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Joint mobilization refers to manual therapy techniques that are used to modulate pain and treat joint dysfunctions that limit range of motion (ROM) by specifically addressing the altered mechanics of the joint.
The altered joint mechanics may be due to 1. Pain 2. Joint effusion, 3. Contractures or adhesions in the joint capsules or supporting ligaments, 4. Malalignment or subluxation of the bony surfaces.
Subluxation of joint
Terminology
Mobilization It is a passive joint movement for decreasing pain and increasing range of motion. Applied to joints and related soft tissues at varying speeds and amplitudes using physiological or accessory motions. Force is light enough that patients can stop the movements.
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Manipulation
It is a Passive joint movement for increasing joint mobility. Incorporates a sudden forceful thrust that is beyond the patients control.
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Physiological Movements Physiological movements are movements the patient can do voluntarily (e.g., the classic or traditional movements, such as flexion, abduction, and rotation). The term osteokinematics is used when these motions of the bones are described.
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Accessory Movements Accessory movements are movements in the joint and surrounding tissues that are necessary for normal ROM but that cannot be actively performed by the patient.
Terms that relate to accessory movements are component motions and joint play.
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Component motions Component motions are those motions that accompany active motion but are not under voluntary control. The term is often used synonymously with accessory movement. For example, motions such as upward rotation of the scapula and rotation of the clavicle, which occur with shoulder flexion.
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Joint play Joint play describes the motions that occur between the joint surfaces which allows the bones to move.
The movements are necessary for normal joint functioning through the ROM and can be demonstrated passively, but they cannot be performed actively by the patient.
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The movements include Rolling, sliding, spinning compression, and distraction, The term arthrokinematics is used when these motions of the bone surfaces within the joint are described.
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Roll Characteristics of one bone rolling on another are as follows. The surfaces are incongruent. New points on one surface meet new points on the opposing surface. Rolling is always in the same direction as the swinging bone motion whether the surface is convex or concave
Rolling
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Slide/Translation Characteristics of one bone sliding (translating) across another include the following. For a pure slide, the surfaces must be congruent, either flat or curved. The same point on one surface comes into contact with the new points on the opposing surface.
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The direction in which sliding occurs depends on whether the moving surface is concave or convex. Sliding is in the opposite direction of the angular movement of the bone if the moving joint surface is convex. Sliding is in the same direction as the angular movement of the bone if the moving surface is concave.
Sliding
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Spin Characteristics of one bone spinning on another include the following. There is rotation of a segment about a stationary mechanical axis. The same point on the moving surface creates an arc of a circle as the bone spins.
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Spinning rarely occurs alone in joints but in combination with rolling and sliding. Examples of spin occurring in joints of the body are the radiohumeral joint with pronation or supination
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Compression Compression is the decrease in the joint space between bony partners. Compression normally occurs in the extremity and spinal joints when weight bearing.
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Traction/Distraction Traction is a longitudinal pull. Distraction is a separation, or pulling apart. Whenever the surfaces are to be pulled apart, the term distraction, joint traction, or joint separation is used.
Mobilization techniques cannot change the disease process of disorders such as rheumatoid arthritis or the inflammatory process of injury. In these cases, treatment is directed toward minimizing pain, maintaining available joint play, and reducing the effects of any mechanical limitations
Grades I and II are primarily used for treating joints limited by pain. Grades III and IV are primarily used to improve the range of motion.
Grade III (stretch): A distraction or glide is applied with an amplitude large enough to place stretch on the joint capsule and surrounding periarticular structures.
The treatment force (either gentle or strong) is applied as close to the opposing joint surface as possible. The larger the contact surface, the more comfortable is the patient with the procedure. For example, instead of forcing with your thumb, use the flat surface of your hand.
The direction of movement during treatment is either parallel or perpendicular to the treatment plane.
The direction of gliding is easily determined by using the CONVEX-CONCAVE RULE. If the surface of the moving bony partner is convex, the treatment glide should be opposite to the direction in which the bone swings. If the surface of the moving bony partner is concave, the treatment glide should be in the same direction
Grades I and IV are usually rapid oscillations, like manual vibrations. Grades II and III are smooth, regular oscillations at 2 or 3 per second for 1 to 2 minutes. Vary the speed of oscillations for different effects such as low amplitude and high speed to inhibit pain or slow speed to relax muscle guarding.
Sustained For painful joints, apply intermittent distraction for 7 to 10 seconds with a few seconds of rest in between for several cycles. Note the response and either repeat or discontinue. For restricted joints, apply a minimum of a 6-second stretch force followed by partial release (to grade I or II), then repeat with slow, intermittent stretches at 3- to 4second intervals.
Hand Placement Use the hand nearer the part being treated (e.g., left hand if treating the patients left shoulder) and place it in the patients axilla with your thumb just distal to the joint margin anteriorly and fingers posteriorly.
Your other hand supports the humerus from the lateral surface.
With the patient supine, stand facing the patients feet and stabilize the patients arm against your trunk with the hand farthest from the patient. Slight lateral motion of your trunk provides grade I distraction. With the patient sitting, face the patient and cradle the distal humerus with the hand closest to the patient; this hand provides a grade I distraction. Place the web space of your other hand just distal to the acromion process on the proximal humerus.
Techniques Because of the danger of subluxation when applying an anterior glide with the humerus externally rotated, use a distraction progression or elevation progression to gain range.
Distraction progression: Begin with the shoulder in resting position; externally rotate the humerus to end range and then apply a grade III distraction perpendicular to the treatment plane in the glenoid fossa. Elevation progression. This technique incorporates end-range external rotation.
Hand Placement When in the resting position or at end-range flexion, place the fingers of your medial hand over the proximal ulna on the volar surface; reinforce it with your other hand.
When at end-range extension, stand and place the base of your proximal hand over the proximal portion of the ulna and support the distal forearm with your other hand.
Patient Position Sitting, with the forearm supported on the treatment table, wrist over the edge of the table.
Mobilizing Force Apply long-axis traction to the metacarpal to separate the joint surfaces.
Resting Position The resting position is midway between flexion and extension and between abduction and adduction.
Stabilization Fixate the trapezium with the hand that is closer to the patient.
Mobilizing Force The glide force is applied by the thumb against the proximal end of the bone to be moved. Progress by taking the joint to the end of its available range and applying slight distraction and the glide force.
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