You are on page 1of 9

Glenohumeral Joint

concave glenoid fossa


-convex humeral head

horizontal
plane

Indications

Patient Position

Glenohumeral
Distraction

Testing; initial treatment


(sustained grade II); pain
control
(grade I or II
oscillations); general
mobility (sustained
grade III).

Supine, with arm in


the resting position.
Support the forearm
between your trunk
and elbow.

Glenohumeral Caudal
Glide in Resting
Position

To increase abduction
(sustained grade III); to
reposition the
humeral head if
superiorly positioned.

Supine, with arm in


the resting position.
Support the forearm
between your trunk
and elbow
Supine, with arm in
the resting position.
Support the forearm
between your trunk
and elbow.
Supine or sitting
arm abducted
External rotation

Glenohumeral Caudal
Glide (Long Axis
Traction)

Glenohumeral Caudal
Glide

To increase abduction.

Supine

Glenohumeral
Elevation Progression
(Fig. 5.17)

To increase elevation
beyond 90 of
abduction.

sitting,
Supine or sitting, with
the arm abducted and
externally

Resting position.
shoulder abducted 55o
horizontally
adducted 30o
rotated
Therapist

Treatment plane.
glenoid fossa
and moves with the
scapula as it rotates.

stabilization.
scapula with a
belt or have an
assistant help

Hand Placement

Mobilizing
Force
move the
humerus la ally

h:patients axilla with


your thumb just distal to
the joint
margin anteriorly and
fingers posteriorly.
S: humerus from the
lateral
surface.
D: axilla(grade I)

H: web space distal to


the
acromion process on the
proximal humerus.

G:distal to
the acromion
process.
caudal glide
hand around the
arm, pulling
caudally as you
shift your body
weight inferiorly.
G: proximal
humerus inferior
direction

St: arm against your


trunk with the hand
farthest from the
patient:D: Slight lateral
motion of your
trunk(gr1)
d: distal humerus(gr1)

Hand placement is the


same as for caudal glide
progression
hand grasping the
elbow, apply a grade I

proximal
humerus, glide
the humerus
in a progressively
anterior direction

distraction
force.

Glenohumeral
Anterior Glide,
Resting Position

To increase extension; to
increase external
rotation.

Prone, with the arm in


resting position over
the edge of
the treatment table,
supported on your
thigh.

Stand facing the top of


the table with the leg
closer to the
table in a forward stride
position.

St: acromion with


padding
S: patients arm against
your thigh with your
outside
Hand*(D:gr1)

against the
inferior
folds of the
capsule in the
axilla.
G: humeral head
in an anterior
and slightly
medial direction.

H:ulnar border of your


other hand just distal to
the posterior angle of
the acromion process,
with your
fingers pointing
superiorly
Glenohumeral
External Rotation
Progressions

To increase external
rotation.

Distraction
progression: shoulder
in resting
position; externally
rotate the humerus
(D:gr3)
Elevation progression

incorporates
end-range external
rotation.
Acromioclavicular
Joint

Anterior Glide of
Clavicle on Acromion

Indication.
To increase mobility of
the joint.

Stabilization.
Fixate the scapula
with your more lateral
hand around the
acromion process.
Sitting

stand behind the patient

St: acromion process


with the fingers of your
lateral
hand.

Push the clavicle


anteriorly with
your thumb.

St: acromion with a


towel
roll under the shoulder.

prone.

Sternoclavicular Joint

Sternoclavicular
Posterior Glide and
Superior
Glide

Sternoclavicular
Anterior Glide and
Caudal
(Inferior)

Scapulothoracic SoftTissue
Mobilization

Joint surfaces.

Treatment plane.

proximal articulating
surface of the
clavicle is convex
superiorly/inferiorly and
concave anteriorly/
posteriorly with an
articular disk between it
and the manubrium
of the sternum.
Posterior glide: increase
retraction
superior glide: increase
depression of the
clavicle

For
protraction/retraction,
the treatment
plane : clavicle.

