Joint Mobilization (Therapeutic Ex)

Joint mobilization attempts to

restore the movement in the joint and decrease pain using passive movement of the joint surfaces

Slide

pure slide does not occur in joints due to the fact that the joint surfaces must be congruent

*there are no two perfect surfaces.

Spin

rotation component

Roll

one surface rolling on another

These accessory motions occur together during AROM. You can not selectively do one of these movements actively. _____ is the motions that occur between the joint surfaces from an outside force.

Joint play

All of our joints have some type of a _____ surface.

concave/convex

No joint within the human body has total congruency due to the fact that the articulating surfaces are not in total contact throughout the ROM. Two ways of describing congruency of a joint:

closed packed and open/loose packed

Closed packed position

- most congruent position of a joint

- ligaments are taut and the joint surfaces are aligned

- not used for mobilization because it allows no freedom for movement

Loose-packed position

any other position of the joint except closed packed

Glide

a combination of roll/spin/slide

For those joints that do not have the nice convex/concave shape, ______ will help to make the joint congruent. Such as the pubic synthesis.

fibrocartilage

On a _____ surface you will have more cartilage on the periphery of the joint. On a _______ surface you will have more cartilage in the center of the surfaces

concave; convex

Concave/convex rule

When the concave surface is stationary and the convex surface is moving the gliding movement in the joint occurs in a direction opposite to the bone movement. And if the convex surface is fixed while the concave surface is mobile, the gliding motion occurs in the same direction as the bone movement

How many grades of mobilizations are their?

5

Velocity

speed of the movement

Oscillation

back and forth motion

Amplitude of movement

amount of movement

Grade I

small oscillation that occurs at the beginning of the available ROM

Grade II

larger oscillation that occurs from the beginning to midrange of the ROM

Grade III

large oscillations from midrange to the available ROM

Grade IV

small oscillation that occurs at the very end range of motion

Grade V

high velocity thrust of small amplitude at the end of the available ROM; used by manual PTs and chiropractors

Which grades are used to reduce pain?

Grade I and II

Which grades are used to reduce pain and joint restrictions?

Grade III and IV

______ is commonly used along with mobilization techniques. It can be classified into 3 different grades.

Traction

Grade I (Piccolo traction)

is used for pain and to minimize compression forces/ does not actually separate joint surfaces but is used to neutralize joint pressure

Traction Grade II

is defined as "taking up the slack" in the capsule of the joint

Traction Grade III

involves stretching the soft tissue

_____ is a characteristic pattern of limitation within the capsule. All joints have a capsular pattern which means ROM will be more restricted in one direction vs the other/s.

Capsular pattern

Noncapsular pattern is a restriction of movement that does not correspond to acharacteristic, predetermined capsular pattern. Three possible causes are:

ligamentous adhesion, internal derangement, extra-articular lesion

Ligamentous adhesion can cause

a limitation in one direction where the others stay the same

Internal derangement

a loose or displaced fragment within a joint

Extra-articular lesion

adhesions resulting from injury outside the joint

Contraindications for joint mobilizations

- hypermobile joint

- severe joint effusion - joint is already stretched

- cancer in the area

- bone diseases

- CNS

- acute inflammation - grades 2 through 5

Indications for joint mobilizations

- pain: be careful to find out what stage of healing

- to stretch out the joint capsule (ex. frozen shoulder)

- to break up adhesions or scar tissue

Procedure for performing joint mobilizations

- patient should be in a comfortable position with the joint in a loose packed position

- you may need to use some type of modality to relax the patient

- oscillations should be at the speed of two per second

- usually applied for about 20 to 60 seconds for 4 or 5 times.

Make sure you know the pathology of the joint before performing a mobilization.

Ex. Anterior dislocation of the shoulder - you wouldn't want to mobilize it anteriorly but you may want to do some joint mobs for ABD