Peripheral Joint Mobilization

Joint mobilization

• refers to manual therapy techniques that are used to modulate pain and treat joint dysfunctions that limit range of motion (ROM) by specifically addressing the altered mechanics of the joint.

Joint mobilization stretching techniques

• specifically address restricted capsular tissue by replicating normal joint mechanicswhile minimizing abnormal compressive stresses on the articular cartilage in the joint.

• Decrease pain

• Increase mobilization

Goals of Joint Mobilization

Physiological Movements

• movements the patient can do voluntarily

• classic or traditional movements (flexion, abduction, and rotation)

Accessory Movements

• Movement within the joints necessary for movement to occur

• Cannot be done actively by the patient

Component motions

• Motions that accompany active motion but are not under voluntary control

• Scapulohumeral rhythm

• Motion of tibia and fibula during ankle DF and PF

Joint play

• Motions that occur between joint surfaces as well as distensibility or “give” in the joint capsule

• Necessary for normal movement ▪

• Demonstrated passively

Arthrokinematics

• Distraction

• Sliding

• Compression

• Rolling

• Spinning

Manipulation

• Passive movement using physiologic/accessory motions

• Applied with thrust

• Manipulation under anesthesia

Thrust

• High-velocity, short-amplitude motion such that the patient cannot prevent the motion

• Done at end of available range (pathologic limit)

• Alter positional relationships

• Snap adhesions

• Stimulate joint receptors

Thrust Goals:

Swing

Movement of the bony lever; described as flexion-extension, abduction-adduction, or rotation

Roll

• The surfaces are incongruent.

• New points on one surface meet new points on the opposing surface.

• Results in angular motion of the bone (swing). ▪

• Is always in the same direction as the swinging bone motion whether the surface is convex or concave.

Slide/Translation

• For a pure slide, the surfaces must be congruent, either flat or curved.

• The same point on one surface comes into contact with the new points on the opposing surface

convex

Sliding is in the opposite direction of the angular movement of the bone if the moving joint surface is ____.

concave

Sliding is in the same direction as the angular movement of the bone if the moving surface is ___

Combined Roll-Sliding

• The more congruent the joint surfaces are, the more sliding there is of one bony partner on the other with movement.

• The more incongruent the joint surfaces are, the more rolling there is of one bony partner on the other with movement.

Spin

There is rotation of a segment about a stationary mechanical axis

• Compression

• Traction/Distraction

Accessory Motions that Affect the Joint

Compression

• is the decrease in the joint space between bony partners.

• □Weight bearing activities □ Muscle contraction □ Compression during rolling □ Effect on synovial fluid □ Articular cartilage changes and deterioration

Traction/Distraction

• is a longitudinal pull.

• Distraction is a separation, or pulling apart

• Pain, Muscle Guarding and Spasm

• Reversible Joint Hypomobility

• Positional Faults/Subluxations

• Progressive Limitation

• Functional Immobility

Indication for Joint Mobilization

• Hypermobility

• Joint effusion

• Inflammation

Absolute Contraindications

before

If pain is experienced ____tissue limitation –gentle pain-inhibiting joint techniques may be used.

concurrently

If pain is experienced _____ with tissue limitation -gentle stretching techniques specific to the tight structure are used to improve movement.

after

If pain is experienced ___ tissue -the stiff joint can be aggressively stretched with joint-play techniques and the periarticular tissue with the stretching techniques

Treatment Plane

• A plane perpendicular to a line running from the axis of rotation to the middle of the concave articular surface.

• The plane is in the concave partner, so its position is determined by the position of the concave bone

Perpendicular

Distraction techniques are applied ____ to the treatment plane. The entire bone is moved so the joint surfaces are separated

Parallel

Gliding techniques are applied ___ to the treatment plane. The direction of gliding is easily determined by using the convex-concave rule.

opposite

If the surface of the moving bony partner is convex, the treatment glide should be ___ to the direction in which the bone swings

same

If the surface of the moving bony partner is concave, the treatment glide should be in the ____direction.