Joint mobilization

ConCAVE

-Cave bent like a C or like Cave

ConVEX
-bulges out like it vexes u

Which one is moving?

-The word that comes second is the part that is moving so just remember: stable foundation comes first and the moving parts come second

Convex concave:

Convex is the stable one and the concave is moving

Concave is moving the same

This is due to the fact the saft and head are moving in THE SAME DIRECTION

Concave convex:

Concave does not move and the convex does

The convex moving is complex

This is due to the fact the saft and head are moving in THE OPPOSITE DIRECTION

Accessory movements:

movements, such as roll, spin, and slide, are joint movements that an individual cannot perform by themselves. These movements accompany the physiological motion of a joint and are assessed passively to evaluate range and symptom response in the open pack position of the joint

Kaltenborn's 3 Grades of Mobilization

1 Small-amplitude distraction is applied

  • No stress is placed on the capsule. 

  • Balances forces of muscles acting on joint, reduces muscle tension, and pressure acting on the joint.

2 Tightening of joint - "Take up the slack"

  • Therapist provides enough distraction to tighten the tissues around the joint

  • Determine sensitivity of the joint

  • Pain inhibition and maintain joint play

3 Distraction is used to stretch the joint structures to improve mobility and motion

  • Apply enough amplitude to place stretch on the capsule and surrounding structures

Maitland's 5 Grades of Mobilization

1 Pain management and spasms

Small amplitude rhythmic oscillating mobilization in the early range (beginning of the range) of movement

2 Pain management and spasms. 

Large amplitude rhythmic oscillating mobilization in the midrange of movement

3 Large amplitude rhythmic oscillating mobilization to point of limitation in range of movement

4 Small amplitude rhythmic oscillating mobilization at end of the available range of movement (tissue resistance, no pain)

5 Small amplitude, quick thrust at end of the available range of movement (thrust manipulation)

DO NOT DO JOINT MOBLIZATIONS IF:

Malignancy

Bone disease

Unhealed fracture or malalignment; ligament rupture

Total joint replacements

Systemic diseases (i.e., rheumatoid arthritis)/infectious arthritis

Excessive pain

Spondylolisthesis

Fusion or ankylosis

Osteomylitis

Precaustions

  • Hypermobility

  • Joint effusion (Fluid within the intra-articular space)

  • Inflammation

  • Pregnancy - avoid spine, pelvis, and hips

Joint POS

Resting Position

  • Joint Capsule and ligaments are most relaxed

  • Joint has maximum joint play/mobility

  • Position used during evaluation and treatment of hypomobile joints

Loose-Packed Position

  • Articulating surfaces of bones are maximally separated

  • Joint will have greatest amount of play

  • Position used for traction and joint mobilization

Close-Packed Position

  • Joint surfaces are in contact with each other