Joint Mobilization and Manipulation: Techniques, Grades, and Precautions in Manual Therapy

mobilization

small amplitude, passive movement of a joint to relieve pain and improve range of motion

manipulation

local or global movement of small amplitude following careful positioning of the patient

characteristics of mobilization

repetitive/rhythmic movements, physiologic (osteokinematics) or accessory motions (arthrokinematics)

characteristics of manipulation

single/quick movements, decisive

precautions of joint mobilizations

acute inflammatory conditions, systemic diseases, significant segmental stiffness, spinal cord compression, hypermobility, pregnancy, blood clotting disorders, long term use of steroids

contraindications of joint mobilizations

malignancy, fractures, cauda equina, unstable upper cervical spine, vertebrobasilar insufficiency

what is included in a joint play assessment

amount of mobility and presence of pain

types of joint mobilization

sustained and oscillatory

when is sustained mobilization used

decrease pain

grades of sustained mobilization

1: tissues slacked, 2: tissues taut, 3: tissues stretched

when is oscillatory mobilization used

increase range of motion

grade 1 oscillatory mobilization

small amplitude movements at beginning of range

grade 2 oscillatory mobilization

larger amplitude movements at mid range

grade 3 oscillatory mobilization

large amplitude movements at end range

grade 4 oscillatory mobilization

small amplitude movements at end range

theoretical effects of manual therapy

mechanotransduction affects tissues and nerves to provide positive neuromuscular responses