Joint Mobilization and Manipu... Health Article

Definition

Joint mobilization is a treatment technique used to manage musculoskeletal dysfunction. Most manipulative and mobilization techniques are performed by physical therapists, and fall under the category of manual therapy.

In most cases, at the end of a long bone there is a joint or articulation. The long bone is attached or joined to another bone by a joint. For example, the femur is attached to the tibia at the knee joint. The knee joint is made up of the surface of the tibia, femur, ligaments, and capsule. Thus, the knee joint is stable and yet mobile. When an individual is sitting in a chair and freely kicks his leg out (knee extension), the tibia moves, while the femur is stationary. However, at the surface of the articulating bones (tibia and femur), there is other movement. This movement is known as slide or glide; some have termed it "joint play." When an individual kicks his leg out, the lower leg or tibia is not only moving forward, but also gliding across the end of the femur. Mobilization is the treatment technique that involves the clinician applying a force to mimic the gliding that occurs between bones. It is a passive movement, the goal of which is to produce a slide or glide. Mobilizations are usually completed at slow speed, sometimes with oscillations, and even with a "hold" or stretch. Manipulations are more aggressive, high velocity techniques, or thrusts. They occur very fast, and at the end of available joint play.

Purpose

Mobilizations are used to restore joint play that has been lost due to injury or disease. In order for an individual to kick his leg out, there must be sufficient joint play, or freedom for the tibia to move on the femur. Thus, mobilizations are used when range of motion or mobility is lacking. Furthermore, gentle oscillations within the available joint play range is a technique used to decrease pain. Manipulations are quick movements that occur beyond the available joint play range. The purpose of manipulations, or joint thrusts, is to increase the available range if it is not full. Secondly, manipulations are done to break adhesions that disrupt joint movement.

Precautions

Mobilizations and manipulations should not be done in the following circumstances:

• to the spine if there is severe osteoarthritis or osteoporosis
• if there is any tumor or malignancy in the area
• to the cervical region if there is dysfunction with the flow of blood within the vertebral artery
• if there is bleeding in a joint
• if there is a loose body in the joint
• to total joint replacements
• to joints near a growth plate
• if the joint is degenerative
• until a full diagnosis is reached

Description

Peripheral joint mobilization means mobilizing the joints of the periphery or limbs. There is a grading system for completing mobilizations. The grading system is based on how much joint play is available. Thus, the clinician must know what the total range is by examination through passive movement. Furthermore, there are stretching mobilizations used for pain management and stretching. The first common mobilization techniques are sustained joint play movements that have three grades. These mobilizations aid in decreasing pain and increasing mobility.

Grade 1

Slow oscillations within the first 20-25% of the available joint play range.

Grade 2

Slow oscillations within 45-55% of the available joint play range, or from the beginning to the middle of available joint play range.

Grade 3

Slow oscillations from the middle of the available joint play range to the end of available joint play range.

Grade 4

Slow oscillations at the end of the available joint play range.

Grade 5

Bone is passively moved to the end-range, and a fast thrust is performed. This is manipulation.

Preparation

The clinician should be aware of the following prior to performing manipulations:

• The clinician must use good body mechanics and be comfortable with the patient and the technique.
• The clinician must understand the patient's pain and not proceed if the patient has pain.
• The patient must be comfortable with the clinician, and the procedure must be explained fully to the patient.
• The patient must be relaxed.