Friday, September 8, 2017

Principles of Peripheral Joint Mobilizations

Joint mobilization is a manual therapy intervention, a type of passive movement of a skeletal joint. It is usually aimed at a 'target' synovial joint with the aim of achieving a therapeutic effect. When applied to the spine, it is known as spinal mobilization. When applied to the limbs or extremities, it is known as Peripheral Mobilization. These techniques are often used by chiropractors, osteopaths, occupational therapists, and physical therapists.

The purpose of joint mobilizations are to decrease pain, increase nutrition to the joint, and increase joint play range of motion (please note: this is typically only useful only if limitation in the join is caused by a capsular restriction, not a muscular restriction).  Basic technique for joint mobilizations include manually applied joint glides with or without distraction, hand placement as close to the joint surface as possible, and the direction of the glides must be done according to the restriction (if present).  In terms of patient/client positioning, make sure they and the body part are relaxed.  First examine joint play, then stabilize the proximal bone with a belt or strap.  Use a large contact area of the hand and apply treatment force as close to the joint surface as possible.  Lastly, glide in the direction of normal movement by using convex-concave rule.

Indications for Joint Mobilizations:
    • Reversible joint hypomobility
    • Positional Faults/Subluxations
    • Functional immobility from lack of use of the joint
Contraindications/Precautions:
    • Joint hypermobility
    • Joint effusion (capsule already on stretch)
    • inflammation
    • malignancy/cancer
    • bone disease
    • unhealed fracture
    • excessive pain
    • total joint replacement
    • newly formed connective tissue
    • elderly individuals with weak connective tissue

Mobilization Graded Scale:
  • Grade 1: Small amplitude, at the beginning of range
  • Grade 2: Large amplitude, not reaching either end range limit
  • Grade 3: Large amplitude into resistance at end range
  • Grade 4: Small amplitude, beginning at the limit of resistance
  • Grade 5: Small amplitude thrusts with high velocity (also called a manipulation) 
      • Requires ongoing training and assessment.  Typically used by Chiros and PTs (popping sound in the joint)

Progression of Treatment:
  • Be conservative on day 1 and start with grade 2 mobilization technique.  
  • Determine response of patient; if it makes the pain worse, decrease to grade 1 and reevaluate.  If better, continue and increase to grade 3, then 4 etc
  • Some soreness is expected
  • Mobilizations can be used with many other treatment options such as moist heat, massage and relaxation techniques, movement/exercise (think crossfit mobility, self mobilization techniques)
  • However, it is extremely important that the client follow up with self stretching and movement within the newly acquired range between mobilizations to avoid "losing" the gained range of motion.

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