Patient position and


stabilization.
Supine; the thorax
provides stability to the
sternum.

elevation/depression,t
reatment
plane:manubrium
thumb on the anterior
surface of the proximal
end of the clavicle.
Flex your index finger
and place the middle
phalanx along
the caudal surface of
the clavicle to support
the thumb.

Anterior glide to
increase protraction;
caudal glide to increase
elevation of the clavicle.

patient
prone and progress to
side-lying

fingers are placed


superiorly and thumb
inferiorly
around the clavicle.

therapist
patient
facing you.

S: weight of the
patients arm by draping
it over your inferior arm
and allowing it to hang

H: across the
acromion process
h:, scoop under the
medial
border and under the
inferior angle of the
scapula

Posterior glide:
Push with your
thumb in a
posterior
direction.
Superior glide:
Push with your
index finger in a
superior
direction
Anterior glide: lift
the clavicle
anteriorly with
your fingers
and thumb.
Caudal glide:
press the clavicle
inferiorly with
your fingers.
Move the scapula
in the desired
direction
by lifting from
the inferior angle
or by pushing on
the
acromion
process.

Humeroulnar
Articulation

Humeroulnar
Distraction and
Progression

convex trochlea
articulates with the
concave olecranon
fossa
indications
Testing; initial treatment
(sustained grade II); pain
control
(grade I or II oscillation);

Resting position.
Elbow is flexed 70,
and forearm is
supinated 10.
Patient Position
Supine, with the
elbow over the edge
of the treatment table
or supported with
padding just proximal
to the olecranon
process
Rest the patients
wrist against your
shoulde

Humeroulnar Distal
Glide

To increase flexion.

Supine, with the


elbow over the edge
of the treatment
table.
Begin with the elbow
in resting position.

Humeroulnar Radial
Glide

To increase varus

Humeroulnar Ulnar
Glide

To increase valgus

Side-lying on the arm


to be mobilized, with
the shoulder
laterally rotated and
the humerus
supported on the
table.
Same as for radial
glide except a block or
wedge is placed
under the proximal
forearm for
stabilization (using
distal

Treatment plane.
olecranon
fossa, angled
approximately 45 from
the long axis of the ulna
Hand Placement
end-range
flexion,:fingers of your
medial hand over the
proximal ulna on the
volar surface
endrange
extension: place the
base of your proximal
hand over the proximal
portion of the ulna and
support the
distal forearm with your
other hand.
H: fingers of your
medial hand over the
proximal ulna on the
volar surface;
reinforce it with your
other hand.

Place the base of your


proximal hand just distal
to the elbow;
support the distal
forearm with your other
hand.

Stabilization.
humerus against the
treatment
table with a belt or use
an assistant to hold it.
Mobilizing Force
Apply force against the
proximal ulna at a 45
angle to the
shaft of the bone.

First apply a distraction


force to the joint at a
45 angle to the
ulna, then while
maintaining the
distraction, direct the
force
in a distal direction
along the long axis of
the ulna using a
scooping motion.
Apply force against the
ulna in a radial
direction.

Apply force against the


distal humerus in a
radial direction,
causing the ulna to glide
ulnarly

Humeroradial
Articulation

convex capitulum
articulates with the
concave radial
head (

stabilization).
Resting position.
Elbow is extended,
and forearm is
supinated to the end
of the available range.

indication
To increase mobility of
the humeroradial joint;
to manipulate
a pushed elbow
(proximal displacement
of the radius).
Dorsal glide head of the
radius to increase elbow
extension;
volar glide to increase
flexion.

patient
Supine or sitting, with
the arm resting on the
treatment
table.

Humeroradial
Compression

To reduce a pulled elbow


subluxation

Sitting or supine.

Proximal Radioulnar
Joint

convex rim of the radial


head articulates with the
concave
radial notch on the ulna

Humeroradial
Distraction

Humeroradial
Dorsal/Volar Glides

Proximal Radioulnar

indication
Dorsal glide to increase

Treatment plane.
The treatment plane is
in the concave
radial head
perpendicular to the
long axis of the radius.
therapist
ulnar side of the
patients forearm
so you are between the
patients hip and upper
extremity.

