Joint mobilization is an example of a hands-on treatment in physical therapy. this technique commonly used in a clinical setting to improve the range of movement of a hypomobile joint.
The main aim of joint mobilization is to restore the normal joint play (arthrokinematic) that might have been compromised by damage or injury.
It is a slow, repetitive, rhythmical, oscillatory movement (arthokinematics or osteokinematics) done by a therapist within the available range.
WHAT IS ARTHROKINEMATICS OR OSTEOKINEMATICS ?
ARTHROKINEMATICS- arthro-joint, kinematics-motion. the movement, which occur in the joint surface is called as an arthrokinematics,these movements also called as ‘joint play movements’.
Types of arthrokinematics movement:
- Rolling
- sliding(gliding)
- spinning
- traction
- compression
ROLLING-
- A series of points on one articulating moving surface come into contact with a series of points on another stable surface. just like,ball rolling on ground,example: femoral condyles rolling on tibial plateau.
- roll occur in direction of movements.
- occur on incongruent (unequal) surface.
- usually occurs in combination with sliding or spinning.
Sliding(gliding)-
- gliding occurs between the surface when the same point of the moving surface come into contact the new point on the stable surface. just like, square box is moving on oblique floor.
- surfaces are congruent (equal).
- pure gliding is impossible in human joint,because there are no complete congruent surface joints.
- direction of gliding depends on whether the moving surface is concave or convex.
- types of gliding- antero-posterior, potero-anterior, medial glide, lateral glide,etc…
Spinning-
- occur when one bone rotates around a stationary longitudinal mechanical axis.
- spinning surface creates an arc of a circle.
- it combines with the rolling and gliding, results in rotatory type or physiological movements.
- examples- shoulder with flexion/extension, the hip with flexion/extension, and radial head at the humeroradial joint during pronation/supination.
Compression-
- Articular parts are pushed towards each others.
- more common in weight bearing joint
- squeezing of the synovial fluid takes place during compression.
Distraction-
- two surfaces are pulled apart
- joint space increase during traction
- often used in combination with joint mobilization to increase stretch of capsule.
OSTEOKINEMATICS- osteo-bone, kinematics-movement/motion. the movement occurs in the bone rather than the joints surface,is called as physiological movements.
due to some pathological disturbance some joints may have more mobility is called HYPERMOBILIE JOINTS- It is due to laxity of ligament and reduced tension in joint capsule and the soft tissue around joint. mobilization techniques are totally contraindicated for this variety.
The joint, which have less mobility are called “HYPOMOBILIE JOINT“-it is due to spasm of the ligaments, muscles, capsule or any others soft tissues around the joint and some time may be due to adhesion formation. this type of joints has to undergo for the mobilization treatment.
Osteokinematics movements are: flexion, extension, abduction, adduction, medial rotation, lateral rotation, circumduction, etc..
INDICATIONS OF MOBILIZATION:
- post traumatic stiffness of the joint
- post operative stiffness of the joint
- post-immobilization stiffness of the joint
- adhesive capsulitis
- atrophy of the capsule
- arthritis
- painful joint
- sports injury
- disuse atrophy of the joint structures.
CONTRAINDICATIONS OF MOBILIZATION:
- inflammatory arthritis
- malignancy
- tuberculosis
- osteoporosis
- synovial effusion
- hemarthrosis
- rescent fractures around the joint
- dislocation
- rescent injuries around the joint
- acute R.A.
- immediately after surgery around the joint
- total joint replacements
- spondylolisthesis
- herniated disk with nerve compression
- congenital bone deformities
PRECAUTIONS:
- Osteoarthritis
- pregnancy
- total joint replacement
- severe scoliosis
- poor general health
- patient inability to relax
GRADING OF MOBILIZATION: There are two systems of grading of the mobilization.
- Traction technique
- Oscillatory technique
1)Traction technique
- Grade1: slow,small amplitude perpendicular movement(distraction) to the concave joint surface performed within the first tissue stop.
- Grade2: slow,large amplitude perpendicular movement(distraction) to the concave joint surface done up to the first tissue stop.
- Grade3: slow,large amplitude perpendicular movement(distraction) to the concave joint surface performed up to the level of crossing the first tissue stop, but without reaching the second tissue stop.
Uses:
- Grade1: used for reducing the pain.
- Grade2: used for pain reduction and increases the periarticular extensibility.
- Grade3: used for periarticular extensibility, to correct the positional fault and reduces the spinal disc herniation.
2)oscillatory technique:
- Grade1: slow, small amplitude oscillatory movement parallel to the concave joint surface performed within the beginning range.
- Grade2: slow, large amplitude oscillatory movement parallel to the concave joint surface performed within the first tissue stop.
- Grade3: slow,large amplitude oscillatory movement parallel to the concave joint