How do we move?  Why do sprains or torn ligaments affect how we move?  How do we re-teach our bodies to move after an injury?  Why does it take so long to resume activities after an injury?  There are many mechanical parts of the body and, in some sense, it can be like fixing your car or a door in your house.  To answer these questions and understand why it's important to properly train or 'rehab' requires that we first know a few 'body basics.' 

Bones are hard tissue that make up the skeleton, or frame, of your body.  Ligaments are strong bands of soft, flexible tissue that hold one bone to another.  When two or more bones come together they form a joint (most of which can move, some provide very minimal movement, and still others have ‘fused’ and, therefore, do not move.)  Tendons are strong bands of tissue that come from the end of a muscle and attach that muscle to a bone.  Muscle is soft tissue that has the ability to contract and relax and, working through the tendon and its attachment to a bone, can both stabilize and move a joint. 

The ligaments and muscles maintain the joint’s integrity and stability so that the ‘mover’ muscles can appropriately move the bones and joint(s).  If the surfaces of the joint do not stay aligned then the muscle force will ‘shift’ the bones instead of rotating them for normal movement.  This ‘shift’ will not only disrupt the normal movement, it will also wear down the joint over time, resulting in arthritis.

In most movement situations, there is more than one bone moving.  Usually, the bones closer to the body acts as the ‘base’ for the bones further away from the body to move upon. The exception is when the hand or foot is ‘fixed’ to the ground, a wall or other immovable object, in which case the bone closer to the body will move on the more stable bone further away that is anchored.  Examples of this movement would be performing a pushup or walking down stairs.  However, in both of these examples, you can see that there are many joints involved and that the movement requires the coordinated effort of many, many muscles crossing those joints.

Consider the shoulder joint.  This is a very complex joint that is actually a group of joints.  Shoulder movement involves movement of the shoulder blade (scapula) on the rib cage, the clavicle (collar bone) attaching to the scapula on one end and the sternum (breast bone) on the other end and the ball and socket joint (glenohumeral joint).  This complexity explains why it is so difficult for athletes to return to their prior level of competition after should injuries, particularly those requiring surgery.

By contrast, advances in surgical repair of torn anterior cruciate ligaments (ACLs) in the knee have been able to accurately reconstruct the location and tension of the original ligament.  This restores the normal stability of the joint and allows for full rehabilitation.  Perhaps you have heard about athletes tearing their ACLs and it has become routine to see them back in action within a year.

Typically, rehabilitation programs that overlook or underestimate the widespread impact of an injury will cause the recovery process to be longer.  As there are many factors that affect the rehabilitation process, there is much fine-tuning and many program changes that need to take place to optimize healing and a return to ‘normal.’  This is why athletes who are focused daily on their rehabilitation under the watchful eyes of athletic trainers and physical therapists can accelerate their recovery.  As soon as one aspect of a movement improves, exercises can be added to involve another aspect of the movement, and so on.  For someone with a full-time job and many other daily demands who is only attending a couple of physical therapy sessions each week, progress is naturally going to occur more slowly.