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(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Joint MobilizationJoint Mobilization
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Joint motion is often lost due to injuryContracture of inert connective tissueResistance of contractile tissue to stretch
May result in joint hypomobilityTo regain motion
Joint mobilization
Joint motion is often lost due to injuryContracture of inert connective tissueResistance of contractile tissue to stretch
May result in joint hypomobilityTo regain motion
Joint mobilization
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Relationship Between Physiological and Accessory
Motion
Relationship Between Physiological and Accessory
MotionBiomechanics of joint motion
Page 174 Therapeutic Exercise (White book)Physiological motion
Result of concentric or eccentric active muscle contractions
Also referred to as osteokinetic motionBones moving about an axis or through flexion,
extension, abduction, adduction or rotationAccessory Motion
Motion of articular surfaces relative to one anotherGenerally associated with physiological movementNecessary for full range of physiological motion to
occurLigament and joint capsule involvement in motion
Biomechanics of joint motionPage 174 Therapeutic Exercise (White book)
Physiological motionResult of concentric or eccentric active muscle
contractionsAlso referred to as osteokinetic motionBones moving about an axis or through flexion,
extension, abduction, adduction or rotationAccessory Motion
Motion of articular surfaces relative to one anotherGenerally associated with physiological movementNecessary for full range of physiological motion to
occurLigament and joint capsule involvement in motion
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Stretching techniques must be utilized in order to correct physiological motion deficitsMost effective at end of physiological range of
motionUtilizes long lever arms to apply stretch of muscles
To improve accessory motion mobilization techniques are requiredUsed to correct tight inert tissuesMultidirectional activity that can be effective at
any point in rangeUtilize short lever arms, resulting in less stress
being applied to ligamentous structures
Stretching techniques must be utilized in order to correct physiological motion deficitsMost effective at end of physiological range of
motionUtilizes long lever arms to apply stretch of muscles
To improve accessory motion mobilization techniques are requiredUsed to correct tight inert tissuesMultidirectional activity that can be effective at
any point in rangeUtilize short lever arms, resulting in less stress
being applied to ligamentous structures
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Joint ArthrokinematicsJoint Arthrokinematics
Involves 3 componentsSpin
Motion that occurs about some stationary longitudinal mechanical axis
Radial head at the humeroradial jointRoll
A series of points on one articulating surface come into contact with a series of points on another surface
Rocking chair analogyFemoral condyles rolling on tibial plateauOccurs in direction of movement
Involves 3 componentsSpin
Motion that occurs about some stationary longitudinal mechanical axis
Radial head at the humeroradial jointRoll
A series of points on one articulating surface come into contact with a series of points on another surface
Rocking chair analogyFemoral condyles rolling on tibial plateauOccurs in direction of movement
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Glide (translation)Specific point on one articulating surface comes into
contact with a series of points on another articulating surface
Occurs when performing an anterior drawer of knee (tibial plateau sliding anteriorly relative to femoral condyles)
Pure gliding requires congruent surfacesDirection of movement determined by shape of
articulating surface (convex/concave) Joint motion will often involve a combination of
these componentsRolling and gliding generally occur together
Not always proportional or in same direction
Glide (translation)Specific point on one articulating surface comes into
contact with a series of points on another articulating surface
Occurs when performing an anterior drawer of knee (tibial plateau sliding anteriorly relative to femoral condyles)
Pure gliding requires congruent surfacesDirection of movement determined by shape of
articulating surface (convex/concave) Joint motion will often involve a combination of
these componentsRolling and gliding generally occur together
Not always proportional or in same direction
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Convex-Concave RuleConvex-Concave Rule
Relationship of articulating surfaces associated with gliding
If concave joint is moving on stationary convex surface – glide occurs in same direction as roll
If convex surface is moving on stationary concave surface – gliding occurs in opposite direction to roll
Necessary to understand in order to determine appropriate treatment direction
Relationship of articulating surfaces associated with gliding
If concave joint is moving on stationary convex surface – glide occurs in same direction as roll
If convex surface is moving on stationary concave surface – gliding occurs in opposite direction to roll
Necessary to understand in order to determine appropriate treatment direction