Supine or sitting with


the elbow extended
and supinated to
the end of the
available range.

Resting position.
The elbow is flexed
70 and the forearm
supinated 35

patient

Treatment plane.
The treatment plane is
in the radial notch
of the ulna, parallel to
the long axis of the
ulna.
therapist

Stabilization.
Fixate the humerus with
one of your hands.

St: humerus with your


superior hand.
H: distal radius with the
fingers and thenar
eminence of your
inferior hand
St; humerus with your
hand that is on the
medial
side of the patients
arm.
H: palmar surface of
your lateral hand on the
volar
aspect and your fingers
on the dorsal aspect of
the radial
head.
H: right hand to right
hand, or left hand
to left hand
st: elbow posteriorly
with the other
han
thenar eminence
against the patients
thenar
eminence
Stabilization.
Proximal ulna is
stabilized.

Pull the radius


distally (long-axis
traction causes
joint
traction).

Fixate the ulna with

radial head

Move the radial


head dorsally
with the palm of
your hand
or volarly with
your fingers.

extend the
patients wrist,
push against the
thenar eminence,
and compress
the long axis of
the radius
while supinating
the forearm

Dorsal/Volar Glides

pronation; volar glide to


increase
supination.

Distal Radioulnar
Joint

oncave ulnar notch of


the radius articulates
with the
convex head of the ulna.

Distal Radioulnar
Dorsal/Volar
GlidesDistal
Radioulnar
Dorsal/Volar Glides

Dorsal glide to increase


supination; volar glide to
increase
pronation.

Radiocarpal Joint

concave distal radius


articulates with the
convex proximal
row of carpals, which is
composed of the
scaphoid, lunate,
and triquetrum.
Testing; initial treatment;
pain control; general
mobility of
the wrist.

Radiocarpal
Distraction

Radiocarpal Joint:
General Glides
and Progression

Dorsal glide to increase


flexion
volar glide
to increase extension
radial glide to increase
ulnar deviation
ulnar glide to increase
radial deviation

Hip Posterior Glide

To increase flexion; to

The resting position is


with the forearm

The treatment plane is


the articulating
surface of the radius,
parallel to the long axis
of the radius

Sitting, with the


forearm on the
treatment table

The resting position is


a straight line
through the radius
and third metacarpal
with slight ulnar
deviation.
Sitting, with the
forearm supported on
the treatment table,
wrist over the edge of
the table.
Sitting with forearm
resting on the table in
pronation for the
dorsal and volar
techniques and in
midrange position for
the
radial and ulnar
techniques.
Supine, with hips at

The treatment plane is


in the articulating
surface of the radius
perpendicular to the
long axis of the
radius.

your medial hand


around the
medial aspect of the
forearm
grasp the head of the
radius between
your flexed fingers and
palm of your hand.
Distal ulna.

volarly or
dorsally by
pushing with
your palm or
pulling with your
fingers

St: distal ulna by placing


the fingers of one hand
on
the dorsal surface and
the thenar eminence
and thumb on the
volar surface.
H: in the same manner
around the distal radius.
Distal radius and ulna.

Glide the distal


radius dorsally to
increase
supination or
volarly to
increase
pronation parallel
to the ulna.

The force comes from


the hand around the
distal row of
carpals.

Stand on the medial

Keep your elbows

increase internal rotation

the end of the table.


The patient helps
stabilize the pelvis
and lumbar spine by
flexing the opposite
hip and holding the
thigh against the
chest with the hands.

side of the patients


thigh.
belt around your
shoulder and under the
patients
thigh to help hold the
weight of the lower
extremity.

extended and flex your


knees; apply the
force through your
proximal hand in a
posterior direction

distal hand under the


belt and distal thigh.

Hip Anterior Glide

To increase extension; to
increase external
rotation.

Prone, with the trunk


resting on the table
and hips over the
edge. The opposite
foot is on the floor.

