Peripheral Joint Mobilization
for Impaired Mobility
Chapter 5
Part II: Applied Science of Exercise and
Techniques
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Joint Mobilization/Manipulation
 Manual therapy techniques that are used to
modulate pain and treat joint impairments
that limit ROM by specifically addressing the
altered mechanics of the joint
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Definition of Terms
 Mobilization/Manipulation
– Thrust manipulation/high-velocity thrust (HVT)
 Self-Mobilization (Auto-Mobilization)
 Mobilization With Movement (MWM)
 Physiological Movements
– Osteokinematics
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Definition of Terms (cont'd)
 Accessory Movements
– Component motion
– Joint play: arthrokinematics
 Manipulation Under Anesthesia
 Muscle Energy
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Basic Concepts of Joint Motion:
Arthrokinematics
 Joint Shapes
– Ovoid
– Sellar (saddle)
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Basic Concepts of Joint Motion:
Arthrokinematics (cont'd)
 Types of Motion
– Swing: Movement of the bony lever about an axis
of motion
– Motion of the bone surfaces in the joint
• Roll
• Slide/translation
• Combined roll-sliding in a joint (glide)
• Spin
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Convex-Concave Rule
 Basis for determining the direction of the
mobilizing force when joint mobilization
gliding techniques are used
– Sliding is in the opposite direction of the angular
movement of the bone if the moving surface is
convex
– Sliding is in the same direction if the moving
surface is concave
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Passive-Angular Stretching Versus
Joint-Glide Stretching
 Passive-angular stretching may cause
increased pain or joint trauma
 Joint-glide is safer and more selective
– Controlled
– Replicates normal joint mechanics
– Force is specific to target tissues
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Other Accessory Motions That
Affect the Joint
 Compression
 Traction: Longitudinal Pull
– Long axis traction
 Distraction: Separation of Joint Surfaces
– Joint traction or joint separation
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Effects of Joint Motion
 Helps move synovial fluid to maintain cartilage
health
 Maintains extensibility and tensile strength of
articular and periarticular tissues
 Provides sensory input for proprioceptive
feedback important for balance response
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Indications for Joint
Mobilization/Manipulation
 Pain, Muscle Guarding, and Spasm
– Neurophysiological effects
– Mechanical effects
 Reversible Hypomobility
 Positional Faults/Subluxations
 Progressive Limitation
 Functional Immobility
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Limitations of Joint Mobilization/
Manipulation Techniques
 Cannot Change Disease Process
 Cannot Change Inflammatory Process
 Skill of the Therapist Affects the Outcome
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Contraindications
 Hypermobility
 Joint Effusion
 Inflammation
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Conditions Requiring Special
Precautions for Stretching
 Malignancy
 Bone Disease Detectable on Radiograph
 Unhealed Fracture (With Limitations)
 Hypermobility in Associated Joints
 Total Joint Replacements
 Newly Formed or Weakened Connective Tissue
 Elderly Individuals
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Procedures for Applying Passive
Joint Techniques
 Examination and Evaluation
– Quality of pain
– Capsular restriction (specific pattern)
– Subluxation or dislocation
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Procedures for Applying Passive
Joint Techniques (cont'd)
 Documentation
– Use of standardized terminology
– Characteristics of documentation
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Rate of application of movement
Location of range in the available motion
Direction of force applied by the therapist
Target of force
Relative structural movement
Patient position
Non-Thrust Oscillation Techniques
 Grade I: Small Amplitude at Beginning of Range
– Pain inhibition and fluid movement
 Grade II: Large Amplitude Within the Range
– Pain inhibition and fluid movement
 Grade III: Large Amplitude Up to the Limit into
Resistance
– Stretching maneuver
 Grade IV: Small Amplitude at the Limit into Resistance
– Stretching maneuver
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Non-Thrust Sustained Joint-Play
Techniques
 Grade I: Loosen: Small Amp Distraction
– Pain relief
 Grade II: Tighten: Distraction or Glide to
Tighten Tissue
– Pain relief, assess joint sensitivity, maintain joint
play
 Grade III: Stretch: Distraction or Glide
– Increase joint play
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Comparison of Oscillation and
Sustained Techniques
Representation of Oscillation
Techniques
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Representation of Sustained
Joint-Play Techniques
Thrust Manipulation/High-Velocity
Thrust (HVT)
 Application
– Small-amplitude, high-velocity
– Performed only once
 Indications
– Snap adhesions
– Reposition joint surfaces
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Procedures for Applying Passive
Joint Techniques
 Positioning and Stabilization
 Direction and Target of Treatment Force
– Treatment plane
 Initiation and Progression of Treatment
 Patient Response
 Total Program
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Mobilization With Movement
(MWM): Principles of Application
 Principles and Application of MWM in Clinical
Practice
– Comparable sign
– Passive techniques
– Accessory glide with active comparable sign
– No pain
– Repetitions
– Description of techniques
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Mobilization With Movement (MWM):
Principles of Application (cont'd)
 Patient Response and Progression
– Pain as a guide
– Self treatment
– Total program
 Theoretical Framework
– Brian Mulligan
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Peripheral Joint Mobilization
Techniques
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Shoulder Girdle Complex
Elbow and Forearm Complex
Wrist and Hand Complex
Hip Joint
Knee Joint Complex
Leg and Ankle Joints
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Independent Learning Activities
 Critical Thinking and Discussion
 Laboratory Practice
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