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Joint Mobilization Review


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Joint Mobilization Review

  1. 1. Joint Mobilization Review<br />Casey Christy, MA, ATC, CSCS<br />
  2. 2. Principles<br />Use Grades I and II to reduce pain.<br />Use Grades III and IV to increase mobility.<br />Begin and end all mobilization sessions with Grade I and II mobilizations to facilitate relaxation and to relieve pain.<br />Initial mobilization techniques should be performed in the loose-packed position.<br />
  3. 3. Principles<br />Perform 2 to 3 oscillations per second for 20-60 seconds for joint tightness, 1-2 minutes for pain.<br />Sustained joint mobilization techniques: 10 second hold for painful joints; 10-30 sec hold for joint tightness. Repeat 3-5 times.<br />Understand the indications and contraindications of joint mobilization before implementing any techniques. <br />
  4. 4. Convex-Concave Rule<br />Fixed concave surface, moving convex surface<br />Glide occurs in opposite direction<br />Example: glenohumeral joint<br />Fixed concave glenoidfossa, moving convex humeral head<br />As the glenohumeral joint abducts, the humeral head glides inferiorly<br />Mobilize humeral head in inferior direction to increase abduction ROM<br />
  5. 5. Convex-Concave Rule<br />Fixed convex surface, moving concave surface<br />Glide occurs in same direction<br />Example: tibiofemoral (knee) joint<br />Fixed convex femoral condyles, moving concave tibialplateau<br />As the knee extends the tibia glides anteriorly<br />Mobilize tibia in anterior direction to increase extension ROM; posterior direction to increase flexion ROM<br />
  6. 6. Convex-Concave Rule<br />
  7. 7. Convex-Concave Rule<br />Joints with fixed concave and moving convex surfaces:<br />Glenohumeral<br />Hip joint<br />Talocrural (ankle)<br />Subtalar (concave inferior talus, convex calcaneus)<br />Radiocarpal<br />Apply glide in opposite direction<br />
  8. 8. Convex-Concave Rule<br />Joints with fixed convex and moving concave surfaces:<br />Knee (tibiofemoral joint)<br />Elbow (humeral-radial joint, humeral-ulnar joint)<br />MCP and IP joints of thefingers and toes<br />Apply glide in same direction<br />
  9. 9. Grades of Movement<br />Grade I: Small amplitude movement performed at the beginning of the available ROM.<br />Grade II: Large amplitude movement through the middle of the ROM.<br />Grade III: Large amplitude movement performed from the middle to the limit of the ROM.<br />Grade IV: Small amplitude movement performed at the end of the ROM.<br />Grade V: Small amplitude, manipulative movement performed beyond the end range of motion. Manipulation requires advanced training and is not commonly used by athletic trainers.<br />
  10. 10. Open-Packed Positions<br />Subtalar joint: Neutral<br />Talocrural joint: 10 degrees plantar flexion<br />Knee: 25 degrees of flexion for tibiofemoral joint; full extension for patellofemoral joint<br />Hip: 30 degrees hip flexion, 30 degrees hip abduction, slight external rotation<br />
  11. 11. Open-Packed Positions<br />Elbow joint: humeral–ulnar joint: elbow flexed 70 degrees, forearm supinated 10 degrees; humeral-radial joint: full extension, supination<br />Shoulder joint: 55 degrees abduction, horizontally adducted 30 degrees, rotated so forearm is in horizontal plane<br />Wrist: neutral for radiocarpal joint<br />MCP and IP joints of the hand and fingers: slight flexion<br />MCP joint of thumb: midway between flexion and extension; midway between abduction and adduction<br />
  12. 12. Treatment Glides<br />To improve glenohumeral flexion: apply posterior glide<br />To improve glenohumeral extension: apply anterior glide<br />To improve glenohumeral internal rotation: apply posterior glide<br />To improve glenohumeral external rotation: apply anterior glide<br />To improve glenohumeral abduction: apply inferior glide<br />
  13. 13. Treatment Glides<br />To improve tibiofemoral flexion: apply posterior glide<br />To improvetibiofemoral extension: apply anterior glide<br />Patellofemoral glides: apply superior glide to improve extension; inferior glide to improve flexion <br />
  14. 14. Treatment Glides<br />To improve ankle plantarflexion: apply anterior glide (talocrural joint)<br />To improve ankle dorsiflexion: apply posterior glide (talocrural joint)<br />To improve inversion: apply lateral glide (subtalar joint)<br />To improveeversion: apply medial glide (subtalar joint)<br />
  15. 15. Treatment Glides<br />To improve wrist flexion: apply dorsal (posterior) glide<br />To improve wrist extension: applyvolar (anterior)<br />To improve radial deviation: apply medial glide<br />To improveulnar deviation: apply lateral glide<br />
  16. 16. Treatment Glides<br />To improve elbow flexion: apply humeral-ulnar distal glide (scooping motion)<br />To improve elbow extension: apply humeral-radial posterior glide<br />
  17. 17. A Unique Joint<br />Sterno-clavicular Joint<br />The proximal articulating surface of the clavicle is convex superiorly/inferiorly; concave anteriorly/posteriorly<br />Mobilize clavicle inferiorly to improve abduction ROM<br />Mobilize clavicle posteriorly to improve retraction ROM<br />
  18. 18. Reference<br />Kisner and Colby. Therapeutic Exercise: Foundations and Techniques, 4th ed.<br />