PERIPHERAL Joint Mobilization
Chapter 5
Part 5
PERIPHERAL JOINT MOBILIZATION
TECHNIQUES
Hip Joint
Hip Joint
• The concave acetabulum
receives the convex
femoral head.
• Resting Position
– flexion 30, abduction 30,
and slight external rotation.
• Stabilization
– Fixate the pelvis to the
treatment table with belts.
Bones and joints of the pelvis and hip.
Hip Distraction of the Weight-Bearing
Surface, Caudal Glide
• Indications
–
–
–
–
Testing
Initial treatment
Pain control
General mobility
• PRECAUTION:
– In the presence of knee
dysfunction, this
position should not be
used; see alternate
Hip joint: distraction of the weight-bearing
position
surface.
Alternate Position for Hip Caudal
Glide
• Indication
– To apply distraction to
the weight-bearing
surface of the hip joint
when there is knee
dysfunction.
• Patient Supine, with the
hip and knee flexed.
Hip Posterior Glide
Indications
• To increase flexion
• To increase internal
rotation
Hip joint: posterior glide
Hip Anterior Glide
• Indications
• To increase extension
• To increase external
rotation.
Hip joint: anterior glide (A) prone
Hip Anterior Glide
(Alternate Position)
Knee and Leg
Knee and Leg
• Tibiofemoral Articulation
• The concave tibial plateaus
articulate on the convex femoral
condyles
• Resting Position
• The resting position is 25 flexion.
• Treatment Plane
• The treatment plane is along the
surface of the tibial plateaus
therefore, it moves with the tibia as
the knee angle changes.
• Stabilization
• In most cases, the femur is
stabilized with a belt or by the
table.
Bones and joints of the knee and leg.
Tibiofemoral Distraction, Long-Axis
Traction
•
•
•
•
•
Indications
Testing
initial treatment
pain control
general mobility.
Tibiofemoral joint: distraction (A) sitting
Tibiofemoral Distraction, Long-Axis
Traction
Tibiofemoral joint: distraction supine,
Tibiofemoral Distraction, Long-Axis
Traction
Tibiofemoral joint: distraction PRONE
Tibiofemoral Posterior Glide
• Indications
• Testing
• to increase flexion.
Tibiofemoral joint: posterior glide (drawer
Tibiofemoral Posterior Glide:
Alternate Positions and Progression
• Indication
• To increase flexion
Tibiofemoral joint: posterior glide, sitting.
Tibiofemoral Anterior Glide
• Indication
• To increase extension
Tibiofemoral joint: anterior glide.
Tibiofemoral Anterior Glide
(Alternate positions)
• Alternate Position
• The drawer test position
can also be used. The
mobilizing force comes
from the fingers on the
posterior tibia as you lean
backward
Patellofemoral Joint, Distal Glide
• Indication
• To increase patellar
mobility for knee flexion
• PRECAUTION
• Do not compress the
patella into the femoral
condyles while
performing this
technique
Patellofemoral joint: distal glide.
Patellofemoral Medial-Lateral Glide
• Indication
• To increase patellar
mobility
Patellofemoral joint: lateral glide.
Proximal Tibiofibular Articulation:
Anterior (Ventral)Glide
• Indications
• To increase movement
of the fibular head; to
reposition a posteriorly
positioned head
Proximal tibiofibular joint: anterior glide
Distal Tibiofibular Articulation:
Anterior(Ventral) or Posterior(Dorsal)
Glide
• Indication
• To increase mobility of
the mortise when it is
restricting ankle
dorsiflexion.
Distal tibiofibular articulation: posterior glide
Ankle and Foot Joints
Ankle and Foot Joints
Talocrural Joint (Upper Ankle Joint)
• The convex talus articulates with
the concave mortise made
up of the tibia and fibula.
Resting Position
• The resting position is 10
plantarflexion
Treatment Plane
• The treatment plane is in the
mortise, in an anteriorposterior
direction with respect to the leg.
Stabilization
(A) Anterior view of the bones and joints of
the lower leg and ankle. (B) Medial view. (C)
• The tibia is strapped or held
Lateral view of the bones and joint
against the table.
relationships of the ankle and foot.
Talocrural Distraction
•
•
•
•
•
Indications
Testing
Initial Treatment
Pain Control
General Mobility.
Talocrural joint: distraction.
Talocrural Dorsal (Posterior) Glide
• Indication
• To increase dorsiflexion
Talocrural joint: posterior glide
Talocrural Ventral (Anterior) Glide
Indication
• To increase
plantarflexion
Talocrural joint: anterior glide.
Subtalar Joint (Talocalcaneal),
Posterior Compartment
• The calcaneus is convex,
articulating with a concave
talus in the posterior
compartment
Resting Position
• The resting position is
midway between inversion
and eversion.
Treatment Plane
• The treatment plane is in the
talus, parallel to the sole of
the foot
(A) Anterior view of the bones and joints of the
lower leg and ankle. (B) Medial view. (C)
Lateral view of the bones and joint
relationships of the ankle and foot
Subtalar Distraction
•
•
•
•
•
Indications
Testing
Initial treatment
Pain control
General mobility for
inversion/eversion
Subtalar (talocalcaneal) joint: distraction
Subtalar Medial Glide or Lateral Glide
• Indications
• Medial glide to increase
eversion
• lateral glide to increase
inversion.
Subtalar joint: lateral glide:
(A) prone and
(B) side-lying.
Intertarsal and Tarsometatarsal Joints
• When moving in a dorsalplantar direction with respect
to the foot, all of the
articulating surfaces are
concave and convex in the
same direction.
• For example, the proximal
articulating surface is convex
and the distal articulating
surface is concave.
• The technique for mobilizing
each joint is the same. The
hand placement is adjusted to
stabilize the proximal bone
partner so the distal bone
partner can be moved.
(A) Anterior view of the bones and joints of the
lower leg and ankle. (B) Medial view. (C)
Lateral view of the bones and joint
relationships of the ankle and foot
Intertarsal and Tarsometatarsal
Plantar Glide
• Indication
• To increase
plantarflexion accessory
motions (necessary for
supination).
Plantar glide of a distal tarsal bone on a
stabilized proximal bone. Shown is the
cuneiform bone on the navicular
Intertarsal and Tarsometatarsal
Dorsal Glide
• Indication
• To increase the dorsal
gliding accessory
motion (necessary for
pronation).
Dorsal gliding of a distal tarsal on a proximal
tarsal. Shown is the cuboid bone on the
calcaneus
Intermetarsal, Metatarsophalangeal,
and Interphalangeal Joints
• The intermetatarsal,
metatarsophalangeal, and
interphalangeal joints of the
toes are stabilized and
mobilized in the same
manner as the fingers.
• In each case, the articulating
surface of the proximal bone
is convex, and the
articulating surface of the
distal bone is concave.
.
• It is easiest to stabilize the
proximal bone and glide
the surface of the distal
bone either plantarward
for flexion, dorsalward for
extension, and medially
or laterally for adduction
and abduction