Choosing mobilizations, manipulations,

exercises
Factors – elements in any mobilization manipulation

1 FLEXION OPENING-DIVERGENCE
OTHER FACTORS
2 CONTRALATERAL OPENING-DIVERGENCE TRACTION
LATERAL BENDING
CONTRALATERAL OPENING-DIVERGENCE
COMPRESSION
3
ROTATION SLIP / SLIDE

4 EXTENSION CLOSING - CONVERGENCE

5 IPSILATERAL LATERAL CLOSING - CONVERGENCE

BENDING
RELATED WITH THE SPECIFIC
ANATOMICAL AND BIOMECHANICAL
6 IPSILATERAL ROTATION CLOSING - CONVERGENCE CHARACTHERISTICS OF THE JOINTS
Closing sequences
EXTENSION + IPSILATERAL LATERAL BENDING + ROTATION
(Factor that increases or decreases the closure (compression)
depending on the coupling or the anatomical peculiarities of
the area.
Think = 3 closing items = max compression forces.

EXTENSION + IPSILATERAL LATERAL BENDING 2 CLOSING FACTORS

EXTENSION ALONE = 1 CLOSING FACTOR

IPSILATERAL LATERAL BENDING ALONE = 1 CLOSING FACTOR

ROTATION ALONE = 1 CLOSING FACTOR USUALLY (OPENING WITH OPOSITE COUPLING)?

Opening sequences
FLEXION + CONTRALATERAL LATERAL BENDING + ROTATION
(Factor that increases or decreases the OPENING (DIVERGENCE)
depending on the coupling or the anatomical peculiarities of the
area.
THINK = 3 OPENING FACTORS = max OF OPENING DIVERGENCE.

FLEXION + CONTRALATERAL LATERAL BENDING= 2 OPENING factors

FLEXION ALONE = 1 OPENING FACTOR

CONTRALATERAL LATERAL BENDING ALONE = 1 OPENING FACTOR

CONTRALATERAL ROTATION ΜΟΝΗ ΤΗΣ = 1 OPENING FACTOR USSUALY(WITH NON

TYPICAL COUPLING?)
 REAL TIME PATIENTS DON’T KNOW
BIOMECHANICS
 SEVERITY • Determine the Nature of the problem (Articular muscular neural other..)
 IRITABILITY • Specify the levels involved and whether it is a closing or opening
 NATURE mechanism
 STAGE • Find the dominant direction for Pain and Restriction (Combination of
active passive and accessory movements if required)
• Adjust the combination of motion direction to the treatment level.
(Depending on previous findings)
• Choose mobilization or manipulation based on the specific
characteristics of the patient and your own experience with specific
techniques!
 Selection of Mobilizations

Stage N
Mechanism I
NATURE COMBINE
STAGE • ARTICULAR FINDINGS
• ACUTE MECHANISM: • MUSCULAR • DOMINANT
IRRITABILITY MECHANISM
• SUB-ACUTE OPENING • NEURAL
SEVERITY AT THIS TIME
• CHRONIC CLOSING • BIO PSYCHO
POINT
• OTHER
 Selection of Mobilizations

Moderate/Low irritability Direction

(Articular mechanism) • Towards pain - Limitation
• Opening • Continuous control of the irritability
• or response.
• Closing • The stage and irritability will determine
the intervention volume in frequency
and intensity.
 Selection of Mobilizations

High irritability (articular mechanism) Direction

• Opposite From pain-restriction
• Opening (rare) • Continuous control of the irritability
• Or response.
• Closing • The stage and irritability will determine
the intervention volume in frequency
and intensity.
• The purpose here is initially to relieve
and desensitize and not to improve the
restriction
Selection of Mobilizations

➢ Depending on the irritability we can combine the factors of the

mechanism

➢ With scaling and combinations determined by the patient's

response.

➢ If we produce an alarming irritability we relieve through the

opposite direction.
 Selection of Mobilizations with neural involvement
(Neural involvement)
• Articular mechanism dominant
irritates the nerve
• With compression ?
• Tension or Sliding provokes
irritation?
• Combination ?
• How irritable?
Strategy:
1. No articular technique to "irritate" the
nerve. "Articular" movements that relieve the
nerve without secondary loss of ROM. Towards
Centralization if occurs
2. The mechanical environment in movements
or positions that relieve the nerve
3. Sliders or Tensioners at the minimum
irritability ROM
(Neural involvement) dominant nervous mechanism

Choose the technique

from the point of the
minimum irritability.
 Choosing exercises

Stage NATURE COMBINATION

• ACUTE • ARTICULAR • FINDING THE

DOMINANT
• SUB-ACUTE • MUSCULAR
MECHANISM
• CHRONIC • NEURAL IN THIS PHASE

• BIO-PSYCHO
• OTHER
 • SMALL VOLUME
Stage OF EXERCISE
AND AWAY FROM
THE PAIN
ACUTE • PROGRESSIVE
SUB-ACUTE AGGRAVATION
CHRONIC • PROGRESSIVE
AGGRAVATION +
GRADATION
AND OBJECTIVES
 Directional preference / Copy the mobilization pattern / gradual
adaptation stage depended

Nature What is the goal ? Relaxation / Strengthening / Stretching / motor

pattern functional rehabilitation.
ARTICULAR Neurophysiology – Coaching / Adjustment depending on the stage
• MUSCULAR
• NEURAL
• OTHERS Stage recognition.
Compression or tension mechanism or mixed type
Neurodynamic sequences With or without mechanical enviroment
mobilization .