Ligaments are elastic structures connecting bone to bone; their elasticity allows joints to maintain mobility while ensuring they are held together and not easily dislocated. Articular cartilage is the smooth, translucent or transparent tissue that covers the ends of bones where they come together to form joints; healthy cartilage allows bones to glide over each other with little friction.

Ligaments and articular cartilage are both negatively affected by prolonged immobility. A contracture is a permanent shortening of tissue — such as muscle, tendon or skin tissue — resulting from disuse, injury or disease. It can occur, for example, as a result of changes to the collagen composition of tendons and ligaments caused by disuse. Although contractures are extremely common, their aetiology is still poorly understood Wong et al, Muscle atrophy plays a part in their development because of the shortening and weakening of the muscles.

Contractures can develop over joints, often when there is an imbalance in the strength of opposing muscle groups. If allowed to progress, a joint contracture may develop to involve muscles, tendons, ligaments and internal structure of the joint capsule, resulting in a stiffening joint that is increasingly limited in its range of motion.

A common example of joint contracture caused by immobilisation is contracture of a knee that has been plastered to treat a fractured tibia.

Joint contractures may begin to form within as little as eight hours of immobility Corcoran, Most morning stiffness is transient as, after activity is resumed, the joint tissues are stretched again and stiffness dissipates. However, weeks of immobilisation will produce a much more severe form of joint contracture. Immobility can cause contractures that are severe enough to restrict the range of movement in major joints; this is one of the most frequent complications associated with prolonged bedrest.

Among patients who stayed in an intensive care unit ICU for two weeks or more, over a third developed a movement-limiting joint contracture; the joints most often affected were the elbow, ankle, knee, hip and shoulder Clavet et al, A follow-up study in the same population showed that those who had developed joint contractures had difficulties with mobility three years later Clavet et al, The authors concluded that joint contractures could cause irreversible disability and that identifying and treating them in the ICU could prevent long-term functional limitations.

Furthermore, during bedrest, opposing folds of the synovial membrane connective tissue that lines the inner surface of the capsules of synovial joints may come into contact with each other and form abnormal adhesions that further limit joint movement Trudel et al, The main component of tendons and ligaments is the fibroblast-derived protein collagen. In joints that frequently move, collagen fibres are in a loosely coiled arrangement that allows stretching and normal activity.

In a patient who is immobile, the collagen structure changes into a mass of shortened, straighter and more densely packed fibres within one day. Within two or three weeks, this change in collagen structure can compound a joint contracture. After two or three months of immobility, contracture and stiffness may have become so severe that surgical correction will be needed to restore the full mobility of the joint. A common problem associated with prolonged bedrest and immobility is foot drop contracture or deformity Fig 2 , which results in the inability to place the heel in its correct position on the ground when standing or sitting.

This is usually caused by entrapment of the common peroneal nerve at the neck of the fibula at the top of the calf. Foot drop contracture is compounded by a lack of passive exercise stretching the ankle joint or by inadequate joint support, both of which reduce tension on the Achilles tendon and lead to its shortening Lippincott Williams and Wilkins, Similarly, a lack of stretching of the gastrocnemius muscle one of the two major muscles of the calf when the body is supine can lead to a tightening of the calf, thereby contributing to foot drop contracture Amis, Once the patient regains mobility, a shortened Achilles tendon can result in the toes pointing further forward than normal and make it difficult to place the foot in its usual position.

This makes walking difficult and places undue strain on the Achilles tendon, causing pain and increasing the risk of tendon rupture. The risk of contracture can be reduced through appropriate positioning and body alignment in bed.

Moving each joint through its full range of motion at least once every eight hours, whether actively or passively, also appears to help prevent contractures. A physiotherapist can undertake passive joint mobilisation exercises, as can appropriately trained nurses or healthcare assistants. As discussed here and in previous articles in this series, exercise and mobilisation, when feasible, will help counteract the negative physical and psychological effects of prolonged bedrest.

In particular, they will help avoid muscle disuse weakness and joint contractures. Today, I'll focus on building your immunity against colds! That way you'll move on to the next year in good health! Does anyone here rest your chin on your hands!?

That's a sign that your muscles are weak! Let's see, I'll pick Souji, since you hang out with Yosuke, who does that all the time! Which muscles do you think are weakening when you tend to rest your chin in your hands? This was a trickier one than normal. Kondo: Correct! Bad posture usually comes from your back!

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Changes in immune responses have been reported after bedrest, and, although most studies have focused on conditions facing astronauts during space flight, there is overlap in the immune response of astronauts and those of patients exposed to prolonged bedrest.

One of the most significant findings concerns the reactivation of latent viruses. A study by Sonnenfeld et al found that the Epstein-Barr virus was reactivated in subjects exposed to a day bedrest, with a dramatically increased viral load. The other major effect of bedrest on the immune system appears to be on the production of cytokines.

These chemical messengers regulate the immune response in various ways, including stimulating the production of immune cells leucocytes or mediating inflammation. The production of interleukins IL seems to be most affected by bedrest. A decrease in the production of IL-2 responsible for growth, proliferation and activation of T and B lymphocytes and natural killer cells has been found in patients confined to bed, which may contribute to lower levels of immunity.

This is a pro-inflammatory messenger and it may also be involved in bone mineral loss. Also, there are some reports of a significant decrease in the level of circulating plasma antibodies Craven and Hirnle, ; Shearer et al, If prolonged bedrest itself is a major cause of reduced immunity, this has yet to be scientifically determined.