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Joint PositionsJoint Positions
Resting positionMaximum joint play- position in which joint capsule
and ligaments are most relaxedEvaluation and treatment position utilized with
hypomobile jointsLoose-packed position
Articulating surfaces are maximally separated Joint will exhibit greatest amount of joint playPosition used for both traction and joint mobilization
Close-packed positionMaximal contact of articulating surfaces
Resting positionMaximum joint play- position in which joint capsule
and ligaments are most relaxedEvaluation and treatment position utilized with
hypomobile jointsLoose-packed position
Articulating surfaces are maximally separated Joint will exhibit greatest amount of joint playPosition used for both traction and joint mobilization
Close-packed positionMaximal contact of articulating surfaces
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Mobilization and traction utilize translation movements of joint surfaces relative to one another
Treatment occur perpendicular or parallel to treatment plane
Mobilization techniques involve glides that translate along the treatment plane
Traction – moves perpendicular to treatment plane
Mobilization and traction utilize translation movements of joint surfaces relative to one another
Treatment occur perpendicular or parallel to treatment plane
Mobilization techniques involve glides that translate along the treatment plane
Traction – moves perpendicular to treatment plane
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Joint Mobilization TechniquesJoint Mobilization TechniquesUsed to improve joint mobility or decrease
joint pain by restoring accessory motionUsed to attain mechanical or
neurophysiological treatment goalsPain reductionDecrease muscle guardingStretching or lengthening tissue surrounding a jointReflexogenic effects
Facilitate muscle tone or stretch reflexProprioceptive effects
Used to improve joint mobility or decrease joint pain by restoring accessory motion
Used to attain mechanical or neurophysiological treatment goalsPain reductionDecrease muscle guardingStretching or lengthening tissue surrounding a jointReflexogenic effects
Facilitate muscle tone or stretch reflexProprioceptive effects
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Accessory motion can be hypo-, normal, or hypermobile
Joints have range with anatomical limits (bony and soft tissue)
With hypomobile joints motion stops at point short of anatomical limitsPathological point of limitation
Hypermobile joint move beyond anatomical limitsDue to laxityTreat with strengthening and stability
exercises, bracing, taping, or splinting
Accessory motion can be hypo-, normal, or hypermobile
Joints have range with anatomical limits (bony and soft tissue)
With hypomobile joints motion stops at point short of anatomical limitsPathological point of limitation
Hypermobile joint move beyond anatomical limitsDue to laxityTreat with strengthening and stability
exercises, bracing, taping, or splinting
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
To restore motion in hypomobile joints tissue deformation occurs
Tissue stretch within elastic range does not produce permanent structural change
Stretching in plastic range cause permanent structural changes
Traction and joint mobilization can be used to stretch tissue and break tissue adhesions
Treatments generally involve slow, small amplitude movements Joint mobilizations involve small amplitude oscillations
To restore motion in hypomobile joints tissue deformation occurs
Tissue stretch within elastic range does not produce permanent structural change
Stretching in plastic range cause permanent structural changes
Traction and joint mobilization can be used to stretch tissue and break tissue adhesions
Treatments generally involve slow, small amplitude movements Joint mobilizations involve small amplitude oscillations
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Maitland Joint Mobilization Grading Scale
Maitland Joint Mobilization Grading Scale
Grade ISmall amplitude movement at the
beginning of the range of movementUsed to manage pain and spasm
Grade IILarge amplitude movement within
midrange of movementUtilize when quick oscillation induces spasm
or when slowly increasing pain restricts movement halfway into range
Grade ISmall amplitude movement at the
beginning of the range of movementUsed to manage pain and spasm
Grade IILarge amplitude movement within
midrange of movementUtilize when quick oscillation induces spasm
or when slowly increasing pain restricts movement halfway into range
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Grade IIILarge amplitude movement up to point of
limitation (PL) in the range of movementUsed when pain and resistance from spasm,
inert tissue tension or tissue compression limit movement near end of range
Grade IVSmall amplitude movement at very end of
rangeUsed when resistance limits movement in
absence of pain
Grade IIILarge amplitude movement up to point of
limitation (PL) in the range of movementUsed when pain and resistance from spasm,
inert tissue tension or tissue compression limit movement near end of range
Grade IVSmall amplitude movement at very end of
rangeUsed when resistance limits movement in
absence of pain
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Grades of MovementGrades of Movement
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
