This document defines joint mobilization and related terms. It describes the objectives of joint mobilization including defining terms, describing joint shapes and motion, effects of mobilization, and scales for grading mobilization. Mobilization techniques are explained including indications such as pain or limited mobility and contraindications like inflammation or instability. Maitland and Kaltenborn grading scales for non-thrust mobilization techniques are described. Joint positions and proper technique application are also outlined.

1. JOINT
MOBILIZATION
MAHATMA GANDHI MEDICAL COLLEGE & RESEARCH
INSTITUTE
SRI BALAJI VIDYAPEETH
DEEMED TO BE UNIVERSITY
PONDICHERRY

2. OBJECTIVES..
DEFINE MOBILIZATION, SELF-MOBILIZATION, MOBILIZATION WITH MOVEMENT,
PHYSIOLOGIC MOVEMENTS, ACCESSORY MOVEMENTS, ARTHROKINEMATICS,
THRUST.
DESCRIBE JOINT SHAPES & ARTHROKINEMATICS
EXPLAIN CONVEX-CONCAVE & CONCAVE-CONVEX RULE
DESCRIBE EFFECTS OF JOINT MOBILIZATION
ENUMERATE INDICATION & CONTRAINDICATIONS FOR MOBILIZATION
DESCRIBE MAITLAND JOINT MOBILIZATION GRADING SCALE
DESCRIBE KALTENBORN GRADING SCALE

3. WHAT IS JOINT MOBILIZATION?🤔🤔
“ SKILLED PASSIVE
MOVEMENT OF THE
ARTICULAR SURFACES
PERFORMED BY A
PHYSICAL THERAPIST TO
DECREASE PAIN OR
INCREASE JOINT MOBILITY
”

4. DEFINITION OF TERMS….
• SELF MOBILIZATION:
SELF-STRETCHING TECHNIQUES THAT SPECIFICALLY USE JOINT
TRACTION OR GLIDES THAT DIRECT THE STRETCH FORCE TO THE JOINT
CAPSULE .
• MOBILIZATION WITH MOVEMENT:
CONCURRENT APPLICATION OF A SUSTAINED ACCESSORY MOBILIZATION
APPLIED BY A CLINICIAN, PHYSIOTHERAPIST TO END RANGE AND
PHYSIOLOGICAL MOVEMENT APPLIED BY THE PATIENT.

5. Physiologic Movements :
– movements done voluntarily
Osteokinematics – motions of the bones
Accessory Movements :
movements within the joint & surrounding tissues that are necessary for normal
ROM, but can not be voluntarily performed
Component motions:
motions that accompany active motion, but are not under voluntary control
Joint play :
motions that occur within the joint
Determined by joint capsule’s laxity
Can be demonstrated passively, but not performed actively

6. Arthrokinematics:
– motions of bone surfaces within the joint
5 motions Roll, Slide, spin,Compression,Distraction
Thrust :
– high-velocity, short-amplitude motion that the patient can
not prevent
– Performed at end of pathologic limit of the joint (snap
adhesions, stimulate joint receptors)

7. SHAPES OF JOINT

8. BASIC CONCEPTS OF JOINT MOTION :
ARTHROKINEMATICS
TYPES OF JOINT MOTION
– ROLL
– SLIDE
– SPIN
– COMPRESSION
– DISTRACTION
• JOINT MOTION USUALLY OFTEN INVOLVES A COMBINATION OF
ROLLING, SLIDING & SPINNING

9. EFFECTS OF JOINT MOBILIZATION
• NEUROPHYSIOLOGICAL EFFECTS
– STIMULATES MECHANORECEPTORS TO DECREASE PAIN
– AFFECT MUSCLE SPASM & MUSCLE GUARDING –
NOCICEPTIVE STIMULATION
– INCREASE IN AWARENESS OF POSITION & MOTION
BECAUSE OF AFFERENT NERVE IMPULSES
• NUTRITIONAL EFFECTS
– DISTRACTION OR SMALL GLIDING MOVEMENTS – CAUSE
SYNOVIAL FLUID MOVEMENT
– MOVEMENT CAN IMPROVE NUTRIENT EXCHANGE

10. • MECHANICAL EFFECTS
– IMPROVE MOBILITY OF HYPO-MOBILE JOINTS
(ADHESIONS & THICKENED CONNECTIVE TISSUE FROM
IMMOBILIZATION – LOOSENS)
– MAINTAINS EXTENSIBILITY & TENSILE STRENGTH OF
ARTICULAR TISSUES

11. CONCAVE ANS CONVEX CHARECTERISTIC
• CONVEX SURFACES HAVE MORE
CARTILAGE AT THE CENTER
• CONCAVE SURFACES HAVE MORE
CARTILAGE ON THE PERIPHERY
• WHERE SURFACES APPEAR FLAT -
THE LARGER ARTICULAR SURFACE
IS CONSIDERED CONVEX

12. RULES OF MOBILIZATION
CONVEX-CONCAVE & CONCAVE-CONVEX RULE
• BASIC APPLICATION OF CORRECT MOBILIZATION TECHNIQUES
• ONE JOINT SURFACE IS MOBILE & ONE IS STABLE
CONCAVE-CONVEX RULE:
CONCAVE JOINT SURFACES SLIDE IN THE SAME DIRECTION AS THE BONE
MOVEMENT (CONVEX IS STABLE)
– IF CONCAVE JOINT IS MOVING ON STATIONARY CONVEX SURFACE –
GLIDE
OCCURS IN SAME DIRECTION AS ROLL

13. • CONVEX-CONCAVE RULE:
CONVEX JOINT SURFACES SLIDE IN THE OPPOSITE
DIRECTION OF THE BONE MOVEMENT
(CONCAVE IS STABLE).
IF CONVEX SURFACE IN MOVING ON
STATIONARY CONCAVE SURFACE .
– GLIDING OCCURS IN OPPOSITE DIRECTION TO ROLL .