There is still a considerable lack of research on this area. Immobility and the associated changes in body composition described above can also affect the self-concept of patients. Related to this is self-esteem, which refers to the feeling of self-worth, and is a central component of psychological well-being Walker et al, Although levels of self-esteem and self-concept are relatively stable within people, particular events such as sudden or chronic illness can produce drastic changes.

Prolonged bedrest, which causes both a decrease in body function and altered appearance, can lead to patients having to re-evaluate their physical self. Studies of hospitalised patients indicate that body image plummets during illness Taylor, It can affect:. The three articles in this series have covered the effects of bedrest and immobility on the various organs and systems of the body.

Although bedrest is still a chosen and perhaps necessary intervention in many cases, as soon as a patient is ready, the resumption of even minor activity and movement is in their best interest. Asher, R. British Medical Journal; 2: , Bloomfield, S.

Medicine and Science in Sports and Exercise; 2, — Bortz, W. Western Journal of Medicine ; — Corcoran, P. Western Journal of Medicine; — Craven, R. Dietrich, S. Orthopedic Clinics of North America ; — Dittmer, D. Part 1: musculoskeletal and cardiovascular complications. Canadian Family Physician; —, — Ferrando, A. American Journal of Physiology — Endocrinology and Metabolism; — Fitts, R. Gogia, P. Archives of Physical Medicine and Rehabilitation; — Gulanick, M. Halar, E. In: Ross, M.

Jiricka, M. In: Porth, C. Journal of Applied Physiology; — Kubo, K. British Journal of Sports Medicine; 3, — Lindboe, C. Clinical Physiology and Functional Imaging; 4: 2, — Lorenz, T. In: Nordin, M. Basic Biomechanics of the Musculoskeletal System. Marieb, E. San Francisco, CA: Pearson. Milton, L. In: Avioli, L. They also cause gradual loss of power and function in muscles. Those who have these conditions may become wheelchair-bound.

Sarcoidosis : this is a rare disease in which clumps of cells granulomas form in skin, lungs and soft tissues, including muscles. The condition usually goes away after a few years. Amyloidosis involves deposits of an 'unhelpful' abnormal protein called amyloid throughout the body, including muscles and kidneys. Other rare causes : direct damage to muscles can occur in rare inherited metabolic conditions.

Examples include:. Myotonic dystrophy : this is a rare genetic muscle disorder in which muscles become extremely tired. Myotonic dystrophies are passed down through families and they tend to occur earlier and become worse as they move through the generations.

Motor neurone disease MND : this is a progressive disorder of the nerves which affects all parts of the body. Most forms of MND begin at the outer extremities, hands and feet and gradually move inwards. The condition can take months or years to progress but people with MND often quickly develop profound muscle weakness and wasting.

MND is most often seen in male patients over 50 years of age but there have been many notable exceptions to this, including the scientist Stephen Hawking. Myasthenia gravis : this condition is an uncommon muscle disorder in which muscles tire rapidly with a very long recovery time. This can be so extreme that patients can't keep their eyelids lifted and speech can become slurred. Poisons : poisonous substances also cause muscle weakness and paralysis through their effect on nerves. In the case of organophosphates, the weakness and paralysis symptoms may be permanent.

Addison's disease is a rare condition of underactivity of the adrenal gland, leading to a shortage of steroids in the blood and to abnormalities of the blood's salts. It tends to come on gradually.

Patients can also develop unexpected tanning pigmentation of the skin. Weight loss is common but the symptoms are often vague. Muscle fatigue may be mild and is often an early symptom. The disease can be very difficult to spot and special tests are needed to confirm it.

Other rare hormonal causes of muscle weakness include acromegaly excessive levels of a hormone called growth hormone , underactivity of the pituitary gland hypopituitarism and severe vitamin D deficiency.

Your doctor will need to examine you to see which muscles are affected and whether you have true or perceived muscle weakness. They will check to see whether your muscles are tender to touch which suggests they are inflamed or unusually 'fatigable'.

They may want to watch you walk. They will then need to test your nerves to see whether the muscles are getting the right signals to act. Your doctor may need to test your central nervous system, including your balance and co-ordination.

They may need to perform blood tests to look for abnormalities of hormones, salts and blood cells. The pattern and severity of weakness, associated symptoms, medication use, and family history help the doctor to determine the cause of your weakness. In the physical examination, the doctor should objectively note down your loss of strength, conduct a neurological survey and search for patterns of weakness and other abnormalities.

There are many possible causes of muscle weakness. These range from common to rare, serious to minor, temporary to permanent. Fortunately, most cases of muscle weakness which lack obvious cause are reversible. Muscle weakness is rarely the only sign of serious underlying disease. If you have persisting muscle weakness, particularly if it severe, localised, painful or present for more than two to three weeks, you should discuss this with your doctor.

Once your doctor has talked to you about your symptoms, they will be able to offer some guidance as to the likely cause. They will also be able to tell you if there are any serious concerns about your symptoms and will be able to refer you for further testing if required.

Walking for health. Keeping fit ; Age UK. Staying steady Falls prevention ; Age UK My symptoms are below:-Mid Felt right leg week when I am exercising. Felt right hand weak and fine tremor. Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy.

Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions. In this series. In this article What is muscle weakness? What are the causes of muscle weakness? Uncommon causes of muscle weakness Rare causes of muscular weakness I have muscle weakness - what will the doctor do?

Muscle Weakness In this article What is muscle weakness? What is muscle weakness? The term muscle weakness can be used to describe several different things.