Intro to Joint Mobilizations

open-pack position

position where the joint is most moveable

what can create joint dysfunction?

limited passive joint play, decreased accessory movement, hypomobility, joint block/blockage, joint lock/perched facet, intervertebral or joint derangements, subluxation, or osteopathic dysfunction

types of tissue barriers

- physiological barrier

- elastic barrier

- anatomical barrier

- restrictive barrier

physiological barrier

- active limit

- how far can the patient actively go?

elastic barrier

- passive limit

- END FEEL

anatomical barrier

- absolute limit of the joint

restrictive barrier

- abnormal resistance within physiological barrier

the treatment plane is _______ on the concave structure and _________ to the ________ on the convex structure

parallel; perpendicular; AOR

maitland approach

- oscillatory mobilization

- parallel or perpendicular to the treatment plane

kaltenborn approach

- sustained mobilizations

- translatory glide (parallel) and traction (perpendicular) techniques

M1

low/moderate velocity

small amplitude

don't reach the barrier

M2

low velocity

large amplitude

don't reach the barrier

M3

low velocity

large amplitude

to/through the barrier (between R1 and R2)

M4

low/moderate velocity

small amplitude

to the further barrier (to R2)

M5

high velocity

low amplitude

through the barrier (AT R2)

R1

initial onset of resistance

R2

final onset of resistance

K1

LOOSENING

low amplitude

not to barrier

K2

TIGHTENING

high amplitude

to the barrier

K3

STRETCHING

high amplitude

through the barrier

what is the goal of joint mobilizations

to increase joint mobility

*driven by patient response*

contraindications for stretch mobilizations (M3/M4 and K3)

- acute joint effusion

- capsuloligamentous sprain

- acute/chronic inflammation

- joint hypermobility or instability

precautions to stretch mobilizations (M3/M4 or K3)

malignancy, bone disease, excessive pain, total joint arthroplasty, systemic connective tissue disease, corticosteroid/anticoagulant use, psychological concerns, pregnancy, healing tissue

mobilization with movement (Mulligan)

pain-free active or passive ROM combined with accessory motion/joint mobilization