Chapter 5: Joint Mobilization

Flashcards covering key concepts, definitions, and techniques related to joint mobilization.

What is joint mobilization?

A manual therapy technique used to modulate pain, increase joint mobility, and improve joint mechanics by applying skilled passive movements to joints.

What is manipulation?

A high-velocity thrust (HVT) mobilization performed at end range; NOT performed by PTAs.

What is mobilization with movement (MWM)?

A Brian Mulligan technique combining therapist-applied gliding with patient-performed active or passive motion in a pain-free manner.

What are osteokinematics?

Physiologic movements of bones such as flexion, extension, abduction, adduction, internal rotation, and external rotation.

What are arthrokinematics?

Joint surface motions including roll, slide (glide), and spin.

What is the convex–concave rule?

Convex on concave → roll and glide opposite directions; Concave on convex → roll and glide same direction.

What is joint play?

Accessory movements necessary for full, pain-free osteokinematic range of motion.

What are loose-packed positions?

Positions of minimal joint congruency, maximal joint play, and relaxation—ideal for mobilization.

What are close-packed positions?

Positions of maximal joint congruency, tight ligaments, and minimal joint play—NOT ideal for mobilization.

What are Maitland Grades I–V?

Grade I: Small amplitude at beginning of ROM (pain relief); Grade II: Large amplitude within ROM (pain + fluid movement); Grade III: Large amplitude into resistance (stretch); Grade IV: Small amplitude at end range (stretch); Grade V: HVLA thrust (not PTA-performed).

What are Kaltenborn traction grades?

Grade I: Loosen – reduces compressive forces; Grade II: Tighten – takes up slack; assesses sensitivity; Grade III: Stretch – increases joint play by stretching capsule.

What indications support joint mobilization?

Pain, muscle guarding, joint hypomobility, reversible joint limitations, positional faults.

What are contraindications for joint mobilization?

Fracture, hypermobility, active infection, malignancy, osteoporosis, inflammatory arthritis, joint effusion.

What are precautions in joint mobilization?

Pregnancy, joint replacements, coagulation disorders, osteoarthritis, neurologic symptoms, inability to relax.

Why must joint mobilization begin in loose-packed position?

Because the capsule is most relaxed, allowing safe, effective gliding without excessive compression.

How does oscillation reduce pain?

Grades I–II oscillations stimulate mechanoreceptors and inhibit nociceptive input, decreasing pain and guarding.

Why is the convex–concave rule essential clinically?

It determines the correct direction of gliding to restore arthrokinematic motion and improve osteokinematic range.

When treating pain, which grades are used?

Grades I and II for pain modulation, inhibition of guarding, and synovial fluid movement.

When treating stiffness/hypomobility, which grades are used?

Grades III and IV to stretch tight capsular structures and increase joint play.

Why must distraction accompany glides?

A Grade I distraction prior to glides reduces joint compression and allows smoother, safer gliding.

Why should Grade II or III distraction NOT accompany Grade III glide?

Because excessive capsule tension could cause microtrauma or patient irritability.

What should the PTA do if gliding in the restricted direction is too painful?

Begin mobilization in the painless direction to reduce guarding before progressing.

Why must ROM be performed after mobilization?

To reinforce new joint mobility, prevent re-tightening, and integrate improved arthrokinematics into function.

What does persistent pain >24 hours after treatment indicate?

Excessive dosage; dosage or intensity must be reduced in future sessions.

Why is reassessment before and after treatment essential?

To measure effectiveness, adjust technique, and monitor patient safety/response.

Why should mobilization never reproduce symptoms during MWM?

MWM is intended to be completely pain-free—pain indicates incorrect glide direction or excessive force.