Joint MobilizationJoint Mobilization

KyungMo Han, PhD, ATCKyungMo Han, PhD, ATC

California State University California State University Dominguez HillsDominguez Hills

IntroductionIntroduction

Understanding of joint mobilizationUnderstanding of joint mobilization Planes of the body (& axes)Planes of the body (& axes) Arthrokinematics vs. OsteokinematicsArthrokinematics vs. Osteokinematics Concave-Convex RulesConcave-Convex Rules Treatment planeTreatment plane Mobilization & Traction techniquesMobilization & Traction techniques Examples & Thinking ProblemsExamples & Thinking Problems

What is it?What is it?

Manual therapy techniques that are Manual therapy techniques that are used to modulate pain and treat joint used to modulate pain and treat joint dysfunctions that limit range of dysfunctions that limit range of motion by specially addressing the motion by specially addressing the altered mechanic of the jointaltered mechanic of the joint

Mobilization vs. ManipulationMobilization vs. Manipulation

AxesAxes

Z

X

Y

Planes of the BodyPlanes of the Body

Sagittal planeSagittal plane Frontal (coronal) planeFrontal (coronal) plane Transverse (horizontal) planeTransverse (horizontal) plane

ArthrokinematicsArthrokinematics

Description of movement with Description of movement with reference to the jointreference to the joint

Unobservable articular movements Unobservable articular movements between adjacent joint surfacesbetween adjacent joint surfaces

Osteokinematics: description of Osteokinematics: description of movement with reference to the bones movement with reference to the bones (for example, flexion, extension, (for example, flexion, extension, abduction, etc.)abduction, etc.)

ArthrokinematicsArthrokinematics

3 3 Accessory MovementsAccessory Movements• RollRoll• GlideGlide• SpinSpin

RollRoll

New points on one surface meet new New points on one surface meet new points on another surfacepoints on another surface

Occurs in the same direction as bone Occurs in the same direction as bone movementmovement

Occurs with gliding but never aloneOccurs with gliding but never alone

GlideGlide

Same point on one surface comes Same point on one surface comes into contact with new points on the into contact with new points on the opposite surfaceopposite surface

The direction of the glide depends The direction of the glide depends on shape of the moving surfaceon shape of the moving surface

SpinSpin

Rotation around a stationary Rotation around a stationary mechanical axismechanical axis

Primarily only takes place in the Primarily only takes place in the glenohumeral and radiohumeral glenohumeral and radiohumeral jointsjoints

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Convex-Concave RulesConvex-Concave Rules What is the shape of a concave and convex What is the shape of a concave and convex

surface?surface? What shape is the femur and tibia at the What shape is the femur and tibia at the

knee?knee?

Convex and concave surface-the roll is Convex and concave surface-the roll is always in the direction of the bone always in the direction of the bone movementmovement• For example: If the bone is moving For example: If the bone is moving

anteriorly, the roll is anterior and vice anteriorly, the roll is anterior and vice versaversa

Convex-Concave RulesConvex-Concave Rules

If the convex surface is moving on If the convex surface is moving on fixed concave surface, roll and fixed concave surface, roll and glide occur in the opposite glide occur in the opposite directionsdirections

If the concave surface is moving If the concave surface is moving

on fixed convex surface, roll and on fixed convex surface, roll and glide occur in the same directionglide occur in the same direction

MobilizationMobilization

A passive movement performed by A passive movement performed by the clinicians for intending to the clinicians for intending to increase mobility and/or decrease increase mobility and/or decrease pain using gliding and traction pain using gliding and traction techniquestechniques

Why do we perform mobilizations?Why do we perform mobilizations? What structure is being stretched?What structure is being stretched?

““Target” tissue for Joint MobilizationTarget” tissue for Joint Mobilization

Features of Synovial JointsFeatures of Synovial Joints

A joint capsuleA joint capsule A joint cavityA joint cavity A synovial membraneA synovial membrane Synovial fluidSynovial fluid Hyaline cartilageHyaline cartilage

Treatment PlaneTreatment Plane

Treatment plane lies in the concave Treatment plane lies in the concave articular surfacearticular surface

Treatment plane moves with the Treatment plane moves with the concave surface concave surface

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GlidingGliding Gliding is a movement where the joint Gliding is a movement where the joint

surfaces are passively displaced parallel to surfaces are passively displaced parallel to the treatment planethe treatment plane

Glides are used to improve a particular Glides are used to improve a particular movement (i.e. flexion or extension of the movement (i.e. flexion or extension of the knee)knee)

Glides are performed in the direction of Glides are performed in the direction of arthrokinematic movementarthrokinematic movement

Mobilization GradingMobilization Grading(Maitland)(Maitland)

Grade IGrade I Grade IIGrade II Grade IIIGrade III Grade IVGrade IV Grade VGrade V

Grade I - IVGrade I - IV

II: Small amplitude movement at the : Small amplitude movement at the beginning of the available ROMbeginning of the available ROM

II: Large amplitude movement within II: Large amplitude movement within the available ROMthe available ROM

III: Large amplitude movement that III: Large amplitude movement that reaches the end of ROMreaches the end of ROM

IV: Small amplitude at the very end ROMIV: Small amplitude at the very end ROM

Grade VGrade V

High velocity thrust of small High velocity thrust of small amplitude a the end of the available amplitude a the end of the available ROM and within its anatomical ROM and within its anatomical rangerange

This is referred to as a manipulationThis is referred to as a manipulation

TractionTraction The process of pulling one bony surface The process of pulling one bony surface

away from the other (joint away from the other (joint separation)separation)

A passive bone movement which is at a A passive bone movement which is at a right angle to the treatment planeright angle to the treatment plane

A general mobilization technique that can A general mobilization technique that can improve mobility in all directionsimprove mobility in all directions

Traction (Grading)Traction (Grading)

Grade I: unweighting or barely Grade I: unweighting or barely separating the joint surfaces separating the joint surfaces

Grade II: slack of the capsule taken up Grade II: slack of the capsule taken up

Grade III: capsule and ligaments Grade III: capsule and ligaments

stretchedstretched

ExamplesExamples

Knee extension (femur is fixed)Knee extension (femur is fixed)

Wrist flexion (radius is fixed)Wrist flexion (radius is fixed)

Ankle dorsiflexion (tibia is fixed)Ankle dorsiflexion (tibia is fixed)

Shoulder abduction (scapula is fixed)Shoulder abduction (scapula is fixed)

Thinking Problem 1Thinking Problem 1

An athlete comes in to the An athlete comes in to the training room, an athletic training room, an athletic trainer performs trainer performs POSTERIORPOSTERIOR glides of theglides of the FEMUR FEMUR on the on the TIBIATIBIA. What osteokinematic . What osteokinematic movement is the trainer trying movement is the trainer trying to improve?to improve?

Thinking Problem 2Thinking Problem 2

An athlete comes in to the An athlete comes in to the training room, an athletic training room, an athletic trainer performs trainer performs ANTERIORANTERIOR glides of the glides of the CARPALSCARPALS on the on the RADIUSRADIUS. What osteokinematic . What osteokinematic movement is the trainer trying movement is the trainer trying to improve?to improve?