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

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

3. 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

4. Axes Y X Z

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

7. 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.)

8. Arthrokinematics
3 Accessory Movements
Roll
Glide
Spin

9. 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

11. 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

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

16. 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

17. 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

19. 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?

20. “Target” tissue for Joint Mobilization
Capsule

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

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

24. 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

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

26. 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

27. 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

29. 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

30. 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

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

32. 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?

33. 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?

34. Questions???