After a joint injury, different levels of braking are usually applied to the damaged joint or joints around the damaged area to ensure smooth healing of the damaged tissue and to prevent secondary injuries. Although the degree of braking varies, there is one commonality that is inevitable: braking inevitably causes dysfunction. Usually, the occurrence of dysfunction is related to the degree of braking, the means of braking, the degree of injury, the differences in the injured individual, and many other factors. This includes the patient’s age, gender, communication skills, occupational requirements, chronic medical history, injury history, post-injury management, surgical options (if any), level of surgery (actual assessment), current injury healing, current level of function, original level of function, level of function of the healthy side (one limb injury), and the patient’s expectations for his or her own rehabilitation (even the patient’s standard of living is important to understand, as it is related to how the patient can obtain the most cost-effective treatment plan for him or her). With this information, we can have a clear understanding of the patient we are dealing with, so that we know what we are dealing with, how to deal with it, “what to do”, and what to expect in terms of treatment outcome. Through the initial evaluation, which is of course the right step in rehabilitation, we begin to develop an appropriate treatment plan for the patient’s actual condition. Before any program is implemented, it is very important to gain the full trust of the patient. Imagine facing a patient who is full of doubts and suspicions, a good cooperation between the doctor and the patient is difficult to achieve in any case, so it is necessary to provide a good impression of the patient with a friendly attitude and scientific explanation (brief). As you can imagine, after a long period of braking, the majority of patients will experience significant joint mobility impairment. In order to ensure the therapeutic effect, it is inevitable that the patient should be given heavy manipulation to loosen joint adhesions and pull contracted tissues, therefore, a considerable degree of pain is inevitable while applying the surgery. Before starting the treatment, it is also important to take precautions and explain the possible situations in advance so as not to overstimulate the patient. In order to ensure that the patient’s confidence is not shattered after the first treatment, the amount of treatment should be gradual and progressive, from small to large. At the beginning of the treatment, relatively gentle techniques can be used so that the patient can adapt more easily and feel confident to continue the treatment in the future. When the patient is fully confident and convinced of the need, the training can be gradually increased in intensity to speed up the treatment process. As mentioned above, braking is not a one-day problem, and the dysfunction that results from braking can be very complex. Intra-articular adhesions, adhesions between surrounding tissues, contractures of the soft tissues around the joint (muscles, tendons, ligaments, joint capsule, fascia, skin, scarring, etc.) may all lead to severe ROM impairment. In this complex situation, manipulation for ROM generally produces strong stimulation of the patient, strong irritation of the corresponding tissues, and even some degree of damage. During such treatment, pain, capillary damage between soft tissues, and joint stress reaction (inflammatory response), may follow. At this point, it is necessary to readjust the training volume according to the patient’s response. It is important to understand that although pain is unavoidable, it is never our goal to create pain for the patient, and it is important to try to avoid all painful sensations that can be avoided during the treatment. During the treatment, it is important to maintain good communication with the patient at all times, and carefully ask and attentively appreciate the changes in the location, nature, and degree of pain of the patient. According to the observation, in general, patients subjectively feel the painful sensation of pulling on the contracted tissues during joint loosening manipulation, the dull painful sensation generated by tearing the adhesions inside and outside the joint, the painful sensation of swelling in the joint caused by a large amount of fluid accumulation in the joint, and the sharp painful sensation caused by the synovial membrane embedded in the joint are the most common cases. Different methods should be used to deal with different sensations. First of all, pulling pain is the feeling that I personally would like to see in patients. When this happens, it can be considered that within a certain range, the influence of joint adhesions of the affected limb has been less than contracture, and as long as gentle and persistent pulling force is used, after a certain period of time, the contracted soft tissue can be given a certain physiological length and gradually become normal tension. At this time, it is important not to overdraw and violently pull, otherwise it will be counterproductive. The degree of adhesions in and around joints varies due to a number of factors. For small adhesions that are new (usually no more than three months old), it may be possible to tear them with a small number of high-intensity manipulations (what some textbooks call 4- to 5-grade joint release), using rapid, small-scale (not significantly exceeding the patient’s limit) manipulations, which usually result in a subtle When tearing, you will usually hear a subtle “tearing thread-like sound” and feel a certain “breakthrough” sensation. For more stubborn adhesions formed over a long period of time (usually more than three months), this method is generally no longer used, and the technique should still be stronger, staying at the place of greater resistance for a longer period of time, and then pushing harder for a smaller stroke before the patient feels the limit, so that the adhesions may be partially torn apart. If the adhesions are so stubborn that they cannot be torn away, then a longer-term effort is required, and persistence is needed on the part of both the patient and the doctor. During the course of treatment, the patient will also often feel a sharp pain in the joint space, which is most likely a reaction of the synovial membrane in the joint. Synovial congestion, synovial crepitus, and synovial adhesions due to irritation can cause the synovial membrane to be squeezed in the joint space during movement. In this case, according to the actual situation, a certain amount of axial distraction should be performed on the operated joint without violating the normal direction of human joint movement, and joint release combined with axial distraction can improve the phenomenon of synovial compression as much as possible. Axial distraction is a commonly used joint loosening technique, which belongs to joint accessory motion, with more sliding between joint surfaces. Different joints are suitable for axial distraction along different directions, and it depends on the operator’s personal experience as to how much force is used for the operation, which is difficult to quantify. As for the swelling and pain caused by simple joint effusion, it is basically caused by excessive movement before. Imagine that a fully inflated balloon is also difficult to pinch. At this point, suspend the treatment, appropriate braking, icing, and physical therapy can produce better results, and when the fluid is absorbed to a certain extent, the joint movement can be normalized. If there are no good sterilization conditions, joint puncture is not recommended to extract the fluid, because the stimulation of the joint may lead to more serious fluid accumulation, and we should trust the body’s own regulation ability. There is also a kind of patient, obviously dysfunction is very serious, but in the process of receiving treatment but no pain, function is also difficult to improve, this indicates that adhesions, contractures have reached the point of irremediable, sometimes, persuade patients to give up appropriately is also relatively economic. Of course, it is not possible to just let go, that must be a reluctant decision made only after trying hard and after much deliberation. These changes are never the only ones in functional exercises, they may occur collectively or in other new situations, so it is important to analyze the specific problems, to adopt a contingency plan for the new situation, to enhance the ability to anticipate hidden problems and to nip them in the bud before they occur in order to obtain maximum efficiency. How much training should be appropriate? Multiple times a day? Once a day? Or once a day? In my personal experience, for example, depending on the patient’s injury, I first arrange for a large amount of training with strong stimulation three to five times a week at the beginning of treatment. In several years of practice, there have been cases where the training was never interrupted for more than one day, and there have been cases where the training was rested for six days a week. It seems that the established rehabilitation program cannot be implemented mechanically, and only by adjusting and changing it at any time according to the actual situation can the patient’s injury changes be grasped and correct treatment be made. We must be bold and good at doubting and denying the established rehabilitation program at any time! It is important to know that real rehabilitation is not static, but in a state of change at any time. Only by mastering the rules of changes in the patient’s condition can we take the initiative in the treatment work.