Title: Joint Mobilization
1Joint Mobilization
2Peripheral Joint Mobilization
- Mobilization - is a passive movement performed
slowly by the athletic trainer/therapist, it is
controlled enough that the patient can stop the
movement any time - Goal is to provide a safe and effective means for
restoring normal joint play and/or decreasing
pain - Manipulation - involves a sudden, short
amplitude, high velocity movement the patient
cannot prevent - not in ATCs realm
3Why?
4Mobilization - Indications and Goals
- Indications
- Capsular pattern - pattern of motion loss
- Pain - small amplitude oscillations to treat
- Muscle spasm/guarding - gentle oscillations and
sustained stretch to maintain joint play - Joint hypomobility/stiffness - oscillatory forces
used to stretch joint capsule - Goals
- Gentle joint play techniques stimulate both
mechanical and neurophysiological effects
5Examples of Capsular Patterns
- When a capsular pattern is present, full joint
ROM will not be attained until you address
capsular tightness - Glenohumeral
- lateral rotation gt abduction abduction gt flexion
- Hip
- medial rotation, abduction, flexion gt extension
- Knee
- flexion gt extension
- Ankle
- PF gt DF INV gt EV
gt means motion is more limited
6Mobilization
- Mechanical effects -
- increased nutrition to the avascular portions of
the articular cartilage - physically stretching the capsule which maintains
the potential for normal ROM - Neurophysiological effects -
- stimulate mechanoreceptors that inhibit
transmission of nociceptive stimuli gate
control - Golgi tendon organ autogenic inhibition
7(No Transcript)
8Mobilization
- CONTRAINDICATIONS
- Hypermobility
- Joint effusion
- Acute inflammation
- Fractures/Osteoporosis
- LIMITATIONS
- techniques cannot change a disease process
- Be careful with unexplained pain syndromes
- therapist/athletic trainer skill will affect the
outcome
9Basic Concepts of Joint Motion
- Physiological movements - - Osteokinematics
- the patient can perform these voluntarily
- traditional movements such as flexion,
extension, abduction, rotation - Accessory movements - Arthrokinematics
- joint play and accessory motion
- necessary for and accompanying normal ROM, but
cannot be performed by the patient - examples are
slide, roll, spin, distraction, compression
10Basic Concepts of Joint Motion
- Type of motion is influenced by the shapes of the
joint surfaces - Ovoid - one surface is convex the other concave
most common - Sellar (saddle) - one surface is concave in one
direction and convex in the other, being
opposite of the other joint surface
11Arthrokinematics
- Roll
- Incongruent surfaces new pts to new pts
- Rolling occurs in the same direction as
physiological movement - Slide (Glide)
- Congruent surfaces one pt to new point
- Concave-Convex Rule
- Spin
- Bone rotates around a stationary axis
12RULE OF CONCAVE-CONVEX
- The shape of the joint surface influences the
direction of the accessory movement - If surface of moving bone is convex, sliding is
in the opposite direction of the bones
physiological movement - If the surface of the moving bone is concave,
sliding is in the same direction as the
physiological movement of the bone
13RULE OF CONCAVE-CONVEX
14Techniques of Joint Mobilization
15INDICATIONS FOR JOINTMOBILIZATION
- 1- Pain, Muscle Guarding, and Spasm can be
treated with gentle joint-play techniques to
stimulate - Neurophysiological Effects
- Small-amplitude oscillatory and distraction
movements stimulate mechanoreceptors inhibt
transmission of nociceptive stimuli at the spinal
cord
16- Mechanical Effects
- Small-amplitude distraction or gliding movement
produce synovial fluid motion, for bringing
nutrients to the avascular portions of the
articular cartilage to prevent degeneration of
the joint surfaces
17- 2- Reversible Joint Hypomobility
- 3- Positional Faults/Subluxations
- 4-Functional Immobility
18LIMITATIONS OF JOINTMOBILIZATION TECHNIQUES
- Mobilization techniques cannot change the disease
process(rheumatoid arthritis or the inflammatory.
In these cases, treatment is directed toward
minimizing pain, maintaining available joint
play,
19CONTRAINDICATIONSAND PRECAUTIONS
- Hypermobility
- Joint effusion
- Inflammation
20(No Transcript)
2110 simple steps
- Evaluation and Assessment
- Determine grades and dosage
- Patient position
- Joint position
- Stabilization
- Treatment force
- Direction of movement
- Speed and rhythm
- Initiation of treatment
- Reassessment
22Grades of Oscillations (Maitland)
- Grade I - small amplitude movement at the
beginning of the range (pain and spasm) - Grade II - large amplitude movement within the
midrange of the movement (pain and spasm) - Grade III - large amplitude movement at the end
of the range (into restriction) - Grade IV - small amplitude movement at end range
when tissue resistance (not pain) is limiting - Grade V - small amplitude, quick thrust
manipulation at end range- only w/ training!
23Normal motion
24Grades of Oscillations (Maitland)
25Mobilization
- If there is pain before tissue limitation, use
gentle techniques for decreasing pain and no
stretching - Grades I and II
- If pain is concurrent with tissue limitation,
treat cautiously with gentle techniques, then
gradually increase movement without exacerbating
pain - Grade I and II
- If pain is experienced after tissue limitation, a
stiff articulation can be aggressively mobilized
with joint play techniques - Grades III and IV
26Recommendations for using the Grades
- Pain and spasm
- I and II
- Tissue resistance
- III and IV
- Treatment amplitude
- Low - I, IV
- High - II, III
- Treatment speed
- Fast I, IV
- Slow II, III
- Gentle techniques
- I, II
- Treatment force
- Low I, II
- High III, IV
27Procedures for Application of Joint Mobilization
Techniques
- Position patient in a relaxed, distracted,
supported position so the joint capsule is lax
(loose(open)-packed position). Close-packed
position is one in which there is maximal contact
of the articulating surfaces. - Stabilize proximal bone
- Position joint in open (loose packed) position
- Apply treatment force close to the joint line as
possible (decrease lever) - Use treatment plane
28Open Pack Positions
- Knee 20-25o flexion
- Ankle 10o plantar flexion, mid range
eversion/inversion - Hip 30o flexion, 30o abduction
- Wrist - Neutral
- Elbow
- Humeroulnar/Radioulnar - 70o flexion (supination
varies) - Humeroradial Full extension and supination
- Shoulder 55o flexion, 20-30o horiz. abduction
29- Treatment Plane
- Traction apply perpendicular
- Gliding apply parallel
- Technique
- 2-3 oscillations per second
- Pain 1 to 2 mins.
- Tightness 20 to 60s
30Be sure to PRACTICE!!!