Joint Mobilizations (week 6)

Effects of Joint Motion

Stimulates biological activity by moving synovial fluid

• Prevents atrophy of the articular cartilage due to immobilization

Maintains extensibility and tensile strength of articular tissues

Cause afferent nerve impulses to be sent from joint receptors to the CNS regarding position and motion

• Loss of sensory input can lead to impaired balance

Joint Mobilizations by PTAs

Controversial topic

Not prohibited by the Texas Practice Act

APTA article The Joint Manipulation Debate

Indications

Pain, muscle guarding and spasm

Reverse Joint Hypomobility

Position Faults/Hypomobility

Progressive limitation

Functional Immobility

Contraindications

Necrosis of ligament or capsule

Hypermobility

Joint effusion

Inflammation

Precautions

Malignancy

Bone disease

Unhealed fracture

Excessive pain

Weakness of connective tissue due to injury, surgery, disease (RA)

Elderly with weakened tissue

Pain as the Guide

Pain before tissue limitation

• Gentle pain-inhibiting joint techniques

Pain concurrently with tissue limitation

• Gentle stretching to tight tissue that doesn’t exacerbate pain

Pain after tissue limitation

• Joint play techniques

Non-Thrust Oscillations

Grade I – Small amplitude oscillations at beginning of range. Rapid oscillations

Grade II – Large-amplitude rhythmic oscillations performed within the range. 2-3 osc./second, 1-2 minutes

Grade III – Large amplitude rhythmic oscillations performed up to the limit of the available range and tissues are stressed. 2-3 osc./second, 1-2 minutes

Grade IV – Small-amplitude rhythmic oscillations at the limit, stressed into tissue resistance. Rapid oscillations

Non-Thrust Sustained Joint-Play Techniques

Grade 1 – Small amplitude distraction, no stress to capsule

Grade II – Distraction or glide to tighten tissues. “Taking up the slack”

Grade III – Large amplitude stretch or distraction to stretch joint capsule and surrounding periarticular structures

Oscillating

sustained

Comparing Oscillations and Sustained Techniques

Main differences are in the rhythm and the speed of force application

Remember:

• Grade I and Grade II for both techniques are low intensity and do not cause a stretch force to the joint capsule

• Grade III (both) and Grade IV (oscillations only) are applying a stretch

Thrust Manipulation/ High Velocity Thrust

Small-amplitude , high-velocity thrust performed at end range to snap adhesion or reposition.

One repetition only

Also called Grade V mobilization

Traction

Longitudinal pull.

Distraction

•separation, or pulling apart.

•Important to prevent damage to the joint with mobilization

Direction and Target of Treatment Force

The treatment force is applied as close to the opposing joint surfaces as possible (Get your hands close to the joint line)

Applying the force through a larger surface (hand vs. finger tips) will make it more comfortable for the patient

Remember the convex and concave rule!!

Mobilization with Movement

Treatment concept developed by Brian Mulligan

Application of pain-free accessory mobilization with active and/or passive physiological movement

Pain is the barrier

Documentation

Rate of application of the force

Location in range of available movement

Direction of force as applied by the PT/PTA

Target of the force

Patient position

Adverse Effects

Tearing/ Damage of tissue, joint surfaces, etc.

Damage to surgical repair

Inflammation

Swelling

Impaired function

Hypermobility

Loss of patient trust