Joint Mobilization

How to assess joint motion?

Kaltenborn scale (0-6), End feel, symptoms

List out Kaltenborn scale

0-2: hypomobile

3: normal

4-6: hypermobile

List out Maitland’s Grades of Mobilization

Grade I: small amplitude out of resistance

Grade II: large amplitude out of resistance

Grade III: large amplitude into resistance

Grade IV: small amplitude into resistance

Grade V: Thrust manipulation (get to end range first)

Grades I and II are for _, Grades III and IV are for _ when _ is not a limitation

Pain, Resistance, pain

Pain all the time means -, pain prior to or at resistance means -, pain after resistance means -

Rest, 1/2, 3/4

Mechanical vs Neurophysiological effects of Joint Mobs

Mechanical: Increasing joint nutrition to articular surfaces (decreasing synovial viscosity), stretching the joint capsule, disrupts abnormal cross-linking

Neurophysiological: Gate theory, pain control via mechanoreceptors (endorphin release)

What are the two main joint mob types?

Oscillations and Sustained Holds

Oscillation overview + parameters for pain vs restriction

Passive oscillatory movements anywhere in ROM, 2-3/sec

• Pain: 1-2 min, 1-5 reps

• Restriction: 30-60 sec, 1-5 reps

Sustained hold overview, purpose, timing

Sustained hold is holding at end range (usually restricted range) to treat hypomobility

• 30 second holds, 1-5 reps

Joint play done in _ _ _, used _ in sequence

Loose packed position, first

How to document?

_ glide of R/L - joint grade - in LPP, pt in supine, 3×40 seconds followed by manual DF stretch

Contraindications for joint mobilization? (Grade V in bold)

Undiagnosed lesion, ankylosis, cauda equina, instability, active inflammatory joint disease, malignancy, osteoporosis, recent fx, herniated discs with nerve compression, questionable ligamentous integrity, vertebrobasilar insufficiency

Precautions

Arthrosis, joint effusion from trauma/disease, metabolic bone disease, pregnancy, hypermobility, general debilitation/poor health, total joint replacement, severe scoliosis/spondylolisthesis, severe radicular involvement, inability to relax

Grade V mobilization reasoning and other term

HVLA, for overcoming joint restriction by releasing capsular adhesions + restoring accessory motion + inducing neurophysiological pain modulation

The pop sound (-) is not necessary for grade V to be effective

Cavitation

Indications for grade V

Pain after resistance where stiffness is greater than pain, hypomobility with firm end feel