Joint Mobilization and Manipu... Health Article

Aftercare

Individuals with a chronic joint problem may have Grade 1 and Grade 2 techniques used at the beginning of treatment to decrease pain. Then, after treatment, the patient progresses to more aggressive rehabilitation such as therapeutic exercise. At the end of a rehabilitation session, Grades 3 and 4 can be used in conjunction with stretching to increase mobility. In an acute joint pathology, only Grades 1 and 2 should be used. Grades 1 and 2 mobilizations can be used at the beginning of therapy to reduce pain in an effort to increase performance during therapeutic exercise. Grades 1 and 2 mobilizations can be used again at the end of the treatment before cryotherapy to help alleviate pain.

Complications

Some complications associated with mobilizations, but more so with manipulations are:

• fracture
• dislocation
• joint capsule tearing
• ligamentous tearing
• muscle or tendon injury
• nerve damage

Results

If done appropriately, mobilizations can help reduce pain and restore joint play, which is critical for normal mobility. Manipulations are beneficial for releasing adhesions and are usually done under anesthesia by a medical physician. Chiropractic manipulations are not discussed here.

Health care team roles

It is important that nurses and other members of the allied health care team be aware of patients who undergo mobilization and monitor pain and any possible inflammation after treatment. Moreover, pain and inflammation may need to be more closely monitored in individuals having manipulation to restore joint mobility. An example of a patient requiring closer monitoring is an individual having manipulation after total knee replacement secondary to increased adhesions and limited range of motion. Today, most manual therapy is done by physical therapists. However, the education for physical therapists to conduct forceful or thrust manipulations continues to grow and is becoming more a part of physical therapy education and post education.

KEY TERMS

Cryotherapy—Usually an ice or cold treatment after physical therapy treatment.

Femur—The long bone of the thigh which articulates with the hip bone and the tibia.

Knee extension—The act of straightening the knee or kicking the leg out, as in kicking a ball.

Ligaments—Fibrous structures that provide an attachment on bone to bone, and provide stability to joint structures.

Musculoskeletal—Pertains to the muscular and skeletal systems, and the relationship between the two.

Passive movement—Movement that occurs under the power of an outside source such as a clinician. There is no voluntary muscular contraction by the individual who is being passively moved.

Tibia—The larger, longer bone of the lower leg which articulates or joins with the ankle and knee.

BOOKS

Hertling D., and R.M. Kessler. Management of Common Musculoskeletal Disorders. Baltimore: Lippincott, Williams & Wilkins, 1996.

Lehmkuhl L.D., and L. K. Smith. Brunnstroms Clinical Kinesiology. Philadelphia: F.A. Davis Co., 1996.

Magee D. J. Orthopedic Physical Assessment. Philadelphia: W.B. Saunders Co., 1997.

ORGANIZATIONS

American Physical Therapy Association. 1111 N. Fairfax Street, Alexandria, Va 22314. (703) 684-2782. <http://www.apta.org>.

Mark Damian Rossi Ph.D., P.T., C.S.C.S.