Restricted Mobility: Causes, Examples, and How to Address It

What is an example of restricted mobility?

Restricted mobility refers to a limited range of motion (ROM) at one or more joints, often due to pain, stiffness, or structural limitations. A common and illustrative example is shoulder impingement syndrome, where inflammation or structural issues limit the arm's ability to move freely, particularly overhead.

Understanding Restricted Mobility

Mobility, in the context of human movement, is the capacity of a joint to move actively through its full anatomical range of motion without pain or restriction. It encompasses both the flexibility of the soft tissues (muscles, tendons, ligaments, fascia) and the structural integrity and health of the joint itself (cartilage, joint capsule). When this capacity is compromised, we experience restricted mobility.

Restricted mobility is not merely a lack of flexibility; it's a complex issue that can arise from various factors, including:

• Tissue Shortening: Muscles or connective tissues that have become shortened or stiff due to inactivity, repetitive movements, or injury.
• Joint Dysfunction: Issues within the joint itself, such as osteoarthritis, capsular restrictions, or structural abnormalities (e.g., bone spurs).
• Pain and Inflammation: Conditions like tendinitis or bursitis that cause pain, leading to protective guarding and reduced movement.
• Neurological Factors: Nerve impingement or conditions affecting motor control.
• Post-Surgical Adhesions: Scar tissue formation following an operation.

A Common Example: Shoulder Impingement Syndrome

One of the most prevalent examples of restricted mobility, particularly in active populations, is shoulder impingement syndrome. This condition occurs when the tendons of the rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis) and/or the subacromial bursa become compressed or "impinged" between the head of the humerus (upper arm bone) and the acromion (a bony projection of the shoulder blade).

Anatomy Involved:

• Rotator Cuff Tendons: These four muscles stabilize the glenohumeral (shoulder) joint and facilitate a wide range of arm movements.
• Subacromial Bursa: A fluid-filled sac that reduces friction between the rotator cuff tendons and the acromion.
• Acromion: The roof of the shoulder blade, beneath which the rotator cuff tendons and bursa pass.

How it Restricts Mobility: In shoulder impingement, inflammation or swelling of the tendons (tendinitis) or bursa (bursitis) reduces the space available for these structures to glide freely during arm movement. This often leads to:

• Painful Arc of Motion: Typically, pain is felt when lifting the arm overhead or reaching out to the side, especially between 60 and 120 degrees of abduction (lifting arm out to the side) and flexion (lifting arm forward).
• Limited Overhead Reach: The most noticeable restriction is often the inability to fully elevate the arm without pain or compensation.
• Difficulty with Internal Rotation: Reaching behind the back (e.g., to tuck in a shirt or fasten a bra) can also be severely limited.
• Stiffness and Weakness: Chronic inflammation can lead to stiffness and a perceived or actual weakness in the affected movements.

Causes:

• Overuse or Repetitive Overhead Activities: Common in athletes (swimmers, baseball pitchers) or occupations requiring frequent overhead work.
• Poor Posture: Forward head posture and rounded shoulders can reduce the subacromial space.
• Muscle Imbalances: Weakness in the rotator cuff or scapular stabilizers can lead to improper shoulder mechanics.
• Structural Factors: Variations in acromion shape can predispose individuals to impingement.

Other Examples of Restricted Mobility

While shoulder impingement is a clear illustration, restricted mobility can manifest in various other joints and conditions:

• Osteoarthritis of the Knee: Degeneration of articular cartilage leads to pain, swelling, and stiffness, limiting knee flexion and extension (e.g., difficulty squatting, climbing stairs).
• Frozen Shoulder (Adhesive Capsulitis): A condition where the joint capsule of the shoulder thickens and tightens, severely restricting all movements, often in distinct "freezing," "frozen," and "thawing" stages.
• Tight Hamstrings or Hip Flexors: Common in sedentary individuals, leading to difficulty touching toes (hamstrings) or achieving full hip extension (hip flexors), impacting gait and posture.
• Post-Surgical Limitations: Following joint replacement (e.g., hip or knee), scar tissue and initial pain can restrict range of motion, requiring targeted rehabilitation.
• Scoliosis: Severe curvature of the spine can restrict spinal rotation and flexion/extension, impacting overall trunk mobility.

Impact of Restricted Mobility

The consequences of restricted mobility extend far beyond just discomfort:

• Pain and Discomfort: The most immediate and obvious impact, often leading to reduced activity levels.
• Compensatory Movements: The body finds alternative ways to achieve tasks, often placing undue stress on other joints and muscles, increasing the risk of secondary injuries (e.g., low back pain due to tight hamstrings).
• Reduced Quality of Life: Simple daily activities like dressing, reaching for objects, or walking become challenging, impacting independence and well-being.
• Functional Limitations: Impaired ability to perform occupational tasks, recreational activities, or exercise.
• Performance Decrements: Athletes experience reduced power, speed, and agility, impacting their sport-specific movements.

Addressing Restricted Mobility

Effectively addressing restricted mobility requires a comprehensive and often multi-faceted approach:

• Accurate Assessment: A thorough evaluation by a healthcare professional (e.g., physical therapist, physician, kinesiologist) is crucial to identify the underlying cause and extent of the restriction. This often involves specific mobility screens, range of motion measurements, and diagnostic imaging if necessary.
• Targeted Interventions:
  • Manual Therapy: Techniques like joint mobilizations, soft tissue release, and massage can help restore joint play and reduce tissue stiffness.
  • Stretching and Flexibility Exercises: Static, dynamic, and PNF (proprioceptive neuromuscular facilitation) stretching can improve tissue extensibility.
  • Strengthening Exercises: Addressing muscle imbalances and strengthening surrounding musculature (e.g., rotator cuff and scapular stabilizers for shoulder impingement) is vital for joint stability and proper mechanics.
  • Corrective Exercise: Specific exercises designed to improve movement patterns and address biomechanical dysfunctions.
  • Pain Management: Modalities such as ice, heat, anti-inflammatory medications, or in some cases, injections, may be used to manage pain and allow for rehabilitation.
• Lifestyle Modifications: Incorporating regular movement, maintaining good posture, and understanding ergonomic principles can prevent recurrence.

Conclusion

Restricted mobility is a significant barrier to optimal physical function, ranging from the frustrating inability to perform daily tasks to the debilitating impact on athletic performance. Shoulder impingement syndrome serves as a clear example, demonstrating how structural and inflammatory issues can severely limit a joint's range of motion. Understanding the causes and consequences of restricted mobility is the first step toward proactive management. By seeking professional guidance and adhering to evidence-based strategies, individuals can often restore joint health, alleviate pain, and regain the freedom of movement essential for a full and active life.