SELF- MOBILIZATION ( AUTO MOBILIZATION)- Self stretching techniques that specifically used joint traction and glides that directs the stretch force to the joint force. MOBILIZATION WITH MOVEMENT (MWM)- Concurrent application of a sustained accessory mobilization applied by a clinician and an active physiological movement to end range applied by the patient. Applied in a pain free direction

1. FACULTY OF PARAMEDICAL SCIENCES

2. MOBILIZATION
Dr. Gulwish Sadique
Assistant Professor
(Dept of Physiotherapy)
RIPS, Rama University, Kanpur.

3. TERMINOLOGY
• JOINT MOBILIZATION-
•Slow passive movement imparted to an Articular surface and muscle energy.
• JOINT MANIPULATION-
• Defined as a technique involving movement of One Articular surface in
relation to other.
•Eg- Performed on an Articular structure that has been shown to be im physical
dysfunction.
•Or
•Specific technique in which the Articular capsule is stretched by delivering a
quick thrust manuable to joint.

4. TERMINOLOGY
• SELF- MOBILIZATION ( AUTO MOBILIZATION)-
• Self stretching techniques that specifically used joint traction and
glides that directs the stretch force to the joint force.
• MOBILIZATION WITH MOVEMENT (MWM)- Concurrent application
of a sustained accessory mobilization applied by a clinician and an active
physiological movement to end range applied by the patient.
• Applied in a pain free direction.

5. • Pain in adjacent segments that may aggravated by Mobilization.
• Any indication of Vertebrobacillar insufficency in the upper cervical
spine.
• Rheumatoid Arithritis in cervical spine.
• Traumatised upper cervical ligament.
• Cowdaequina Syndrome.
• Spinl cord involvement.
• Spondylolisthesis/.
• Scoliosis.
• Spinal Annurysm.
• Pregnancy.

6. Positive Neurological SIGN
• Genetic Disorder affecting the spine .
• Such as Down Syndrome, when Cervical spine being considered.

7. Factors that may alter joint Mechanics
• Pain and Muscle Guarding.
• Joint Hypomobility.
• Joint Effusion.
• Contractures or Adhesions in the joint Capsules or supporting ligaments.
• Malalignment or subluxation of bony surfaces.

8. TERMINOLOGY
• PHYSIOLOGICAL MOVEMENTS- Movements done voluntarily.
• Osteokinematics- Motions of Bones.
• ACCESSORY MOVEMENTS- Movements within the joint and
surrounding tissues that are necessary for normal range of motion, but
cannot be voluntarily performed.
• Component Motions- Motion that accompany active motions, but are not
under voluntarily control.
• Eg- Upward rotation of Scapula & rotation of Scapula that occur with
shoulder flexion.
• JOINT PLAY- Motions that occur with in the joint.
• Determined by joint capsules laxity.
• Can be demonstrated passively, but not performed actively.

9. TERMINOLOGY
• ARTHROKINEMATICS- Motions of bone surfaces within the joint.
• -5 motion – Roll, Slide, Compression, Distraction, Spin.
• Muscle Energy- Use an active Contraction of deep muscles that attach
near the joint and whose line of pull can cause the desired accessory
motion.
• - Clinician Stabilizes segment on which the distal aspect of muscle
attaches, command for an isometric contraction of the muscle is given,
which causes the accessory movement of joint.
• THRUST- High Velocity, Short amplitude motion that the patient cannot
prevent.
• - Performed at end of Pathologic limit of the joint (Snap adhesions,
Stimulate Joint receptors)

10. TERMINOLOGY
• CONCAVE- Hollowed or Rounded Inward.
• CONVEX- Curved or Rounded Outward.
• CONCAVE-CONVEX RULE- Concave joint surfaces slide in same
direction as the bone moves.
• If Concave joint is moving on Stationary Convex surface- glide occurs in
same direction as roll.
• CONVEX-CONCAVE RULE- Convex joint surfaces slide in opposite
direction of the bone movement.
• If Convex surface is moving on stationary Concave surface- gliding occurs
in opposite glide to roll.

11. • CONCAVE- CONVEX RULE/ CONVEX- CONCAVE
RULE-

12. GRADES OF MAITLAND MOBILIZATION
• Grade 1-[PAIN REDUCTION] Slow. Small Amplitude Oscillatory
Movement Parallel to Concave joint Surface that does not take the joint up
to the patient tissue stop.
• Grade 2- Slow, Larger Amplitude Oscillatory movement Parallel to the
Concave joint surface that does not take joint up to the 1st tissue stop.
(Reduce pain, Increase periarticular , Extensibility, Correct positional
faults, Release Meniscoid Impingement).
• Grade 3- [PAIN REDUCTION] Same as Grade 2 that takes the joint up to
and slightly through the 1st tissue stop.

13. • Grade 4- [PAIN REDUCTION] Slow, Small Amplitude Oscillatory
Movements parallel to Concave joint surface that takes the joint up to and
slightly through 1st tissue stop.
• Grade 5- Fast, Small Amplitude, High Velocity Non-Oscillatory
movements parallel to Concave joint surface that begins at the 1st tissue
stop . (To reduce spinal disc herniation).

14. INDICATIONS
• Increase joint Extensibility .
• Correcting positional fault.
• Nutrition.
• Pain control.
• Muscle relaxation.
• Meniscoid Impingement.
• Reduction of disc herniation.
• Psychological Benefits.

15. CONTRAINDICATIONS
• Any undiagnosed relation.
• Joint Ankylosis.
• Joint Hypermobility.
• Any infection in the area being treated.
• Malignancy.
• An Unhealed Fracture.
• Inflammatory Arithritis.
• Metabolic Bone Diseases.
• Considerable joint Effusion.
• Considerable joint Irratitabilty.
• Protective Muscle Spasm.

16. THANKYOU