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Joint mobilization
- 1. Joint Mobilization Dr ShrikrishnaShinde Assistant professor at MVPS College of Physiotherapy Nashik
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- 3. Terminology Mobilization –passive joint movement for increasing ROM or decreasing pain Applied to joints & related soft tissues at varying speeds & amplitudes using physiologic or accessory motions Force is light enough that patient’s can stop the movement Manipulation – passive joint movement for increasing joint mobility Incorporates a sudden, forceful thrust that is beyond the patient’s control
- 4. Basic concepts ofjoint motion : Arthrokinematics 2. Types of joint motion 5 types of joint arthrokinematics Roll Slide Spin Compression Distraction 3 components of joint mobilization Roll, Spin, Slide Joint motion usually often involves a combination of rolling, sliding & spinning
- 5. Roll A seriesof points on one articulating surface come into contact with a series of points on another surface Roll occurs in direction of movement Example: Femoral condyles rolling on tibial plateau
- 6. Spin Occurs whenone bone rotates around a stationary longitudinal mechanical axis Example: Radial head rotate at the humeroradial joint during pronation/supination;
- 7. Slide Specific pointon one surface comes into contact with a series of points on another surface When a passive mobilization technique is applied to produce a slide in the joint – referred to as a GLIDE.
- 8. Compression – Decrease in space between two joint surfaces. Adds stability to a joint. Normal reaction of a joint to muscle contraction. Distraction - Two surfaces are pulled apart Often used in combination with joint mobilizations to increase stretch of capsule
- 9. Convex-Concave & Concave-ConvexRule One joint surface is MOBILE & one is STABLE Concave-convex rule: concave joint surfaces slide in the SAME direction as the bone movement (convex is STABLE) If concave joint is moving on stationary convex surface – glide occurs in same direction as roll
- 10. Convex-concave rule:convex joint surfaces slide in the OPPOSITE direction of the bone movement (concave is STABLE) If convex surface in moving on stationary concave surface – gliding occurs in opposite direction to roll
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- 12. Open Packed Position Joint position where the capsule is most relaxed and therefore has the greatest room and accommodate the most fluid. Least amount of joint contact Greatest amount of joint play
- 13. Close Packed Position Joint capsule and ligaments are tight Maximal contact between surfaces
- 14. Effects of Joint Mobilization Neurophysiological Stimulates large mechanoreceptors to decrease pain Gate ControlTheory Nutritional Synovial fluid movement improve nutrient exchange Mechanical Improve the mobility of hypomobile joints due to immobilization or dysfunction (capsular adhesions or scar adhesions)
- 15. Maitland Joint Mobilization About Maitland: G. D. Maitland, born in 1924 in Australia, is the founder of the Maitland mobilization techniques. He completed his training as a physiotherapist in 1949 and quickly developed an interest in “careful clinical examination and assessment of patients with neuro-musculo-skeletal disorders."1
- 16. Maitland Joint MobilizationGrading Scale Grading based on amplitude of movement & where within available ROM the force is applied. Grade I Small amplitude rhythmic oscillating movement at the beginning of range of movement Manage pain and spasm Grade II Large amplitude rhythmic oscillating movement within midrange of movement Manage pain and spasm Grades I & II – often used before & after treatment with grades III & IV
- 17. Grade III Large amplitude rhythmic oscillating movement up to point of limitation (PL) in range of movement Used to gain motion within the joint Stretches capsule & CT structures Grade IV Small amplitude rhythmic oscillating movement at very end range of movement Used to gain motion within the joint Used when resistance limits movement in absence of pain GradeV – (thrust technique) - Manipulation Small amplitude, quick thrust at end of range Accompanied by popping sound (manipulation) Velocity vs. force Requires training
- 18. Indications for Mobilization Grades I and II - primarily used for pain Grades III and IV - primarily used to increase motion
- 19. Joint Positions Restingposition Maximum joint play - position in which joint capsule and ligaments are most relaxed Evaluation and treatment position utilized with hypomobile joints Loose-packed position Articulating surfaces are maximally separated Joint will exhibit greatest amount of joint play Position used for both traction and joint mobilization Close-packed position Joint surfaces are in maximal contact to each other General rule: Extremes of joint motion are close-packed, & midrange positions are loose-packed
- 20. Joint Mobilization Application All joint mobilizations follow the convex-concave rule Patient should be relaxed Explain purpose of treatment & sensations to expect to patient Evaluate BEFORE & AFTER treatment Stop the treatment if it is too painful for the patient Use proper body mechanics Use gravity to assist the mobilization technique if possible Begin & end treatments with Grade I or II oscillations
- 21. Positioning & Stabilization Patient & extremity should be positioned so that the patient can RELAX Initial mobilization is performed in a loose- packed position In some cases, the position to use is the one in which the joint is least painful Firmly & comfortably stabilize one joint segment, usually the proximal bone Hand, belt, assistant Prevents unwanted stress & makes the stretch force more specific & effective
- 22. Treatment Force &Direction of Movement Treatment force is applied as close to the opposing joint surface as possible The larger the contact surface is, the more comfortable the procedure will be (use flat surface of hand vs. thumb) Direction of movement during treatment is either PARALLEL or PERENDICULAR to the treatment plane
- 23. Gliding techniquesare applied parallel to the treatment plane Glide in the direction in which the slide would normally occur for the desired motion Direction of sliding is easily determined by using the convex-concave rule The entire bone is moved so that there is gliding of one joint surface on the other When using grade III gliding techniques, a grade I distraction should be used If gliding in the restricted direction is too painful, begin gliding mobilizations in the painless direction then progress to gliding in restricted direction when not as painful
- 24. Speed, Rhythm, &Duration of Movements Joint mobilization sessions usually involve: 3-6 sets of oscillations Perform 2-3 oscillations per second Lasting 20-60 seconds for tightness Lasting 1-2 minutes for pain 2-3 oscillations per second Apply smooth, regular oscillations
- 25. Vary speedof oscillations for different effects For painful joints, apply intermittent distraction for 7-10 seconds with a few seconds of rest in between for several cycles For restricted joints, apply a minimum of a 6-second stretch force, followed by partial release then repeat with slow, intermittent stretches at 3-4 second intervals
- 26. Joint 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 system Combines traction and mobilization Joint looseness = slack
- 27. Patient Response Maycause soreness Perform joint mobilizations on alternate days to allow soreness to decrease & tissue healing to occur Patient should perform ROM techniques Patient’s joint & ROM should be reassessed after treatment, & again before the next treatment Pain is always the guide
- 28. References Houglum, P.A.(2005).Therapeutic exercise for musculoskeletal injuries, 2nd ed. Human Kinetics: Champaign, IL Kisner, C. & Colby, L.A. (2002).Therapeutic exercise: Foundations and techniques, 4th ed. F.A. Davis: Philadelphia.
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