KyungMo Han, PhD, ATC California State University Dominguez Hills Joint Mobilization KyungMo Han, PhD, ATC California State University Dominguez Hills

Introduction Understanding of joint mobilization Planes of the body (& axes) Arthrokinematics vs. Osteokinematics Concave-Convex Rules Treatment plane Mobilization & Traction techniques Examples & Thinking Problems

What is it? Manual therapy techniques that are used to modulate pain and treat joint dysfunctions that limit range of motion by specially addressing the altered mechanic of the joint Mobilization vs. Manipulation

Axes Y X Z

Planes of the Body Sagittal plane Frontal (coronal) plane Transverse (horizontal) plane

Arthrokinematics Description of movement with reference to the joint Unobservable articular movements between adjacent joint surfaces Osteokinematics: description of movement with reference to the bones (for example, flexion, extension, abduction, etc.)

Arthrokinematics 3 Accessory Movements Roll Glide Spin

Roll New points on one surface meet new points on another surface Occurs in the same direction as bone movement Occurs with gliding but never alone

Glide Same point on one surface comes into contact with new points on the opposite surface The direction of the glide depends on shape of the moving surface

Spin Rotation around a stationary mechanical axis Primarily only takes place in the glenohumeral and radiohumeral joints

Convex-Concave Rules What is the shape of a concave and convex surface? What shape is the femur and tibia at the knee? Convex and concave surface-the roll is always in the direction of the bone movement For example: If the bone is moving anteriorly, the roll is anterior and vice versa

Convex-Concave Rules If the convex surface is moving on fixed concave surface, roll and glide occur in the opposite directions If the concave surface is moving on fixed convex surface, roll and glide occur in the same direction

Mobilization A passive movement performed by the clinicians for intending to increase mobility and/or decrease pain using gliding and traction techniques Why do we perform mobilizations? What structure is being stretched?

“Target” tissue for Joint Mobilization Capsule

Features of Synovial Joints A joint capsule A joint cavity A synovial membrane Synovial fluid Hyaline cartilage

Treatment Plane Treatment plane lies in the concave articular surface Treatment plane moves with the concave surface

Gliding Gliding is a movement where the joint surfaces are passively displaced parallel to the treatment plane Glides are used to improve a particular movement (i.e. flexion or extension of the knee) Glides are performed in the direction of arthrokinematic movement

Mobilization Grading (Maitland) Grade I Grade II Grade III Grade IV Grade V

Grade I - IV beginning of the available ROM I: Small amplitude movement at the beginning of the available ROM II: Large amplitude movement within the available ROM III: Large amplitude movement that reaches the end of ROM IV: Small amplitude at the very end ROM

Grade V High velocity thrust of small amplitude a the end of the available ROM and within its anatomical range This is referred to as a manipulation

Traction The process of pulling one bony surface away from the other (joint separation) A passive bone movement which is at a right angle to the treatment plane A general mobilization technique that can improve mobility in all directions

Traction (Grading) Grade I: unweighting or barely separating the joint surfaces Grade II: slack of the capsule taken up Grade III: capsule and ligaments stretched

Examples Knee extension (femur is fixed) Wrist flexion (radius is fixed) Ankle dorsiflexion (tibia is fixed) Shoulder abduction (scapula is fixed)

Thinking Problem 1 An athlete comes in to the training room, an athletic trainer performs POSTERIOR glides of the FEMUR on the TIBIA. What osteokinematic movement is the trainer trying to improve?

Thinking Problem 2 An athlete comes in to the training room, an athletic trainer performs ANTERIOR glides of the CARPALS on the RADIUS. What osteokinematic movement is the trainer trying to improve?

Questions???