PERIPHERAL JOINT

1LECTURE - 8
MOBILIZATION

Dr. Momena
Lecturer (RCRS)
 JOINT MOBILIZATION 2

• Also known as manipulation.

• Refers to manual therapy techniques
• Used to modulate pain
• Used to increase ROM
• Used to treat joint dysfunctions that limit
ROM by specifically addressing altered joint
mechanics
Factors that may alter joint
mechanics 3

• Pain & Muscle guarding

• Joint hypomobility
• Joint effusion
• Contractures or adhesions in the joint
capsules or supporting ligaments
• Malalignment or subluxation of bony
surfaces
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DEFINITIONS OF TERMS
MOBILIZATION 5

• Passive, skilled manual therapy

techniques applied to joints and related
soft tissues at varying speeds and
amplitudes using physiological or
accessory motions for therapeutic
purposes.
• The varying speeds and amplitudes can
range from a small-amplitude force
applied at fast velocity to a large-
amplitude force applied at slow
velocity.
MANIPULATION 6

• Passive joint movement for increasing

joint mobility.
• Incorporates a sudden, forceful thrust
that is beyond the patient’s control.
SELF-MOBILIZATION (AUTO
MOBILIZATION) 7

• Self-stretching techniques that specifically use joint

traction or glides that direct the stretch force to the
joint capsule.
MOBILIZATION WITH MOVEMENT
(MWM) 8

• Concurrent application of
sustained accessory mobilization
applied by a therapist and an
active physiological movement
to end-range applied by the
patient.
• Applied in a pain-free direction.
• Brian Mulligan of New Zealand
originally described these
techniques.
PHYSIOLOGICAL MOVEMENTS 9

• Movements the patient can do voluntarily (e.g., the

classic or traditional movements, such as flexion,
abduction, and rotation).
• Osteokinematics ------- motions of the bones
ACCESSORY MOVEMENTS 10

• 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.
• Component motions:
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• Motions that accompany
active motion but are not
under voluntary control.
•
• 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:

• 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.

• The movements include distraction, sliding,

compression, rolling, and spinning of the joint
surfaces.
Thrust/ HVT 13

• Thrust refers to high-velocity, short-amplitude

techniques such that the patient cannot prevent the
motion.
• The thrust is performed at the end of the pathological
limit of the joint.
• Pathological limit means the end of the available ROM
when there is restriction.
MANIPULATION UNDER
ANESTHESIA 14

• A procedure used to restore full ROM

by breaking adhesions around a joint
while the patient is anesthetized.
• The technique may be a rapid thrust
or a passive stretch using
physiological or accessory
movements.
• Therapists may assist surgeons in the
application of these skilled
techniques in the operating room and
continue with follow-up care.
MUSCLE ENERGY 15

• Use active contraction of

deep muscles that attach
near the joint and whose
line of pull can cause the
desired accessory motion.
• The technique requires
the therapist to provide
stabilization to the
segment on which the
distal aspect of the muscle
attaches.
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Basic Concepts of Joint

Motion: Arthrokinematics
JOINT SHAPES 17

• In ovoid joints one surface is

convex, and the other is
concave.
• In sellar (saddle) joints, one
surface is concave in one
direction and convex in the
other, with the opposing
surface convex and concave,
respectively.
TYPES OF MOTION 18

• The movement of the bony lever is called swing and is

classically described as flexion, extension, abduction,
adduction, and rotation. The amount of movement can
be measured in degrees with a goniometer and is called
ROM.
• Motion of the bone surfaces in the joint is a variable
combination of rolling and sliding, or spinning. These
accessory motions allow greater angulation of the bone
as it swings.
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• Roll

• New points on one surface meet new points

on the opposing surface.

• The surfaces are incongruent.

• Roll occur in direction of motion.
• Rolling, if it occurs alone, causes compression of
the surfaces on the side to which the bone is
swinging and separation on the other side
• Usually occurs in combination with sliding or
spinning
• Example: movement of tibia over femur during
knee flexion and extension
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• Spin
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• Occurs when one bone
rotates around a
stationary longitudinal
mechanical axis

• Same point on the

moving surface creates
an arc of a circle as the
bone spins
• Example: Radial head at
the humeroradial joint
during
pronation/supination;
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• Slide/Translation
23
• The same point on one surface
comes into contact with the new
points on the opposing surface.

• surfaces must be congruent, either

flat or curved
• Pure sliding does not occur in
joints.
• The direction in which sliding occurs
depends on whether the moving
surface is concave or convex.
• When a passive mobilization
technique is applied to produce a
slide in the joint – referred to as a
GLIDE.
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• Combined Roll-Sliding in a Joint

• The more congruent the joint surfaces are, then

more sliding occur.
• The more incongruent the joint surfaces are, then
more rolling occur.
• When muscles actively contract to move a bone,
some of the muscles may cause or control the
sliding movement of the joint surfaces.
• For example, the posterior sliding of the tibia
during knee flexion is caused by the hamstring
muscles.
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PASSIVE-ANGULAR STRETCHING
VERSUS JOINT-GLIDE STRETCHING 26

• Passive-angular stretching procedures, as when the bony lever is

used to stretch a tight joint capsule, may cause increased pain
or joint trauma because:
• 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.
OTHER ACCESSORY MOTIONS THAT AFFECT
THE JOINT 27

• 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.
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• Whenever there is pulling on the long axis of a bone, the term long-axis
traction is used.
• Whenever the surfaces are to be separated, the term distraction, joint
traction, or joint separation is used.
EFFECTS OF JOINT MOTION 29

• Joint motion stimulates biological activity by moving

synovial fluid, which brings nutrients to the avascular
articular cartilage of the joint surfaces and intra-
articular fibrocartilage of the menisci.
• Extensibility and tensile strength of the articular and
periarticular tissues are maintained with joint
motion.
• Afferent nerve impulses from joint receptors transmit
information to the central nervous system and,
therefore, provide awareness of position and motion.
There are various types of receptors that provide sensory
30
input relative to joint motion:

• Static position and sense of speed of movement (type

I receptors in superficial joint capsule).
• Change of speed of movement (type II receptors in
deep layers of the joint capsule and articular fat
pads).
• Sense of direction of movement (type I and III
receptors; type III in joint ligaments).
• Regulation of muscle tone (type I, II, and III
receptors).
• Nociceptive stimuli (type IV receptors in the fibrous
capsule, ligaments, articular fat pads, periosteum,
and walls of blood vessels).
CONVEX-CONCAVE & CONCAVE-
CONVEX RULE 31

• Basic application of correct mobilization techniques -

**need to understand this!
• Relationship of articulating surfaces associated with
sliding/gliding

• One joint surface is MOBILE & one is STABLE

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• 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
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• 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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