Rehabi l i tat ion Techniques for Sports Medicine & Athlet ic Training

Wil l iam E. Prentice

JOINT MOBILIZATION & TRACTION TECHNIQUES

Slow, passive movements of articulating surfacesFollowing injury loss of motion may occur at a jointContracture of connective tissueResistance of contractile tissue to stretch

Or some combination of the two If left untreated joint will become HYPO-mobileMotion stops at pathological point of limitation (PL)

Caused by pain, spasm or tissue resistance

JOINT MOBILIZATION (JM) & TRACTION

Regain normal active joint range of motion (AROM)

Restore normal passive motionsReposition or realign a jointRegain normal distribution of forces and

stresses about a jointReduce pain

All will help improve joint functionEffective and widely used techniques in injury rehabilitation

INDICATIONS FOR JOINT MOBILIZATION & TRACTION

PhysiologicalResult of concentric or eccentric muscle action

Bone can move about axis of rotation

Also called osteokinematics

Voluntary

AccessoryManner in which one articulating joint surface moves relative to another

Normal accessory movement must occur for full range physiological mvmt. to occur

Also called joint arthrokinematics

PHYSIOLOGICAL & ACCESSORY MOTION

Accessory motion cannot occur independently but can be produced by external force JM and Traction can be used if accessory motion is limited due to some restriction of the joint capsule or ligaments

JM can be used at any point in the range of motion and in any direction in which movement is restricted

PHYSIOLOGICAL & ACCESSORY MOTION

Include spin, roll and glideSpin: Around a stationary axis, clockwise or counterclockwise i.e.. Radial head at humeroradial joint during pronation/supination

Roll: series of points on 1 articulating surface come in contact with series of points on another i.e.. Femoral condyles on tibia plateau during squat

Will always occur in same direction as physiological movement

Glide: when a specific point on 1 articulating surface comes in contact with series of points on another Also called translationTibial plateau on fixed femoral condyles during anterior drawer test

Occurs simultaneously with rolling in most joints

Direction of glide will be determined by shape of articulating surface that is moving i.e.. Convex-rounded Concave-flat or divot

ACCESSORY MOTION

If concAve surface is moving on a stationary convex surface, gliding will occur in the sAme direction as the rolling motion

If a cOnvex surface is moving on a stationary concave surface, gliding will occur in Opposite direction to rolling JM for hypomobile joints use gliding technique

Critical to know direction of glide

CONVEX-CONCAVE RULE

CONVEX-CONCAVE RULE

Closed-Packed positionMaximal contact of articulating surfaces

Joint capsule and ligaments tight or tense

No joint play

Loose-packed positionResting position Joint surfaces maximally separated

Joint capsule and ligaments most relaxed

Most appropriate for eval of joint play, traction, and JM

JOINT POSITIONS

JM and traction techniques use translational movement of one joint relative to anotherTreatment plane (TP): Perpendicular or at right angle to a line from axis of rotation on convex surface to center of concave surfaceTP lies within the concave surface

If convex segment moves TP remains fixed If Concave surface moves TP moves with concave surface

JM -parallel with treatment planeTraction-perpendicular to treatment plane

JOINT POSITION

JOINT POSITIONS

JOINT POSITIONS

Indications/GoalsReduce painDecrease muscle guardingStretching or lengthening tissue surrounding joint (capsular & ligamentous) Break adhesions and stretch tissue to

permanent structural changes Reflexogenic effects that inhibit or facilitate muscle tone or stretch reflex

Proprioceptive effects to improve postural and kinesthetic awareness

JOINT MOBILIZATION TECHNIQUES

Patient and AT positioned in a comfortable and relaxed manner

AT should mobilize 1 joint at a time

Hand positioning should be as close to the joint as possible Avoid long lever arm Short lever arm will allow stretch of capsule and

ligaments w/o rolling Avoid rolling, move as 1 segment in appropriate plane

Segment that is moving should be held in a fi rm and confi dent manner

JOINT MOBILIZATION TECHNIQUES

Amplitude: distance joint moves passively within total range From Beginning point in ROM (BP) to anatomical limit (AL)

Oscillations: movement that glides or slides articulating surface in appropriate direction

3-6 sets of 20-60 second oscillations w/ 1-3 oscillations/second

Grade I: small amplitude movement at beginning of range of motion Pain and spasm limit mvmt early in ROM

Grade II: large amplitude mvmt w/in midrange of mvmt Pain and spasm occur toward mid-ROM

Grade III: Large amplitude mvmt. From mid-range to PL Pain, spasm or tissue tension/compression limit mvmt. Near

end range

MAITLANDS 5 MOBILIZATION GRADES

Grade IV: small amplitude movement at end of range of motion. Got to PL and perform small-amplitude oscillations Resistance limits movement in absence of pain and spasm

Grade V: small amplitude mvmt from PL to anatomical limit (AL) Manipulation (chiropractic) Usually accompanied w/ popping sound Velocity of thrust more important/effective that force of

thrust Great deal of skill and judgment necessary for safe and

effective treatment

MAITLANDS 5 MOBILIZATION GRADES

MAITLANDS 5 MOBILIZATION GRADES

IndicationsPain

Grades I & II Pain treated 1st and

stiffness 2nd Stimulate

mechanoreceptors that limit transmission of pain perception

Treated dailyHypomobility

Grades III & IV 3-4 x week

ContraindicationsPain with mobilization technique

Inflammatory arthritisMalignancyBone diseaseNeurological involvement

Bone fractures/deformities

Vascular disorders

JM INDICATIONS & CONTRAINDICATIONS

Manual techniqueMay require strap for stabilization or tractionWedge or foam roll for stabilizationTreatment table-preferably a high-low tableTheraband may be used for grip

EQUIPMENT

Pulling 1 articulating segment to produce separation from another articulating segmentPerformed perpendicular to treatment planeAlso used to decrease pain and reduce joint hypomobility

Grade I traction techniques accompany JM techniques

TRACTION

Grade I Traction neutralizes

pressure w/o actual separation

Used w/all JM Pain relief

Grade II Effectively separates

articulating surfaces “Takes up slack” or

eliminates play in joint capsule

Grade III “Stretch” traction that

involves actual stretching of surrounding soft tissue

Increase mobility

KALTENBORNS 3 GRADES

KALTENBORNS 3 GRADES

Manual technique Towel sometimes used to assist pull

Traction Tables Cervical and Lumbar

Home Devices Cervical and lumbar

EQUIPMENT FOR TRACTION

Should only be performed by or under direct supervision of trained healthcare professionals

Can cause further injury if performed incorrectly

CONCLUSION