Rehabilitation
Techniques for
Sports Medicine
& Athletic
Training
William E.
Prentice

 Slow, passive movements of articulating surfaces
 Following injury loss of motion may occur at a joint
 Contracture of connective tissue
 Resistance of contractile tissue to stretch
 Or some combination of the two
 If left untreated joint will become HYPO-mobile
 Motion stops at pathological point of limitation
(PL)
 Caused by pain, spasm or tissue resistance

 Regain normal active joint range of motion (AROM)
 Restore normal passive motions
 Reposition or realign a joint
 Regain normal distribution of forces and stresses about a joint
 Reduce pain
 All will help improve joint function
 Effective and widely used techniques in injury rehabilitation

 Physiological
 Result of concentric or eccentric muscle action
 Bone can move about axis of rotation
 Also called osteokinematics
 Voluntary
 Accessory
 Manner in which one articulating joint surface moves relative to another
 Normal accessory movement must occur for full range physiological mvmt. to occur
 Also called joint arthrokinematics

 Accessory motion cannot occur independently but can be produced by external force
 JM and Traction can be used if accessory motion is limited due to some restriction of the joint capsule or ligaments
 JM can be used at any point in the range of motion and in any direction in which movement is restricted

 Include spin, roll and glide
 Spin: Around a stationary axis, clockwise or counterclockwise
 i.e.. Radial head at humeroradial joint during pronation/supination
 Roll: series of points on 1 articulating surface come in contact with series of points on another
 i.e.. Femoral condyles on tibia plateau during squat
 Will always occur in same direction as physiological movement

 Glide: when a specific point on 1 articulating surface comes in contact with series of points on another
 Also called translation
 Tibial plateau on fixed femoral condyles during anterior drawer test
 Occurs simultaneously with rolling in most joints
 Direction of glide will be determined by shape of articulating surface that is moving
 i.e.. Convex-rounded Concave-flat or divot

 If concAve surface is moving on a stationary convex surface, gliding will occur in the sAme direction as the rolling motion
 If a cOnvex surface is moving on a stationary concave surface, gliding will occur in Opposite direction to rolling
 JM for hypomobile joints use gliding technique
 Critical to know direction of glide

 Closed-Packed position
 Maximal contact of articulating surfaces
 Joint capsule and ligaments tight or tense
 No joint play
 Loose-packed position
 Resting position
 Joint surfaces maximally separated
 Joint capsule and ligaments most relaxed
 Most appropriate for eval of joint play, traction, and JM

 JM and traction techniques use translational movement of one joint relative to another
 Treatment plane (TP): Perpendicular or at right angle to a line from axis of rotation on convex surface to center of concave surface
 TP lies within the concave surface
 If convex segment moves TP remains fixed
 If Concave surface moves TP moves with concave surface
 JM -parallel with treatment plane
 Traction-perpendicular to treatment plane

 Indications/Goals
 Reduce pain
 Decrease muscle guarding
 Stretching or lengthening tissue surrounding joint
(capsular & ligamentous)
 Break adhesions and stretch tissue to permanent structural changes
 Reflexogenic effects that inhibit or facilitate muscle tone or stretch reflex
 Proprioceptive effects to improve postural and kinesthetic awareness

 Patient and AT positioned in a comfortable and relaxed manner
 AT should mobilize 1 joint at a time
 Hand positioning should be as close to the joint as possible
 Avoid long lever arm
 Short lever arm will allow stretch of capsule and ligaments w/o rolling
 Avoid rolling, move as 1 segment in appropriate plane
 Segment that is moving should be held in a firm and confident manner

 Amplitude: distance joint moves passively within total range
 From Beginning point in ROM (BP) to anatomical limit (AL)
 Oscillations: movement that glides or slides articulating surface in appropriate direction
 3-6 sets of 20-60 second oscillations w/ 1-3 oscillations/second
 Grade I: small amplitude movement at beginning of range of motion
 Pain and spasm limit mvmt early in ROM
 Grade II: large amplitude mvmt w/in midrange of mvmt
 Pain and spasm occur toward mid-ROM
 Grade III: Large amplitude mvmt. From mid -range to PL
 Pain, spasm or tissue tension/compression limit mvmt. Near end range

 Grade IV: small amplitude movement at end of range of motion.
 Got to PL and perform small-amplitude oscillations
 Resistance limits movement in absence of pain and spasm
 Grade V: small amplitude mvmt from PL to anatomical limit
(AL)
 Manipulation (chiropractic)
 Usually accompanied w/ popping sound
 Velocity of thrust more important/effective that force of thrust
 Great deal of skill and judgment necessary for safe and effective treatment

Indications
 Pain
 Grades I & II
 Pain treated 1 st and stiffness 2nd
 Stimulate mechanoreceptors that limit transmission of pain perception
 Treated daily
 Hypomobility
 Grades III & IV
 3-4 x week
Contraindications
 Pain with mobilization technique
 Inflammatory arthritis
 Malignancy
 Bone disease
 Neurological involvement
 Bone fractures/deformities
 Vascular disorders

 Manual technique
 May require strap for stabilization or traction
 Wedge or foam roll for stabilization
 Treatment table-preferably a high-low table
 Theraband may be used for grip

 Pulling 1 articulating segment to produce separation from another articulating segment
 Performed perpendicular to treatment plane
 Also used to decrease pain and reduce joint hypomobility
 Grade I traction techniques accompany JM techniques

 Grade I
 Traction neutralizes pressure w/o actual separation
 Used w/all JM
 Pain relief
 Grade II
 Effectively separates articulating surfaces
 “Takes up slack” or eliminates play in joint capsule
 Grade III
 “Stretch” traction that involves actual stretching of surrounding soft tissue
 Increase mobility

 Manual technique
 Towel sometimes used to assist pull
 Traction Tables
 Cervical and Lumbar
 Home Devices
 Cervical and lumbar

 Should only be performed by or under direct supervision of trained healthcare professionals
 Can cause further injury if performed incorrectly