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Joint MobilizationJoint Mobilization

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Grades of MovementGrades of Movement

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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

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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

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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

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Pain and ResistancePain and Resistance

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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

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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

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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

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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