Dpt

1. Chapter no 5
Spinal joint mobilization
Dr Ayesha Anwer Ali

2. Topics today..
• Goals of joint mobilization treatment.
• Goals of joint mobilization
• Spinal joint mobilization
• Pain-relief mobilization
• Pain-relief traction mobilization (Grade I - IISZ)
• Vibrations and oscillations
• Relaxation mobilization
• Relaxation-traction mobilization
Grade I – II
• Stretch mobilization
• Preparation for stretch mobilization

3. Goals of joint mobilization treatment
• Unlike peripheral joints, In spine a mobile
segment with three joints is moved and
closely related sensitive structures like nerves
and inter-vertebral discs are affected.

4. Goals of joint mobilization treatment
• Symptoms associated with an abnormal
endfeel and a slight or significant
hypomobility (Class 1 or 2), use
Grade II relaxation-mobilization
or Grade III stretch-mobilization
• Class 0 ankylosed joints cannot be mobilized.

5. • Symptoms associated with a slight or
significant hypermobility (Class 4 or
5)……apply stabilizing (limiting) treatment.
• Complete instabilities (Class 6 dislocations or
ligamentous laxity with unstable vertebrae)
usually require medical intervention.

6. • If the biomechanical status of the joint cannot
be determined due to severe pain, spasm,
paraesthesia, or other symptoms, or if
stretching techniques cannot be tolerated,
treatment is first directed toward symptom
control (for example, Grades I-II relaxation
mobilization or other treatment modalities).

7. Goals of joint mobilization
1. Pain-relief mobilization
• To ease severe pain, spasm, and paraesthesia, and to
help normalize joint fluid viscosities that interfere with
movement.
2. Relaxation mobilization
• To relax muscles, decrease pain and facilitate
movement ease.
3. Stretch mobilization and manipulation (quick
mobilization)
• To stretch shortened joint tissues, increase movement
range and correct positional faults.

8. Spinal joint mobilization
1. Pain-relief mobilization
- Grade I - IISZ in the (actual) joint resting position.
2. Relaxation mobilization
- Grade I - II in the joint (actual) resting position.
3. Stretch mobilization
- Grade III in the joint (actual) resting position
- Grade III at the point of restriction.
4. Manipulation (quick mobilization)
- Grade III , high velocity, short amplitude, low force
traction manipulation in the (actual) resting position.

9. 1. Pain-relief mobilization
• Only in the slack zone.
• Grade I and II slack zone mobilizations,
particularly intermittent traction movements,
also help to normalize joint fluid viscosities.

10. Pain-relief traction mobilization
(Grade I - IISZ)
• Intermittent Grade I and II traction-
mobilizations in the Slack Zone, applied in the
resting position or actual resting position is
the initial trial treatment of choice for
symptom control.

11. Vibrations and oscillations
• Short amplitude, oscillatory joint movements are
also used for the treatment of pain.
• Mechanical devices such as vibrators for very high
frequency and very short amplitude movement.
• These movements can decrease pain and muscle
spasm,
• Can also be applied in the grade IITZ and Ill range,
interspersed with stretch mobilizations, to
minimize discomfort.

12. 2. Relaxation mobilization
• Use where joint movement is limited by
muscle spasm rather than by shortened
tissues.
• Relaxation mobilizations are also useful as
preparation for more intensive treatments
• Relaxation mobilizations should not produce
or increase pain.

13. Relaxation-traction mobilization
Grade I - II
• Apply intermittent traction-mobilizations in the
actual joint resting position within the Grade I or
II range, including the Transition Zone.
• Slowly distract the joint surfaces, then slowly
release until the joint returns to the starting
position.
• Rest the joint a few seconds in the starting
position before you repeat the procedure.
• Between each traction movement, readjust
three-dimensional positioning (the actual resting
position)

14. • There should be a natural progression towards
the resting position.
• Avoid tissue stretching.
• Mobilization forces , and the rhythm and
amplitude of the traction procedure based on
the patient's response to treatment.
• Immediate improvement in signs and
symptoms

15. 3. Stretch mobilization
• For restoring normal joint play.
• Stretching shortened connective tissues in muscles,
joint capsules and ligaments can increase and maintain
mobility and delay progressive stiffness and loss of
range of movement in chronic musculoskeletal
disorders.
• Hypomobility with hard end-feel = bony limitation and
should not be stretched.
• Restricted range of movement presenting with a
normal end-feel is a normal anatomical variation so not
treated but may be stretched in order to release stress
to a vulnerable neighboring hypermobile joint.

16. • Sustain a stretch mobilization for a minimum of
seven seconds, up to a minute or longer, as long
as the patient can comfortably tolerate the
stretch.
• In viscoelastic structures, the longer a stretch is
sustained the greater and more lasting the
mobility gain.
• Dose?
• Fixation of one joint partner is absolutely
essential for an effective stretch mobilization.

17. • Rather than releasing completely, return to
the end of the grade II range, into the
transition zone.
• Apply enough force to stretch the shortened
tissue.
• To determine the most effective amount of
force to use, begin with forces approaching,
but not exceeding, what the patient safely
tolerates during daily activities.

18. • Grade III stretch mobilizations should not produce or
increase the patient's dominant symptoms
• Slight local discomfort is normal.
• Discontinued if protective muscle spasm, severe pain, or
symptoms at locations other than the site being treated.
• Such a response to treatment suggests the need to
reposition the joint, alter the intensity or direction of
treatment, or discontinue stretch-mobilization treatment.
• Grade III stretch-mobilizations usually produce immediate
improvement within the first treatment session. Lasting
effects may require several treatments.

19. Preparation for stretch mobilization
• Begin with procedures to decrease pain and
muscle spasm or increase soft tissue mobility.
• Make the joint mobilization easier to perform and
produce a longer lasting effect.
• Treatment to improve circulation and thereby
warming soft tissue
• Surface heat application or deep heat application
• The most effective way "warm-up" soft tissues is
with exercise.

20. • Cooling tissues after stretch mobilization
treatment often helps preserve mobility gains
for a longer period of time.
• Cold application not recommend prior to or
during stretch technique, since cooled tissues
can be more easily injured from
overstretching.

21. Progression of stretch-mobilization
treatments
• If reassessment reveals increased range of
movement or normalization of end-feel and
decreased symptoms, then Grade III stretch-
mobilization treatment may continue.
• If there is marked improvement in one treatment
session, it is wise to discontinue additional
treatments that day.
• Chronic cases and significant (Class 1)
hypomobilities may require several treatment
sessions before a change is apparent.

22. • If reassessment indicates no change in mobility or
symptoms, reevaluate joint positioning and the
vigor (i.e., time and force) and direction of
treatment or reconsider whether mobilization is
indicated.
• Discontinue stretch mobilization when gains in
the patient's symptoms and range of movement
plateau and the patient can perform active
movement throughout this range.

23. • Stretch a joint in all restricted directions.
• If the mobility gains produced by stretch-
traction mobilization plateau, the practitioner
may progress to stretch-glide mobilizations,
first with the joint pre-positioned in the
resting position, then progressing toward the
point of restriction.

24. • Stretch mobilization is more effective and
better controlled when joint stretching is
carefully timed to occur during periods of
maximum muscle relaxation.
• Reflex inhibition relaxation techniques