Manual Mobilization Of The Extremity Joint Introduction
Manipulation vs. Mobilization
Manipulation Any manual procedure used for the purpose of examination , correction or modification of an articular or soft tissue dysfunction. The skilled passive movement to a joint, either within or beyond its active limited motion.
A sudden small amplitude thrust delivered at a speed which renders the patient powerless to prevent it
The act of imparting movement, either actively or passively, to joints or soft tissue structures. Passive oscillatory movements or sustained stretch at the limit of range using graded amplitude movements. Mobilization
Component of MT referring to any procedure that increases the mobility of joints or ST structures
History & School Of Thought
Examination by selective tissue tension
John Mennell Concept of joint dysfunction loss of accessory or joint play movement Jt. dysfunction as pain- producing entity, causing loss of movement
Jt dysfunction is detected by passive movement. Normal passive movement is pain free.
Freddy Kaltenborn Norwegian School- biomechanical model Applied the works of MacConnell to joint mobilization Open/ Closed Pack Position
Focus is on movement taking place within the joint capsule
Freddy Kaltenborn Brought into play the arthrokinematic and osteokinematic relationship of joint movement.
The osteokinematic and arthrokinematic at a specific joint may be the same, opposite direction.
Geoffrey Maitland Deviated from biomechanical model Advocating treatment of painful joints by oscillating passive movement that provide Neurophysiological therapeutic
Implemented the grading system
Define joint dysfunction as “ a state of altered mechanics either increased or decreased from the expected normal motion.
Movement of one articular surface in relation to it partner- roll, glide, spin
Bone Rotation ( roll-gliding ) All bone movements occur around an axis. From a mechanical viewpoint are considered to be rotation or spin
In normal joints all active movements produce joint roll-gliding
Roll, Slide , Spin Roll: Movement in which points at interval on the moving JT, surface contacts points at the same intervals on the opposite surface. Slide. Movement in which a single point on the moving surface contacts various points on the opposing surface.
Spin. Type of slide that accompanies spin of a bone . 1/2 of the jt surface slides in one direction while the other 1/2 slide the opposite direction.
Distraction / Compression Distraction: Separation of joint surfaces
Compression: Approximation of joint surfaces- moving toward close pack position.
Those movements which accompany the physiological movements and are necessary for normal function, but not under voluntary neuromuscular control
Categories Of Accessory Movements
Joint Play Movement Movement that can be produced passively at a joint but cannot be isolated actively. Spin, roll, glide, compression, & distraction
Joint play movements are used when applying specific mobilization techniques to restore accessory movements so that full & painless osteokinematic movement may return. ( eg . Inferior distraction of the shoulder)
Component Motion A type of accessory movement that is directly associated with the production of osteokinematic movement or motion that takes place in a joint complex or related joint to facilitate a specific active motion Example: at glenohumeral Jt.
Inferior and posterior glide of humeral head to produce flexion of the shoulder (humerus)
Closed & Open Pack Positions Jt caps. & ligs. are twisted Jt becomes locked in position
Movements of roll slide are allowed
End Feel Refers to the nature of movement limitation experienced by the examiner
It is the sensation imparted to the examiner’s hands during passive movement of a joint at end range