1. REMOBILIZATION

2. Mobilization of musculoskeletal injuries has changed greatly in some clinical practices in recent years. The advent of the concept and technology of continuous passive movement brought new dimensions to the prevention of deformity and limited movement after injury and to the promotion of healing of articular cartilage and connective tissue..

3. Modern surgery, antibiotics, and the use of cast bracing and intracast electrical stimulation have decreased the length of time of immobility needed for adequate healing. Physicians, physical therapists, and patients are requesting early mobilization of injuries. It is hoped that prevention rather than treatment. Until this comes to pass, however, therapists will have to be prepared to evaluate and treat muscles, joints, ligaments, and tendons that have undergone the changes inherent in the inflammatory and immobilizational processes

4. Muscle, Bone, and Connective Tissue 1-muscle regeneration begins within 3 to 5 days of the start of a reconditioning program after injury. 2- Within the first week, muscle weight increases, 3- Some fibers may have completed regeneration of their contractile elements by 1 to 3 days. 4- One week after release from immobilization, muscle fibers showed intense regenerative activity, although no evidence of mitosis.

5. 5- Mitochondria increased in number, and contractile proteins were added. 6- As regeneration proceeded, sarcomere size became normal, alignment became normal andthick, 7-Normal contraction and relaxation times were regained within the first week after release from immobilization. 8- Muscle weight within normal by 3 months.

6. Recovery in muscle takes place at a faster rate and begins substantially sooner after immobilization or trauma than in bone or connective tissue, most likely because of the superior vascular supply of muscle tissue. Muscle immobilized for 4 weeks required an equal amount of time for recovery, Bone immobilized for longer periods of time, however, required proportionately longer periods for complete recovery. Connective tissue is the slowest of the tissues under consideration to return to normal after immobilization or injury. This may be because of its slow turnover rate, poor vascularity, or both.

7. Ligaments that have been injured begin to regain tensile strength about the fifth week after injury, depending on the severity of the injury. A healing ligament may have about 50 percent of its normal strength by 6 months after injury, 80 percent after 1 year, and 100 percent only after 1 to 3 years, depending on the type of stresses placed upon it and the prevention of a repeated injury. Thus, stressing a connective tissue structure during remobilization is important for full recovery and yet must be properly graded to avoid reinjury. Patients with ligament injuries or reconstructions need to be cautioned about returning gradually to pre injury activities.

8. The response of articular cartilage injuries, total joint replacements, tendon lacerations, tendon transplants, and soft tissue injuries to intermittent and continuous movement. 1-Enhanced rate of healing, 2-Earlier recovery of normal range of motion, AND 3-Improved strength. 4-Regular exercise and stress had the beneficial effect of increasing the mass of ligaments and tendons.

9. Collagen is known to align along lines of stress application, especially during healing or reconditioning after immobilization. early during the repair phase of the healing process or soon after immobilization is the optimum time to begin any reconditioning program for connective tissue structures, whether it be a program of continuous passive movement, graded active exercise, manually applied passive movement, or supervised functional activity. Therapeutic intervention can be more effective when collagen is immature and intermolecular bonds are weak.