Intro to joint mobilizations

Assessment

• accessory motion testing

• joint assessment

Intervention

joint mobilizations

Osteokinematics

• motion you “see”

• flex, ext, abd, ect.

Arthrokinematics

• aka accessory motion/joint play

• motion you “feel”

• occur independently or involuntarily

• if restricted, can limit physiological motion

• roll, glide, spin

• end feel

convex on concave joints

roll & glide opposite

concave on convex joints

roll and glide same

open packed positions

• AKA loose-packed or resting position

• position of joint where surrounding tissue is as lax as possible (max amount of joint play, least amount of force)

• intracapsular space as large as possible

• assessment & treatment position

close packed position

• most congruent position for joint

• surrounding tissues under maximal tension

• intracapsular space is minimal

• more aggressive treatment position as you approach closed pack position

glide directions

parallel to joint surface

distraction directions

perpendicular to joint surface

• work on entire capsule - every motion

treatment plane

• direction of which joint is facing

joint distraction during mobilization creates ______

more space and decreased irritation

accessory motion testing

• better for ruling in noncontractile tissue

• oscillations

  • small, medium, large

• 3 Rs

  • range

  • resistance

  • reactivity

oscillations

• depth

• amplitude (size)

sustained translations

• joint mobs

• depth

neurophysiologic effects of oscillations

depolarization of mechanoreceptors

• more movement = more depolarization

mechanical effects of oscillations

• increased synovial fluid production - improves with movement

• stretching of tissue - helps with pain (increased input = increased pain tolerance)

  • depending on depth

Grade I & II oscillations are used for _____

pain

Grade III & IV oscillations are used for ____

improving ROM

Grades I & II treatment soreness

• none

• should show improved pain

Grades III & IV treatment soreness

• some soreness is normal due to stretch/tension

• not more than 24 hrs

Grade I joint mobs

small amplitude rhythmic oscillating mobilization in the early range of movement

Grade II

large amplitude rhythmic oscillating mobilization in the midrange of movement

Grade III

large amplitude rhythmic oscillating mobilization to point of limitation in range of movement

Grade IV

small amplitude rhythmic oscillating mobilization at end of the available range of movement

Grade V

• thrust manipulation

• small amplitude, quick thrust at end of the available range of movement

• HVLT - high velocity, low amplitude

mobilization with movement functional mobilization

sustained translations

sustained translation

• constant load

• low load, long duration

• improves elongation over time

• increased total & resting length

Grading sustained translations

• no real grade

• taken to end of pain free range and held

  • goal: pain free end range

• introduce physiologic motion while holding

  • muscles around joint fire

  • ex: provide force to tibia, then have pt do a squat

mobilization treatment variables

• joint position - open/close packed

• direction of mobilization

• type of mobilization

  • oscillation vs sustained hold

• grade (intensity) of mobilization

• dosage (how much time on/resting)

contraindications and precautions for joint mobs

• unstable joints!!!

• malignancy

• infectious arthritis

• fusion/ankylosis

• osteomyelitis

• fracture

• arthroplasty

• rheumatoid arthritis

• pain