Tibiofemoral
Articulations

concave tibial plateaus


articulate on the convex
femoral
condyles

The resting position is


25 flexion

Tibiofemoral
Posterior Glide

to increase flexion

Supine, with the foot


resting on the table

proximal hand on the


anterior surface of the
proximal
thigh.
Stand on the medial
side of the patients
thigh
belt around your
shoulder and the
patients thigh
to help support the
weight of the leg.
distal hand, hold the
patients leg.
proximal hand
posteriorly on the
proximal
thigh just below the
buttock.
The treatment plane is
along the surface
of the tibial plateaus;
therefore, it moves with
the tibia as the
knee angle changes.
Sit on the table with
your thigh fixating the
patients foot.
With both hands, grasp
around the tibia, fingers
pointing

Keep your elbow


extended and flex your
knees; apply the force
through your proximal
hand in an anterior
direction.

In most cases, the


femur is stabilized with
a
belt or by the table.

Extend your elbows and


lean your body weight
forward; push
the tibia posteriorly with
your thumbs.

Tibiofemoral
Posterior Glide:
Alternate
Positions and
Progression

Tibiofemoral Anterior
Glide

To increase extension.

Talocrural Dorsal
(Posterior) Glide

To increase dorsiflexion

Sitting, with the knee


flexed over the edge
of the treatment
Table
90 flexion with the
tibia positioned in
internal
rotation.
Prone
small pad under
the distal femur to
prevent patellar
compression.

Supine, with the leg


supported on the
table and the heel
over
the edge.

posteriorly and thumbs


anteriorly.
stand on the medial side
of
the patients leg.

Stand to the side of the


patient

Talocrural Ventral
(Anterior) Glide

To increase
plantarflexion.

Prone, with the foot


over the edge of the
table

end of the table

Subtalar Medial Glide


or Lateral Glide

Medial glide to increase


eversion; lateral glide to
increase
inversion.

patient is side-lying or
prone, with the leg
supported on
the table or with a
towel roll.

Align your shoulder and


arm parallel to the
bottom of
the foot.

Hold the distal leg with


your distal hand
and place the palm of
your proximal hand
along the anterior
border of the tibial
plateaus.

Extend your
elbow and lean
your body weight
onto the
tibia, gliding it
posteriorly.

Grasp the distal tibia


with the hand that is
closer to it and
place the palm of the
proximal hand on the
posterior aspect
of the proximal tibia.

Apply force with


the hand on the
proximal tibia in
an anterior
direction. The
force may be
directed to the
lateral or medial
tibial plateau to
isolate one side
of the joint
Glide the talus
posteriorly with
respect to the
tibia by pushing
against the talus.

palmar aspect of the


web space of your other
hand over the talus just
distal to the mortise.
fingers and thumb
around the foot
D: lateral hand
across the dorsum of
the foot
web space of your other
hand just distal to the
mortise on the posterior
aspect of the talus and
calcaneus.
Stabilize the talus with
your proximal hand.
Place the base of the
distal hand on the side
of the calcaneus
medially to cause a
lateral glide and

Push against the


calcaneus in an
anterior direction
(with
respect to the
tibia); this glides
the talus
anteriorly.
a grade I
distraction force
in a caudal
direction, then
push with the
base of your
hand against the

Intertarsal and
Tarsometatarsal
Plantar Glide

increase plantarflexion
accessory motions
(necessary for
supination).

Supine, with hip and


knee flexed, or sitting,
with knee flexed
over the edge of the
table and heel resting
on your lap.

lateral side of the foot

laterally to cause a
medial glide.
Wrap the fingers
around the plantar
surface.
Place
the proximal hand on
the dorsum of the foot
with the fingers
pointing medially, so the
index finger can be
wrapped
around and placed
under the bone to be
stabilized

Place
the proximal hand on
the dorsum of the foot
with the fingers
pointing medially, so the
index finger can be
wrapped
around and placed
under the bone to be
stabilized

side of the
calcaneus
parallel to the
plantar surface
of the heel
Push the distal
bone in a plantar
direction from
the dorsum
of the foot.