Peripheral Joint Mobilization for Impaired Mobility Chapter 5

Joint Mobilization/Manipulation § Manual therapy techniques that are used to modulate pain and treat joint impairments that limit ROM by specifically addressing the altered mechanics of the joint Copyright © 2013. F. A. Davis Company

Definition of Terms § Mobilization/Manipulation – Thrust manipulation/high-velocity thrust (HVT) § Self-Mobilization (Auto-Mobilization) § Mobilization With Movement (MWM) § Physiological Movements – Osteokinematics Copyright © 2013. F. A. Davis Company

Definition of Terms (cont'd) § Accessory Movements – Component motion – Joint play: arthrokinematics

Basic Concepts of Joint Motion: Arthrokinematics § Joint Shapes – Ovoid – Sellar (saddle)

Basic Concepts of Joint Motion: Arthrokinematics (cont'd) § Types of Motion – Swing: Movement of the bony lever about an axis of motion – Motion of the bone surfaces in the joint • Roll • Slide/translation • Combined roll-sliding in a joint (glide) • Spin Copyright © 2013. F. A. Davis Company

Convex-Concave Rule § Basis for determining the direction of the mobilizing force when joint mobilization gliding techniques are used – Sliding is in the opposite direction of the angular movement of the bone if the moving surface is convex – Sliding is in the same direction if the moving surface is concave Copyright © 2013. F. A. Davis Company

Passive-Angular Stretching Versus Joint-Glide Stretching § Passive-angular stretching may cause increased pain or joint trauma § Joint-glide is safer and more selective – Controlled – Replicates normal joint mechanics – Force is specific to target tissues Copyright © 2013. F. A. Davis Company

Other Accessory Motions That Affect the Joint § Compression § Traction: Longitudinal Pull – Long axis traction § Distraction: Separation of Joint Surfaces – Joint traction or joint separation Copyright © 2013. F. A. Davis Company

Effects of Joint Motion § Helps move synovial fluid to maintain cartilage health § Maintains extensibility and tensile strength of articular and periarticular tissues § Provides sensory input for proprioceptive feedback important for balance response Copyright © 2013. F. A. Davis Company

Indications for Joint Mobilization/Manipulation § Pain, Muscle Guarding, and Spasm – Neurophysiological effects – Mechanical effects § Reversible Hypomobility § Positional Faults/Subluxations § Progressive Limitation § Functional Immobility Copyright © 2013. F. A. Davis Company

Limitations of Joint Mobilization/ Manipulation Techniques § Cannot Change Disease Process § Cannot Change Inflammatory Process § Skill of the Therapist Affects the Outcome Copyright © 2013. F. A. Davis Company

Contraindications § Hypermobility § Joint Effusion § Inflammation Copyright © 2013. F. A. Davis

Conditions Requiring Special Precautions for Stretching § Malignancy § Bone Disease Detectable on Radiograph § Unhealed Fracture (With Limitations) § Hypermobility in Associated Joints § Total Joint Replacements § Newly Formed or Weakened Connective Tissue § Elderly Individuals Copyright © 2013. F. A. Davis Company

Procedures for Applying Passive Joint Techniques § Examination and Evaluation – Quality of pain – Capsular restriction (specific pattern) – Subluxation or dislocation Copyright © 2013. F. A. Davis Company

Procedures for Applying Passive Joint Techniques (cont'd) § Documentation – Use of standardized terminology – Characteristics of documentation • • • Copyright © 2013. F. A. Davis Company Rate of application of movement Location of range in the available motion Direction of force applied by therapist Target of force Relative structural movement Patient position

Non-Thrust Oscillation Techniques § Grade I: Small Amplitude at Beginning of Range – Pain inhibition and fluid movement § Grade II: Large Amplitude Within the Range – Pain inhibition and fluid movement § Grade III: Large Amplitude Up to the Limit into Resistance – Stretching maneuver § Grade IV: Small Amplitude at the Limit into Resistance – Stretching maneuver Copyright © 2013. F. A. Davis Company

Non-Thrust Sustained Joint-Play Techniques § Grade I: Loosen: Small Amp Distraction – Pain relief § Grade II: Tighten: Distraction or Glide to Tighten Tissue – Pain relief, assess joint sensitivity, maintain joint play § Grade III: Stretch: Distraction or Glide – Increase joint play Copyright © 2013. F. A. Davis Company

Comparison of Oscillation and Sustained Techniques Representation of Oscillation Techniques Copyright © 2013. F.

Thrust Manipulation/High. Velocity Thrust (HVT) § Application – Small-amplitude, high-velocity – Performed only once § Indications – Snap adhesions – Reposition joint surfaces Copyright © 2013. F. A. Davis Company

Procedures for Applying Passive Joint Techniques § Positioning and Stabilization § Direction and Target of Treatment Force – Treatment plane § Initiation and Progression of Treatment § Patient Response § Total Program Copyright © 2013. F. A. Davis Company

Mobilization With Movement (MWM): Principles of Application § Principles and Application of MWM in Clinical Practice – Comparable sign – Passive techniques – Accessory glide with active comparable sign – No pain – Repetitions – Description of techniques Copyright © 2013. F. A. Davis Company

Mobilization With Movement (MWM): Principles of Application (cont'd) § Patient Response and Progression – Pain as a guide – Self treatment – Total program § Theoretical Framework – Brian Mulligan Copyright © 2013. F. A. Davis Company

Peripheral Joint Mobilization Techniques § § § Shoulder Girdle Complex Elbow and Forearm Complex Wrist and Hand Complex Hip Joint Knee Joint Complex Leg and Ankle Joints Copyright © 2013. F. A. Davis Company