All joint mobilizations follow the convex-concave rule
If mobilization in the appropriate direction exacerbates pain or stiffness the technique should be applied in the opposite direction until tolerance to the appropriate direction is achieved
Joint mobilization sessions usually involve 3-6 sets of oscillations lasting 20-60 seconds, 1-3 oscillations per second
All joint mobilizations follow the convex-concave rule
If mobilization in the appropriate direction exacerbates pain or stiffness the technique should be applied in the opposite direction until tolerance to the appropriate direction is achieved
Joint mobilization sessions usually involve 3-6 sets of oscillations lasting 20-60 seconds, 1-3 oscillations per second
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Indications for MobilizationIndications for Mobilization
Grades I and II are used primarily for painGrades III and IV can be utilized for stiffnessPain must be treated prior to stiffnessSmall amplitude oscillations are utilized to
stimulate mechanoreceptors, limiting pain perception
Painful conditions can be treated dailyStiff or hypomobile joints should be treated 3-4
times per week – alternate with active motion exercises
Grades I and II are used primarily for painGrades III and IV can be utilized for stiffnessPain must be treated prior to stiffnessSmall amplitude oscillations are utilized to
stimulate mechanoreceptors, limiting pain perception
Painful conditions can be treated dailyStiff or hypomobile joints should be treated 3-4
times per week – alternate with active motion exercises
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Pain prior to resistance being appliedAvoid mobilization techniques
Pain elicited upon resistance to motion appliedGrade I and II mobilizations
Resistance application prior to indication of painGrade III and IV
Athlete and athletic trainer must utilize appropriate positioning to ensure safe and effective treatment
Pain prior to resistance being appliedAvoid mobilization techniques
Pain elicited upon resistance to motion appliedGrade I and II mobilizations
Resistance application prior to indication of painGrade III and IV
Athlete and athletic trainer must utilize appropriate positioning to ensure safe and effective treatment
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Pain and ResistancePain and Resistance
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Contraindications for Mobilization
Contraindications for Mobilization
Should not be used haphazardlyAvoid the following
Inflammatory arthritisMalignancyBone diseaseNeurological involvementBone fractureCongenital bone deformitiesVascular disorders
Should not be used haphazardlyAvoid the following
Inflammatory arthritisMalignancyBone diseaseNeurological involvementBone fractureCongenital bone deformitiesVascular disorders
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Joint Traction TechniquesJoint Traction Techniques
Technique involving pulling one articulating surface away from another – creating separation
Performed perpendicular to treatment plane
Used to decrease pain or reduce joint hypomobility
Kaltenborn classification systemCombines traction and mobilizationJoint looseness = slack
Technique involving pulling one articulating surface away from another – creating separation
Performed perpendicular to treatment plane
Used to decrease pain or reduce joint hypomobility
Kaltenborn classification systemCombines traction and mobilizationJoint looseness = slack
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Kaltenborn Traction Grading
Kaltenborn Traction Grading
Grade I (loosen)Neutralizes pressure in joint without actual surface
separationProduce pain relief by reducing compressive forces
Grade II (tighten or take up slack)Separates articulating surfaces, taking up slack or
eliminating play within joint capsuleUsed initially to determine joint sensitivity
Grade III (stretch) Involves stretching of soft tissue surrounding joint Increase mobility in hypomobile joint
Grade I (loosen)Neutralizes pressure in joint without actual surface
separationProduce pain relief by reducing compressive forces
Grade II (tighten or take up slack)Separates articulating surfaces, taking up slack or
eliminating play within joint capsuleUsed initially to determine joint sensitivity
Grade III (stretch) Involves stretching of soft tissue surrounding joint Increase mobility in hypomobile joint
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Grade I traction should be used initially to reduce chance of painful reaction
10 second intermittent grade I and II traction can be used
Distracting joint surface up to a grade III and releasing allows for return to resting position
Grade III traction should be used in conjunction with mobilization glides for hypomobile jointsApplication of grade III traction (loose-pack position)Grade III and IV oscillations within pain limitation to
decrease hypomobility
Grade I traction should be used initially to reduce chance of painful reaction
10 second intermittent grade I and II traction can be used
Distracting joint surface up to a grade III and releasing allows for return to resting position
Grade III traction should be used in conjunction with mobilization glides for hypomobile jointsApplication of grade III traction (loose-pack position)Grade III and IV oscillations within pain limitation to
decrease hypomobility