The Biggest Mistake My Patients Make in PhysiotherapyArticular Ankylosis – A Hidden and Frightening Threat.

 I often receive patients who come to me with severely restricted joint mobility. This condition, known as articular ankylosis, can persist for a long time and lead to serious functional consequences. In many cases, it results in limping or even functional impairment, where patients are no longer able to perform everyday movements. A stiff or locked joint can make even basic daily activities impossible.

Does Time Matter with Joint Ankylosis?

Yes. Definitely.

One of the most common mistakes patients make when they start physiotherapy with advanced ankylosis is believing they have time. They think they can delay their rehabilitation by weeks or even months and still get the same results. That is a dangerous misconception.

The human body is made of living tissues—muscles, ligaments, tendons, and joint capsules—that naturally tighten and shorten in the absence of movement.

1. Muscle Strength Loss

Among all functional parameters, muscle strength declines the fastest during immobilization. Take, for example, a patient in intensive care confined to bed: they can lose up to 1% of their muscle mass per day. Similar losses occur with a plaster cast or movement avoidance, such as not putting weight on a foot. In all cases, disuse leads to rapid muscular decline.

2. Venous Return and Circulation Problems

When a joint no longer moves properly—for example, the ankle joint, where flexion and extension are limited—venous return is impaired. This affects blood flow back to the heart, especially in the lower limbs. The result? Fluid stasis, swelling, and poor healing due to reduced blood supply. The less the joint moves, the less oxygen and nutrients reach the tissues, and the harder it becomes for the body to recover.

3. Joint Capsule Stiffness

The joint capsule is the soft tissue that surrounds the joint. Inside this capsule, synovial fluid is produced—but only when the joint moves. Without motion, the capsule stiffens and the joint freezes. This stiffness further reduces range of motion, preventing the stretching of ligaments and muscles, locking the joint into a chronic state.

Post-Surgical Rehabilitation – Act Fast

After surgery or immobilization, early physiotherapy is crucial. Ideally, sessions start immediately after cast removal or hospital discharge, three times a week for five to six weeks. The goal is to restore motion and flexibility as fast as possible. Delaying rehab in this context can significantly reduce the chances of full recovery.

No one should come out of a cast after six weeks and wait three more months before starting therapy. Doing so often results in severe limitations, and regaining full movement becomes increasingly difficult.

The Longer You Wait, the Harder It Gets

If joint stiffness lasts for three months, rehab will already be harder. But if it has been six months, or even a year, the challenge becomes enormous. The longer ankylosis persists, the more rigid the tendons, ligaments, and muscles become, and the greater the physiotherapy workload needed to regain function. In such cases, rehabilitation can take months or even years.

Five Years Without Moving a Joint? Yes, It Happens.

Throughout my career, I’ve seen patients who consult five years after losing their joint range of motion. Their expectations are often unrealistic. I try to explain: if your joint has been frozen for years, the result will never compare to someone who starts treatment after just one or two months. It’s also worth questioning why they didn’t seek treatment earlier.

These situations can be life-altering. They can result in chronic pain, permanent loss of function, or irreversible damage.

Final Advice

Don’t wait. If you’re dealing with a stiff or immobile joint, seek help as soon as possible. Every week counts. Physiotherapy is most effective when started early—before the stiffness becomes permanent.

I provide structured and evidence-based online physiotherapy for patients worldwide, offering clinical assessment, diagnosis, and personalised rehabilitation.

I also receive patients in person at my physiotherapy clinic in Phnom Penh.

You can begin your online physiotherapy session through the dedicated platform:

https://www.studiohealthon.com/online-physiotherapy

More information on clinical standards and supporting evidence is available here:

https://www.studiohealthon.com/online-physiotherapy-clinical-evidence

Yannick Sarton, MSc Physiotherapist

International Online Physiotherapy & In-Clinic Care, Phnom Penh

References:

1. A., Jespersen, J.G., Pingel, J. et al. Effects of 2 weeks lower limb immobilization and two separate rehabilitation regimens on gastrocnemius muscle protein turnover signaling and normalization genes. BMC Res Notes 5, 166 (2012). https://doi.org/10.1186/1756-0500-5-166

2. Kunz RI, Coradini JG, Silva LI, Bertolini GR, Brancalhão RM, Ribeiro LF. Effects of immobilization and remobilization on the ankle joint in Wistar rats. Braz J Med Biol Res. 2014 Oct;47(10):842-9. doi: 10.1590/1414-431x20143795. Epub 2014 Aug 15. PMID: 25140815; PMCID: PMC4181219.

3. Craik JD, Clark A, Hendry J, Sott AH, Hamilton PD. The effect of ankle joint immobilization on lower limb venous flow. Foot Ankle Int. 2015 Jan;36(1):18-23. doi: 10.1177/1071100714552823. Epub 2014 Sep 23. PMID: 25249319.