Joint Mobilization

1. Joint Mobilization The forgotten tool

2. Manual therapy for the restoration of joint function • Stimulates joint receptors and increases afferent input from large-diameter afferent nerves

3. Effects of Joint Mobilization • Neurophysiological • Stimulates large mechanoreceptors to decrease pain • Gate Control Theory • Nutritional • Synovial fluid movement  improve nutrient exchange • Mechanical • Improve the mobility of hypomobile joints due to immobilization or dysfunction (capsular adhesions or scar adhesions)

4. General Principles • Open Packed Position • Joint position where the capsule is most relaxed and therefore has the greatest room and accommodate the most fluid. • Least amount of joint contact • Greatest amount of joint play • See handout Table 6.3

5. General Principles • Close Packed Position • Joint capsule and ligaments are tight • Maximal contact between surfaces • See handout Table 6.3

6. General Principles • Convex • Evenly curved; resembling the segment of a sphere • Concave • Having a spherically depressed or hollow surface

7. Anatomical Planes of Reference • Sagittal Plane • Right and left halves • Frontal Plane • Anterior and posterior halves • Transverse Plane • Upper and lower halves

8. Bone and Joint Movements • Kinematics • Study of movements in the human body • Osteokinematics • Study of bone movement • Arthrokinematics • Study of joint movement

9. Osteokinematics / Arthrokinematics • Rolling • Gliding • Spinning • Compression • Distraction • Roll – Gliding Joint Movement • Combination of rolling and gliding movements which is possible only between incongruent, curved surfaces. Since human joint surfaces are not fully congruent, physiological movements can only result in roll-gliding

10. Rolling Direction • Rolling component of roll-gliding is always in the same direction as bone movement • Gliding Direction • If concave surface moves, gliding and bone movement are in the same direction • If convex surface moves, gliding and bone movement are in opposite directions

11. Translation • Straight line movement with resultant movements of traction, compression, and gliding • Traction • Direction of bone movement is perpendicular to and away from treatment plane, and results in separation of joint surfaces • Compression • Direction of bone movement is perpendicular to and toward the treatment plane, and presses joint surfaces together • Gliding • Direction of bone movement is parallel to the treatment plane, and results in gliding movement between joint surfaces

12. Convex / Concave Rule • Convex – Opposite • Joint with convex surface moving, mobilize in the opposite direction of restricted bone movement • Glenohumeral joint, hip joint • Concave – Same • Joint with concave surface moving, mobilize in the same direction of restricted bone movement • Knee

13. Capsular Pattern • All joints have an expected and normal range of motion / If loss of motion is associated with tightness in the capsule motion loss will follow the capsular pattern • See handout Table 6.2

14. Grades of Movement • Maitland • 5 grades of movement • Grade I - small amplitude, beginning ROM • Grade II – large amplitude, tissue reistance • Grade III – large amplitude, pathological limit • Grade IV – small amplitude, end ROM • Grade V - manipulation

15. Kaltenborn • Grade I – small amplitude, beginning ROM • Grade II – large amplitude, up to resistance • Grade III – large amplitude, into resistance