What is misuse syndrome?

  Disuse syndrome is an artificial syndrome caused by incorrect treatment. Disuse syndromes are common in stroke patients and include inflammation due to unreasonable force on joints, injury to ligaments, tendons and muscles, deformation of bones and joints, increased spasticity, increased imbalance between strong and weak muscles, habituation of abnormal gait and fractures due to falls. For example, improper handling of the shoulder joint causes rotator cuff injury, resulting in shoulder pain; having the patient practice against resistance exercise to the best of his ability before the onset of dissociative movement further aggravates the spasm of an already apparently spastic muscle, rather than trying to make it less spastic.  In stroke patients with stroke, generally the flexors of the upper limbs are dominant and spastic and the extensors of the lower limbs are dominant and spastic. If overtraining further strengthens the strength (spasticity) of the two groups of muscles mentioned above, instead of trying to reduce their spasticity and promote the recovery of antagonist muscle tone and strength, then a more serious imbalance in the strength of the flexors and extensors will result, making upper limb extension and lower limb (mainly knee) flexion more difficult, if not impossible. By the same token, if the patient is allowed to practice excessive anterior rotation when the forearm cannot be rotated posteriorly, then the imbalance between the anterior and posterior rotators will be exacerbated, making the recovery of posterior rotation function more difficult. From the point of view of stroke recovery, it is not the poor strength of the extensor and posterior rotator muscles of the upper limb and the flexor muscles of the lower limb that is important, but the strong antagonistic “muscle strength” (spasm). Therefore, we should suppress the strong muscles, promote the weak muscles, restore the balance between the two, and promote the restoration of the separation movement, i.e., dominance, rather than indiscriminately and with full force “strengthening muscle strength”. The strength should be gradually trained after the dominance is restored. Hemiplegic gait is often seen in patients who have not been properly rehabilitated. This abnormal gait can often be completely or partially corrected if correct walking training is started early in the course of the disease. Once an abnormal gait has developed, it is very difficult, if not impossible, to correct it; therefore, it can even be said that “improper rehabilitation is worse than no rehabilitation at all”.