14. RULES OF MOTION…..
BECAUSE THEIR IS ALWAYS
INCONGRUENT SURFACES, THERE MUST
BE SOME COMBINATION OF GLIDE AND
ROLL
• ARTHROKINEMATIC ROLL ALWAYS
OCCURS IN THE SAME DIRECTION AS
BONY MOVEMENT REGARDLESS
OF WHETHER THE JOINT SURFACE IS
CONVEX OR CONCAVE IN SHAPE.

15. INDICATIONS
• PAIN, MUSCLE SPASM, MUSCLE GUARDING
NEUROPHYSIOLOGIC EFFECTS:
SMALL AMPLITUTDE OSCILLATORY AND DISTRACTION MOVEMENTS ARE USED TO STIMULATE
STIMULATE THE MECHANORECEPTORS THAT MAY INHIBIT THE TRANSMISSION OF
NOCICEPTIVE STIMULI AT SPINAL CORD OR BRAIN STEM LEVELS.
MECHANICAL EFFECTS:
GLIDING AND DISTRACTION MOVEMENTS ARE USED TO CAUSE SYNOVIAL FLUID MOTION,
WHICH BRINGS NUTRITION TO THE AVASCULAR PORTIONS OF ARTICULAR CARTILAGE, THUS
THUS PREVENTING FROM PAINFUL AND DEGENERATING EFFECTS OF STASIS.

16. INDICATIONS……
• REVERSIBLE JOINT HYPOMOBILITY
• POSITIONAL FAULTS/SUBLUXATION
• PROGRESSIVE LIMITATION
• FUNCTIONAL IMMOBILITY

17. CONTRAINDICATIONS
• INFLAMMATORY ARTHRITIS
• MALIGNANCY
• TUBERCULOSIS
• OSTEOPOROSIS
• LIGAMENTOUS RUPTURE
• HERNIATED DISKS WITH NERVE
COMPRESSION
• BONE DISEASE
• NEUROLOGICAL INVOLVEMENT
• BONE FRACTURE
• CONGENITAL BONE DEFORMITIES
• VASCULAR DISORDERS

18. CONTRAINDICATIONS…..
HYPERMOBILITY:
JOINTS OF THE PATIENT WITH POTENTIAL NECROSIS OF LIGAMENTS OR
CAPSULE SHOULD NOT BE STRETCHED.
JOINT EFFUSION:
THERE MAY BE SWELLING FROM TRAUMAOR DIESEASE. RAPID SWELLING
BLEEDING WITHIN THE JOINTS.(HEMOPHILIA). MEDICAL INTERVENTIONS
REQUIRED FOR ASPIRATION OF BLOOD TO MINIMIZE NECROTIZING EFFECT ON
ARTICULAR CARTILAGE.
INFLAMMATION:
STRETCHING WILL INCREASE PAIN AND MUSCLE GUARDING AND WILL RESULT IN
GREATER TISSUE DAMAGE. GENTLE OSCILLATION OR DISTRACTION MOTION MAY
TEMPORARILY INHIBIT THE PAIN RESPONSE.

19. GRADES OF MOBILIZATION
NON THRUST OSCILATION TECHNIQUES(MAITLAND)
GRADE-1
GRADE-2
GRADE-3
GRADE-4

20. NON THRUST SUSTAINED JOINT PLAY
TECHINIQUES(KALTENBORN)
GRADE-1(LOOSEN)
GRADE-2(TIGHTEN)
GRADE-3(STRETCH)

21. INDICATIONS FOR MOBILIZATION
• MAITLAND:
GRADES I AND II - PRIMARILY USED FOR PAIN .
GRADES III AND IV- PRIMARILY USED TO INCREASE MOTION.
• KALTENBORN:
GRADE I- USED FOR RELIEF OF PAIN.
GRADES II – USED FOR INITIAL TREATMENT TO DETERMINE THE SENSITIVITY
OF PAIN.
GRADES III- USED TO STRETCH THE JOINT STRUCTURE.

22. JOINT POSITIONS
• RESTING POSITION
• LOOSE- PACKED POSITION
• CLOSE- PACKED POSITION
• GENERAL RULE

23. • JOINT MOBILIZATION APPLICATION
• POSITIONING & STABILIZATION
• TREATMENT FORCE & DIRECTION OF MOVEMENT

24. REFERENCES..
• CAROLYN KISNER□LYNN ALLEN COLBY(THERAPEUTIC EXERCISES
FOUNDATIONS AND TECHNIQUES)
• MAITLAND GD. PERIPHERAL MANIPULATION.
• KALTENBORN FMM, ET AL. MANUAL MOBILIZATION OF THE JOINTS: THE
KALTENBORN METHOD OF JOINT EXAMINATION AND TREATMENT

25. THANK YOU
SPECIAL THANKS TO
FOR THIS