Joint Mobilization
Intervention to increase range of motion and decrease pain





Mobilization (vs. manipulation) - a passive movement performed by the therapist at a speed slow enough that the patient can stop the movement.

The technique may be applied with an oscillatory motion or a sustained stretch intended to decrease pain or increase.

Joint mobilization concentrates on maintaining and restoring accessory movements.

Accessory movements are movements within the joint and surrounding tissues that are necessary for normal range of motion, but cannot be actively performed by the patient.


Joint Play - motions that occur between the joint surfaces as well as the distensibility or “give” in the joint capsule, which allows the bones to move.


Component motions - are those motions that accompany active motion but are not under voluntary control (upward rotation of the scapular and clavicle, rotation of the fibula,









Roll - one bone rolling on another

Surfaces are incongruent


New points on one surface meet new points on the opposing surface


Rolling results in angular motion of the bone


Rolling is always in the same direction as the angulation bone motion


Rolling causes compression of the surfaces on the side to which the bone is angulating and separation on the other side


In normally function joints pure rolling does not occur alone but in combination with joint sliding and spinning.

Glide - One bone sliding across another


For a pure slide, the surfaces must be congruent, either flat or curved, therefore there is no pure sliding anatomically.

The same point on one surface comes into contact with new points on the opposing surface.


Direction of slide is dependent on whether the moving surface is convex or concave. (Convex-Concave rule)


Combined roll-sliding


The more congruent the joint surfaces are, the more sliding there is of one bony partner on the other with movement


The more incongruent the joint surfaces the more rolling


Muscles can actviely cause or control sliding movements of joint surfaces (rotatator cuff downward glide/ hamstring tibial posterior glide during flexion)


Spin — Rotation of a segment about a stationary mechanical axis


The same point on the moving surface creates an arc or a circle as the bone spins


Spining rarely occurs alone in joints but in combination with rolling and sliding.

Examples of spin include: shoulder flexion/extension, hip flexon/extension, and radiohumeral pronation/supination.









Disadvantages to Isolated Passive-Angular Stretching


The use of a lever significantly magnifies the force at the joint


The force causes excessive joint compression in the direction of the rolling bone


The roll without a slide does not replicate normal joint mechanics


Advantages of Joint-Glide Stretching


The force is applied close to the joint surface and controlled at an intensity compatible with the pathology.

The direction of the force replicates the sliding component of the joint mechanics and does not compress the cartilage.


The amplitude of the motion is small yet specific to the restricted or adhered portion of the capsule or ligaments thus, the forces are selectively applied to the desired tissue.





This is an article. You can add as many elements as you wish to create a post or any other large amount of content.





Your Subtitle Here



Indications for Joint Mobilization


Neurophysiologic effects - small amplitude oscillatory and distraction movements are used to stimulate the mechanoreceptors that may inhibit the transmission of nociceptive stimuli at the spinal cord or brain stem levels.

Mechanical effects - small amplitude distraction or gliding movements of the joint are used to cause synovial fluid motion, which is the vehicle for bringing nutrients to the avascular portion of the articular cartilage


Gentle joint-play techniques help maintain nutrient exchange and thus prevent the painful and degenerating effects of stasis when a joint is swollen or painful and cannot move through a range of motion.


Reversible joint hypomobility - progressively vigorous joint-play stretching techniques to elongate hypomobile capsular and ligamentous connective tissue. (can also be used in a preventive mode in the case of functional immobility)





Contraindications


Hypermobility - do not stretch joints with potential necrosis of ligaments or capsule.

Patients with painful hypermobile joints may benefit from gentle joint-play techniques if kept within the limits of motion. Stretching is not done.

Joint effusion - rapid joint swelling from trauma or disease usually indicates bleeding within the joint. Medical aspiration is required to minimize its necrotizing effect on the articular cartilage.


Slow swelling (4 hours or more) usually indicted serous (build-up of synovial fluid) effusion or edema within the joint from mild trauma irritation or disease such as arthritis.


Inflammation