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Joint Mobilization

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° Joint motion is often lost due to injury
° Contracture of inert connective tissue
° Resistance of contractile tissue to stretch
° May result in joint hypomobility
° To regain motion
° Joint mobilization

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Relationship Between
Physiological and Accessory
Motion
° Biomechanics of joint motion
° Page 174 Therapeutic Exercise (White book)
° Physiological motion
° Result of concentric or eccentric active muscle
contractions
° Also referred to as osteokinetic motion
° Bones moving about an axis or through flexion,
extension, abduction, adduction or rotation
° Accessory Motion
° Motion of articular surfaces relative to one another
° Generally associated with physiological movement
° Necessary for full range of physiological motion to
occur
° Ligament and joint capsule involvement in motion
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° 9tretching techniques must be utilized in
order to correct physiological motion
deficits
° Most effective at end of physiological range of
motion
° Utilizes long lever arms to apply stretch of
muscles
° To improve accessory motion mobilization
techniques are required
° Used to correct tight inert tissues
° Multidirectional activity that can be effective at
any point in range
° Utilize short lever arms, resulting in less stress
being applied to ligamentous structures
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Joint Arthrokinematics
° involves 3 components
° 9pin
° Motion that occurs about some stationary
longitudinal mechanical axis
° Radial head at the humeroradial joint
° Roll
° A series of points on one articulating surface
come into contact with a series of points on
another surface
° Rocking chair analogy
° Femoral condyles rolling on tibial plateau
° Occurs in direction of movement

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° Glide (translation)
° 9pecific point on one articulating surface comes into
contact with a series of points on another articulating
surface
° Occurs when performing an anterior drawer of knee
(tibial plateau sliding anteriorly relative to femoral
condyles)
° Pure gliding requires congruent surfaces
° Direction of movement determined by shape of
articulating surface (convex/concave)
° Joint motion will often involve a combination of
these components
° Rolling and gliding generally occur together
° Not always proportional or in same direction

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Convex-Concave Rule
° Relationship of articulating surfaces
associated with gliding
° if concave joint is moving on stationary
convex surface ± glide occurs in same
direction as roll
° if convex surface is moving on
stationary concave surface ± gliding
occurs in opposite direction to roll
° Necessary to understand in order to
determine appropriate treatment
direction
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Joint Positions
° Resting position
° Maximum joint play- position in which joint capsule
and ligaments are most relaxed
° Evaluation and treatment position utilized with
hypomobile joints
° Loose-packed position
° Articulating surfaces are maximally separated
° Joint will exhibit greatest amount of joint play
° Position used for both traction and joint mobilization
° Close-packed position
° Maximal contact of articulating surfaces

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° Mobilization and
traction utilize
translation
movements of joint
surfaces relative to
one another
° Treatment occur
perpendicular or
parallel to treatment
plane
° Mobilization
techniques involve
glides that translate
along the treatment
plane
° Traction ± moves
perpendicular to
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Joint Mobilization Techniques
° Used to improve joint mobility or decrease
joint pain by restoring accessory motion
° Used to attain mechanical or
neurophysiological treatment goals
° Pain reduction
° Decrease muscle guarding
° 9tretching or lengthening tissue surrounding a joint
° Reflexogenic effects
° Facilitate muscle tone or stretch reflex
° Proprioceptive effects

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° Accessory motion can be hypo-, normal,
or hypermobile
° Joints have range with anatomical limits
(bony and soft tissue)
° With hypomobile joints motion stops at
point short of anatomical limits
° Pathological point of limitation
° Hypermobile joint move beyond
anatomical limits
° Due to laxity
° Treat with strengthening and stability
exercises, bracing, taping, or splinting

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° To restore motion in hypomobile joints
tissue deformation occurs
° Tissue stretch within elastic range does
not produce permanent structural change
° 9tretching in plastic range cause
permanent structural changes
° Traction and joint mobilization can be
used to stretch tissue and break tissue
adhesions
° Treatments generally involve slow, small
amplitude movements
° Joint mobilizations involve small amplitude oscillations

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Maitland Joint Mobilization
Grading 9cale
° Grade i
° 9mall amplitude movement at the
beginning of the range of movement
° Used to manage pain and spasm
° Grade ii
° Large amplitude movement within midrange
of movement
° Utilize when quick oscillation induces spasm
or when slowly increasing pain restricts
movement halfway into range

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° Grade iii
° Large amplitude movement up to point of
limitation (PL) in the range of movement
° Used when pain and resistance from spasm,
inert tissue tension or tissue compression limit
movement near end of range
° Grade i
° 9mall amplitude movement at very end of
range
° Used when resistance limits movement in
absence of pain

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Grades of Movement

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° All joint mobilizations follow the convex-
concave rule
° if mobilization in the appropriate direction
exacerbates pain or stiffness the
technique should be applied in the
opposite direction until tolerance to the
appropriate direction is achieved
° Joint mobilization sessions usually involve
3-6 sets of oscillations lasting 20-60
seconds, 1-3 oscillations per second

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indications for Mobilization
° Grades i and ii are used primarily for pain
° Grades iii and i can be utilized for stiffness
° Pain must be treated prior to stiffness
° 9mall amplitude oscillations are utilized to
stimulate mechanoreceptors, limiting pain
perception
° Painful conditions can be treated daily
° 9tiff or hypomobile joints should be treated 3-
4 times per week ± alternate with active
motion exercises

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° Pain prior to resistance being applied
° Avoid mobilization techniques
° Pain elicited upon resistance to motion
applied
° Grade i and ii mobilizations
° Resistance application prior to indication
of pain
° Grade iii and i
° Athlete and athletic trainer must utilize
appropriate positioning to ensure safe and
effective treatment

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Pain and Resistance

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Contraindications for
Mobilization
° 9hould not be used haphazardly
° Avoid the following
° inflammatory arthritis
° Malignancy
° Bone disease
° Neurological involvement
° Bone fracture
° Congenital bone deformities
° ascular disorders

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Joint Traction Techniques
° Technique involving pulling one
articulating surface away from another
± creating separation
° Performed perpendicular to treatment
plane
° Used to decrease pain or reduce joint
hypomobility
° Kaltenborn classification system
° Combines traction and mobilization
° Joint looseness = slack

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Kaltenborn Traction
Grading
° Grade i (loosen)
° Neutralizes pressure in joint without actual surface
separation
° Produce pain relief by reducing compressive forces
° Grade ii (tighten or take up slack)
° 9eparates articulating surfaces, taking up slack or
eliminating play within joint capsule
° Used initially to determine joint sensitivity
° Grade iii (stretch)
° involves stretching of soft tissue surrounding joint
° increase mobility in hypomobile joint

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° Grade i traction should be used initially to
reduce chance of painful reaction
° 10 second intermittent grade i and ii
traction can be used
° Distracting joint surface up to a grade iii
and releasing allows for return to resting
position
° Grade iii traction should be used in
conjunction with mobilization glides for
hypomobile joints
° Application of grade iii traction (loose-pack
position)
° Grade iii and i oscillations within pain
limitation to decrease hypomobility
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