1. Peripheral Joint Mobilization for Impaired Mobility
Chapter 5

2. 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

3. Definition of Terms Mobilization/Manipulation
Thrust manipulation/high-velocity thrust (HVT)
Self-Mobilization (Auto-Mobilization)
Mobilization With Movement (MWM)
Physiological Movements
Osteokinematics

4. Definition of Terms (cont'd)
Accessory Movements
Component motion
Joint play: arthrokinematics
Manipulation Under Anesthesia
Muscle Energy

5. Basic Concepts of Joint Motion: Arthrokinematics
Joint Shapes
Ovoid
Sellar (saddle)

6. 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

7. 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

8. 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

9. Other Accessory Motions That Affect the Joint
Compression
Traction: Longitudinal Pull
Long axis traction
Distraction: Separation of Joint Surfaces
Joint traction or joint separation

10. 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

11. Indications for Joint Mobilization/Manipulation
Pain, Muscle Guarding, and Spasm
Neurophysiological effects
Mechanical effects
Reversible Hypomobility
Positional Faults/Subluxations
Progressive Limitation
Functional Immobility

12. Limitations of Joint Mobilization/ Manipulation Techniques
Cannot Change Disease Process
Cannot Change Inflammatory Process
Skill of the Therapist Affects the Outcome

13. Contraindications
Hypermobility
Joint Effusion
Inflammation

14. 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

15. Procedures for Applying Passive Joint Techniques
Examination and Evaluation
Quality of pain
Capsular restriction (specific pattern)
Subluxation or dislocation

16. Procedures for Applying Passive Joint Techniques (cont'd)
Documentation
Use of standardized terminology
Characteristics of documentation
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
Box 5.1 contains Characteristics to Describe Mobilization and Manipulation Techniques.

17. Non-Thrust Oscillation Techniques
Grade I: Small Amplitude at Beginning of Range
Pain inhibition and fluid movement
Grade II: Large Amplitude Within the Range
Grade III: Large Amplitude Up to the Limit into Resistance
Stretching maneuver
Grade IV: Small Amplitude at the Limit into Resistance

18. 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

19. Comparison of Oscillation and Sustained Techniques
Representation of Oscillation Techniques
Representation of Sustained Joint-Play Techniques
Figures 5.9 and 5.10 shown here.

20. Thrust Manipulation/High-Velocity Thrust (HVT)
Application
Small-amplitude, high-velocity
Performed only once
Indications
Snap adhesions
Reposition joint surfaces

21. 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
Figure 5.12 illustrates initiation and progression of treatment.
Box 5.2 contains Suggested Sequence of Treatment to Gain and Reinforce Functional Mobility.

22. 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

23. 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

24. Peripheral Joint Mobilization Techniques
Shoulder Girdle Complex
Elbow and Forearm Complex
Wrist and Hand Complex
Hip Joint
Knee Joint Complex
Leg and Ankle Joints
Figures 5.13 through 5.64 illustrate techniques and underlying bone anatomy.

25. Independent Learning Activities
Critical Thinking and Discussion
Laboratory Practice