role early in the healing process, but only should be used for a minimal period of time. As soon as possible, mobility exercises need to be undertaken to prevent the possibility of compounding the original injury with the tissue effects of immobility.
Getting the Glenohumeral Joint Moving
The benefit of getting the shoulder moving is that the deleterious effects of immobilization are quickly reversed with early mobilization.
One of the first sets of exercises that can be done to get the glenohumeral joint moving is called Codman’s pendulum exercises. This group of exercises does not require large movements of the joint, and can be performed with minimal muscle requirements.
The patient bends over slightly at the waist and leans on a table with his/her uninjured arm. With slight shifting movements of the patient’s lower body, the patient begins to allow the injured arm to move in a clockwise pattern in very small circles. The patient starts with small circles and then gradually increases the diameter of the movements until the arm is moving into progressively larger circles.
The patient can then stop the clockwise movements and begin the same exercise in the opposite direction. The patient can also alter the pattern to straight line patterns side to side and up and down.
Care should be taken by the patient to ensure that all of the movements are within a pain-free range of motion. As the movement within the glenohumeral joint increases, the patient can begin active range of motion exercises.
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