PTH 122 Lecture - Joint Mobilization

what is a joint mobilization/manipulation?

A passive, skilled manual therapy technique applied to joints and soft tissues to increase ROM

what are the benefits of increasing joint mobility?

• Increases functional ROM​

• Increases nutrition to the joint​

• The compressing/decompressing movement allows nutrition and continuous remodeling​

• Prevents adhesions and contractures​

• Maintains movement into and out of closed pack position (position of joint stability)

what are the indications for joint mobilization?

1. Decrease Pain (Gr. 1 & 2 mobilizations only)​

2. Decrease Muscle Guarding and Spasm

4. Faulty positioning /tracking of the joint surfaces

5. Limited ROM

6. Prevent degenerating and restrictive effects of immobility

what are the neuro effects of joint mobilization?

Small amplitude oscillations and distraction stimulate the mechanoreceptors than then inhibit the pain messages from the nociceptors at the spinal cord level (gait theory)

what are the mechanical effects of joint mobilization?

gliding movements cause movement of the synovial fluid which brings nutrients to the cartilage which in turns decreases pain and prevents degeneration

what are contraindications for joint mobilization?

1. Joint Hypermobility​

2. Joint effusion (swelling) due to trauma or disease ​

3. Inflammation

what are precautions for joint mobilization?

• Malignancy​

• Bone Disease (osteoporosis)​

• Post Fracture​

• Excessive pain​

• Hypermobility in surrounding joints​

• Total Joint Replacements​

• Pts. taking corticosteroids​

• Connective tissue diseases - such as RA​

• Elderly with weak connective tissue and poor circulation

what are some things joint mobilization cannot do?

• Change the disease process​

• Alter the inflammatory process

what does a physiological: voluntary/normal movement look like?

• Active ROM - actively performed by the patient​

• Passive ROM - passively performed by the PT/PTA​

• Osteokinematics

what do accessory: normal occurring, needed for full ROM

think: scapular rotation while in shoulder flexion

• they cannot be actively performed by the patient​

• Also called joint play or component motions

what is joint play?

• Motion that occurs between joint surfaces that allows the bones to move​

• Can be demonstrated passively, not actively

TRUE or FALSE when the concave surface moves on the convex surface, the slide occurs in the same direction as the bone that is moving

true

TRUE or FALSE when the convex surface moves on the concave surface, the slide occurs in the opposite direction as the bone that is moving

true

what is rolling arthrokinematics?

• Rolling results in angular motion of the bone​

• Rolling causes joint compression so generally not used in jt. mobilization​

• Rolling usually occurs with a slide or a spin

what is the slide/glide arthrokinematics?

• The direction of the sliding /gliding depends upon whether the moving surface is concave or convex.​

• If the surface is CONVEX: sliding occurs opposite the direction of the moving bone

what is spin arhtrokinematics?

• Rotation of a bone around a stationary mechanical axis​

• The same point on the moving surface creates a circle as the bone spins​

• Usually occurs with rolling and gliding

what is the key to performing joint mobilizations? who cares??

Always Perform Joint Mobilization in the Loose-Packed position!! ​

Loose-packed position:​

• Capsule and ligaments are lax, on slack​

• Most motion occurs in the maximally loose-packed position​

Closed-packed position: ​

• Joint surfaces are maximally congruent​

• joint capsule and ligaments are maximally taut​

• Articulating surfaces cannot be separated by traction

what is traction/distraction? who cares??

• A separation or pulling apart of joint surfaces​

• KEY:​

Always used prior to applying a slide/glide during mobilization

what is the kaltenborn technique?

• Grade I: (Loosen) ​

slow, sustained, small amplitude distraction, does not stress the joint capsule​

• Grade II: (Tighten)​

Distraction or glide that tightens up the tissue around the joint - “Takes up the slack”​

• Grade III: (Stretch)​

Distraction or glide large enough to stretch the joint capsule and surrounding structures: 6 sec stretch f/b partial release

what is the dosage for the kaltenborn?

Dosage: Distract and then hold for 7 – 10 seconds, relax, repeat

what is the Maitland: oscillation technique?

• Grade I: Rapid, small amplitude oscillations , at the beginning of ROM (Vibration)​

• Grade II: Larger amplitude oscillations that do not reach the limit – 2-3/sec for 1-2 min.​

• Grade III: Large amplitude oscillations that are performed up to and slightly through the limit of resistance 2-3/sec for 1-2 min​

what does each joint mobilization grade mean?

• Grade I: decrease pain and/or muscle guarding​

• Grade II: decrease pain & maintain joint play and therefore available ROM​

• Grade III: increase ROM by increasing amount of joint play

what is the procedure for joint mobilization?

1. Use proper joint position: “resting position” Must not be in “close packed” position.​

2. Hands should be applied close to the joint​

3. Stabilize the proximal bone with one hand or another body part​

4. Grasp the distal bone with the other mobilizing hand​

5. Distract the joint and take up the slack​

6. Glide the distal bone in the desired direction with the desired intensity

what is the suggested treatment sequence?

• Warm up the tissues​

• Relax the muscles with Grade I or II oscillations​

• Perform desired joint mobilization technique to achieve a goal​

• Perform a passive stretch into new ROM​

• Pt. performs AROM using new range​

• Home Exercise Program to maintain new ROM​

• Pt. education: functional activities using new ROM

what do you look for in patient response?

• Joint mobilization may cause some mild soreness (this is normal) should not last more than 24 hours​

• Decrease the dosage and duration of the joint mobilization if the patient experiences pain lasting longer than 24 hours.​

• Assess patient’s PROM and AROM prior to and after every treatment

what do you need to consider when working with geriatrics?

• ROM is progressively lost starting at age 30, with greater losses after 60 - WNL vs. WFL

• To maximize ROM gains in the elderly, incorporate exercises into ADL’s