Benefits of Early Mobilization in Physiotherapy

People who have experienced a traumatic injury such as a car accident or fall injury must have also experienced the process of medical treatment and rehabilitation depending on the level of severity. The major part of rehabilitation includes early mobilization. Early mobilization is referred to physical activity performed to the intensity that results in physiological changes. Early mobilization is the physical activity that should be started as early as the 2nd to 5th day after the onset of critical illness or injury. The physiotherapist is one of the healthcare professionals responsible for mobilizing the patient. The physiotherapist designs a protocol for the early mobilization of the patient. In this blog, we will discuss the physiological effects and benefits of early mobilization.

Early mobilization:

Early mobilization reduces the risk of postoperative complications, accelerates the recovery of functional walking capacity, and reduces hospital length of stay, thereby reducing care costs. Early mobilization is safe and improves mobility, and strengthens muscles and joint flexibility. Walking promotes the blood flow of oxygen throughout the body while maintaining normal breathing functions, and stimulates circulation which can help stop the development of stroke-causing blood clots. It also improves blood flow which aids in quicker wound healing.

Patients who are critically ill, and spend time in an ICU, can develop muscle weakness and other problems. This can occur because of the illness that led to their admission to the ICU, the impact of ongoing health conditions, treatments associated with this illness, and their lack of movement while in the ICU. They may also have ongoing problems when they leave ICU such as an inability in doing daily activities like dressing, bathing, and mobility feeling depressed or anxious and having difficulty returning to work.

Early mobilization helps these people to move early in their ICU stay, would allow them to be better, able to look after themselves, be stronger and feel better about life.

Muscle injuries represent one of the most common traumas depending on the trauma mechanism these include laceration, contusion, and strain. The range of lesions varies from partial ruptures to complete ruptures of the muscle. The muscular tissue can regenerate. The process of healing consists of the regeneration of muscle fibers and the formation of a connective tissue scar.

The healing is also dependent on the vascularity and regeneration of intramuscular nerve branches. Immobilization and mobilization have a great impact on the recovery, the former being of importance initially by reducing the size of the injury and the latter later on by inducing greater granulation tissue production. Mobilization treatment is also a prerequisite for muscle fiber regeneration and achieving the original tensile properties of the muscle. Surgical intervention is occasionally required in complete ruptures to suture the ruptured ends of the muscle to apposition or evacuate the hematoma.

Effects of early mobilization

The biological processes following muscle injury include the regeneration of muscle fibers and the production of granulation tissue. Muscle fiber regeneration is inhibited by the formation of dense connective tissue scars. Immobilization after injury limits the size of the connective tissue area formed at the site of injury, the penetration of muscle fibers through the connective tissue is prominent, has a complex orientation and is not parallel with the uninjured muscle fibers.

Immobilization for longer than 1 week is followed by marked atrophy of the injured muscle. Mobilization started immediately after injury followed by a dense scar formation in the injury site that prohibits muscle regeneration. When mobilization is started after a short period of immobilization, better penetration of muscle fiber through the connective tissue is found and the orientation of regenerated muscle fibers is aligned with the uninjured muscle fibers. For mobilization after short immobilization, there is a little delay in healing processes in muscles, the gain in strength and energy absorption capacity is the same as compared to the muscles treated by early mobilization alone.

Mobilization Technique

Mobilization is a manual technique used by physiotherapists to improve the mobility and function of the soft tissues, joints, muscles, ligaments, and tendons. Mobilization with movement (MWM), is a type of manual therapy which causes hypoalgesic effects. It increases joint ROM, and flexibility and enhances muscle function. Joint mobilizations are performed by the physiotherapist. The patient typically feels like a stretch. The technique is usually relatively pain-free, however, the pressure from the physiotherapist may be more tender in some areas compared to others. The patient may experience some soreness in the area surrounding the joint following a mobilization.

Benefits of early mobilization

One should emphasize the benefits of structured postoperative mobilization. Early mobilization has the following benefits:

• Reduces adverse effects of mobility.
• Improves respiratory function.
• Increase level of consciousness.
• Increase functional independence.
• Improve cardiovascular fitness.
• Increase physiological well-being.
• Pain reduction.
• Improved range of motion,
• Improved quality of joint movement itself.

Impairments seen with prolonged bed rest

Modifiable barriers to early mobilization include lack of education and lack of resources, creating a culture that prioritizes preoperative physical activity and exercises during rehabilitation. Prolonged bed rest cause:

• Impaired strength.
• Physiological impairments.
• Increased risk of skin breakdown.
• Respiratory dysfunction.

Early mobilization is a crucial component of enhanced recovery after surgery that reverses the adverse physiological consequences of immobilization and surgical stress