Introduction to Joint Mobilizations

Types of Thrust Manipulations

High velocity thrust (HVT)

High velocity, low amplitude (HVLA)

Maitland grade V

Descriptors for Joint Dysfunction

Limited Passive Joint Play

Decreased assessors movement

Hypo mobility

Joint block

Subluxation

- malalignment of one vertebrae in relation to the next

Osteopathic Dysfunction

- FR(L)S(L) or E(L)S(R)

Positional Faults

How to assess joint mobility

Multifactorial

Passive joint play

- quality of pain = present before, with, after

- Capsular Restriction = Capsular pattern, end-feel

- Subluxation, dislocation

3 Rs of a patient exam

Reproducible sign

Region of Origin

Reactivity Level

Requirements for Joint Mobilization

Palpation of landmarks

Arthrokinematic motions

Open/closed pack positions

Force application

Mobilization grade, progression, intent

Physiological Limit

Active Limit

Elastic Barrier

Passive limit

End-feel

Anatomical Barrier

Absolute limit

Restrictive Barrier

Abnormal resistance within physiological barrier

Concave Surface Mobilization

Mobilize in the SAME direction as the motion limitation

Convex Surface Mobilization

Mobilize in OPPOSITE direction as the motion limitation

Treatment plane for joint Mobilization

Mobilization should be PERPENDICULAR to the concave surface

Maitland Approach

Parallel or Perpendicular to Treatment plane; Oscillatory motions

MI

MODERATE velocity, small amplitude, NO barrier

- BEFORE R1

MII

Low velocity, LARGE amplitude, NO barrier

MIII

Low velocity, LARGE amplitude to OR through barrier

- Between R1 to R2

MIV

Moderate velocity, SMALL amplitude to OR at barrier

- TO R2

MV

High velocity, low amplitude THROUGH barrier

- Thurst

MI/MIV Speed

3-4 oscillations / s for 1-2 min

MII/MIII Speed

2-3 oscillations / s for 1-2 min

R1

Initial Onset of resistance

R2

Final onset of resistance

Kaltenborn Mobilization

Sustained mobilization

Translators glide and traction techniques

K1

Loosening

NOT a treatment, just taking up slack

- Low amplitude, not to barrier

- NO stres on capsule

- UNWEIGHING of joint surface

KII

Tightening, 10s hold

- high amplitude TO barrier

- tighten the tissues around the joint

KIII

Stretching, 10-60s hold

- High amplitude THROUGH barrier

- Stretch placed on joint capsule/surrounding periarticular structures

Joint Mob. Application

Ensure examination findings support use

Timing

Asses PJP

Treatment

- open-pack to start

- Stabilization!

- Mobilization = try to consider contact area, want to be comfortable for pt.

Joint mob. Progression

Increase joint mobility is the goal

- Grade should progress

- start in open-pack, go closer to restriction

Effects of Joint Mobs.

relieve pain, increase mobility, restore functional movement

Address hypo mobility w/ mechanical stretch of shortened joint capsule

Restore normal joint accessory motion

Address potential faults

Improve circulation of synovial fluid

Contraindications to Joint Mobilizations

Stretch Mobilization = MIII/MIV or KIII

- acute joint effusion

- Capsuloligmaentous sprain

- Acute inflammation

- Joint HYPERmobility/instability

Precautions to MIII/IV or KIII

Malignancy

Bone disease

Excessive pain

Total joint replacement

Systemic connective tissue disease

Corticosteroid use

Pregnancy = increase elasticity hormones

Healing tissues

Mulligan: Mobilization w/ Movement

Positional fault framework

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

Dosage

- 6-10 reps pain-free

Consider joint mob. Precautions & contraindications

Documentation of Joint Mobiizations

Rate

Direction

Location

Moving vs Stabilized Structure

Patient position

Soft Tissue Mobilization

Muscle and facial restrictions

- MAY limit joint motion

- address before joint mobilizations!

EXs

- Myofascial release

- Strain-counter strain

- Functional positional release

- Soft tissue mobilization cascade