Hey there! I’m Hoang Tran, an occupational therapist and certified hand therapist. At Hand Therapy Secrets, my mission is to help occupational therapists develop both their clinical and business skills. Today, I want to address a common question from therapists regarding stiffness after tendon repair. Many patients often wonder why they experience such stiffness after joint mobilizations, whether passive or active.
The Common Patient Concern
Let’s dive into this post-operative tendon repair question. I often hear from my patients: “Why does it feel so stiff when I wake up? And why does it get stiffer after I do my exercises?” It’s crucial to understand that stiffness can set in quickly—often within three hours—regardless of whether you’re doing passive or active range motion.
The Nature of Injuries and Surgeries
To grasp why stiffness develops, we first need to look at the nature of injuries and surgeries. When you sustain an injury, your body sends in what I like to call “construction workers” to repair the damage. This is especially true when surgery is involved, like repairing a broken tendon. Let’s consider flexor tendons, for example. When they’re cut, the muscle retracts and needs to be sewn back together to function properly and allow movement across the joint.
For flexor tendons to work effectively, various supportive structures surround them. When there’s a cut and an injury, combined with surgery, it’s almost like two separate injuries are occurring: one from the initial injury and another from the surgical repair. This prompts your body to send extra cells to the area to heal, which in turn creates edema (swelling) and scar tissue.
Understanding Scar Tissue
If you take a closer look at scar tissue, you’ll find that its fibers are jumbled. Picture dropping a box of spaghetti noodles and mixing them up. Instead of lying in neat lines, they end up all tangled together. It’s through consistent movement—what I call “stress” on the tissues—that these fibers can start to realign. However, they can easily become bunched up again if not managed properly. This is why stiffness can set in so quickly, regardless of whether you’re performing joint mobilizations, working on scar management, or addressing edema and passive range of motion.
The injury itself doesn’t take long to heal, but the process of recovery—where your body heals itself, supported by surgery—is what allows for more motion. Stiffness occurs rapidly because the body is continuously sending its “construction workers” to the area, promoting scar formation and healing. Over time, this cellular activity decreases, and the fibers begin to realign.
Quality vs. Quantity of Movement
One key lesson I share with my therapists, students, and patients is the distinction between quantity and quality of movement. Quantity refers to how much range of motion a patient has. Quality, on the other hand, relates to how long that range of motion lasts.
In the early stages of recovery—within the first two to four weeks—passive movements may only result in looseness lasting about 30 minutes. However, after one to two months, that looseness can last for hours. As the patient continues to improve, they may find that they can maintain that looseness for days.
The other aspect of quality involves the time it takes to achieve that looseness. Initially, it may take an entire hour to loosen up a finger, but as progress is made, that time may decrease to just 30 minutes or even 15 minutes. Therefore, it’s essential to evaluate both quantity (the amount of movement) and quality (how long the looseness lasts and how quickly it’s achieved).
Active vs. Passive Movement
Let’s also consider the differences between active and passive movement. At first, a patient might struggle to achieve a significant active range of motion. Eventually, they may report, “Oh, this part is good, but I can’t get the very end part.” The recovery process itself is essential. While injuries may heal relatively quickly, recovery is a more gradual process that requires consistent effort.
Many patients ask me if taking anti-inflammatory medication will help their stiffness. I explain that while anti-inflammatories can reduce inflammation, they must be digested and circulated throughout the body before reaching the targeted area—like a specific finger suffering from stiffness.
The Role of Movement in Recovery
To effectively reduce inflammation in a localized area, movement is crucial. When a patient moves, their muscles work to push out excess fluid. However, in the hands, this isn’t straightforward. The hands contain small muscles and tendons, which can easily become stuck. For instance, in the PIP (proximal interphalangeal) joint, numerous delicate tendons and structures are at play.
Stiffness can be particularly pronounced in the PIP joint due to the tightness of the collateral ligaments, which provide stability during both flexion and extension. This tightness is a natural response to injury, but it also contributes to the development of stiffness.
Understanding Stiffness Duration
Understanding the nature of the injury and the involved structures helps explain why stiffness can linger for so long. While edema can dissipate over time, it may take six to twelve months to fully resolve. This means that while patients may notice gradual progress, complete resolution can take up to a year. Setting this expectation with patients is vital.
Can progress occur during this time? Absolutely! However, being in therapy for the entire year isn’t necessary. There’s a “magic window” for therapy that should be consistent, early, and aggressive. This doesn’t mean daily therapy, but it does involve the right level of guidance to help patients achieve their goals.
The Importance of Trust in Therapy
I hope my insights into why stiffness occurs help you understand your patients’ experiences better. As hand therapists and occupational therapists, we have the knowledge to explain these processes to our patients, which helps build trust. Many patients are looking for someone they can rely on, and as certified hand therapists, we have the potential to support them through their recovery journey.
I also encourage you to check out our YouTube video, which may benefit your practice.
Promoting Hand Therapy Secrets
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