MOBILISATION AND

MANIPULATION
Introduction
Joint mobilization, also known as manipulation, refers to manual therapy
techniques that are used to modulate pain and treat joint impairments that
limit range of motion (ROM) by specifically addressing the altered
mechanics of the joint. The altered joint mechanics may be due to pain and
muscle guarding, joint effusion, contractures or adhesions in the joint
capsules or supporting ligaments, or aberrant joint motion.
Historically, mobilization has been the preferred term to use as therapists
began using the passive, skilled joint techniques because mobilization had a
less aggressive connotation than manipulation. High-velocity thrust (HVT)
techniques, typically called manipulation. The terms "mobilization" and
"manipulation" will be used interchangeably, with the distinction made
between non-thrust and thrust techniques.
To use joint mobilization/manipulation techniques for effective
treatment, the practitioner must know and be able to examine the
anatomy, arthrokinematics, and pathology of the neuromusculoskeletal
system and to recognize when the techniques are indicated or when
other techniques would be more effective for regaining lost motion.
Indiscriminate use of joint techniques, when not indicated, could lead
to potential harm to the patient's joints.
Indications
1. Painful joint
2. Reflex muscle guarding
3. Muscle spasm
4. Reversible
5. Positional faults hypomobility
6. Progressive limitation
7. Functional immobility
Contraindications
1.Hypermobility
2.Joint effusion
3.Inflammation

Limitations
Joint mobilization and manipulation 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.
Various school of thoughts of manual
therapy.
1. Physical therapist generated
Maitland mobilisation technique
Kaltenborn mobilisation technique
McKenzie mobilisation technique
Mulligan mobilisation technique
MET
D.O.Rolfing
Bindegewe massage
Swedish remedial technique/NVTT
Australian approach
New Zealand approach
Norwegian approach

2.Physician generated
Osteopaths
Chiropractic
Cyriax
Craniosacral therapy
 Mc Kenzie Mobilization
 The Mc Kenzie Method on Mechanical diagnosis and therapy (MDT) is a system of
diagnosis and treatment for spinal and extremity musculoskeletal disorders.
 MDT was introduced in 1981 by Robin McKenzie (1937-2013), a physical therapist from
New Zealand.
A key feature of the method is initial assessment - a safe and reliable format to reach and
accurate classification and only then develop the appropriate management plan, taking into
account all the various factors that can influence the patients experience of pain.
 In the treatment by MDT disorders in the spine, which have become reflected symptoms in
the extremities, important place takes an -Centralization the symptoms movement from
the distal segment of body to the. Proximal Advent of centralization is a good signal and
speaks of correctness action being taken. And in contrast, Peripheralization the movement
of pain from the spine to the extremities. indicates worsening.
• MDT exist of 4 steps
1. Assessment
2. Classification
- Derangement syndrome
- Dysfunction syndrome
- Postural syndrome
3. Treatment
4. Prevention
Assessment
• History tacking
• Physical examination
• Ruling out Red flag Sign – 1) anorexia
2) history of significant weight loss
3) presence of night pain
4) presence of on and off fever.
Classification
1. Postural syndrome: pain is created from mechanical deformation of normal soft tissue or vascular insufficiency as a
result of prolonged position and postural stresses.
Treating postural syndrome: reeducate the patient
correct sitting posture
Use of a lumber roll
Correct standing and sleeping posture as appropriate
2. Dysfunction syndrome: pain is caused by mechanical deformation of structurally impaired soft tissue.
Pain occurs when the end range stress is applied to adaptively shortened structures.
Pain always intermittent and symptoms must have been present for at least 6 to 8 weeks.
Treatment for dysfunction syndrome: Goal is increase ROM by remodeling tissue.
Pain should never peripheralize.