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Peripheral Joint Mobilization

Musculoskeletal Management 1 (Northeastern University)

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Peripheral Joint Mobilization

Joint Mobilizations
 Modulate pain
 Treat joint impairments limiting ROM
o Replicate normal joint mechanics while minimizing abnormal compressive stresses on
articular cartilage.
 Skilled, passive manual therapy techniques applied to joints and related soft tissues at varying
speeds and amplitudes

Motion
 Osteokinematic
o Movements of bones in space
o “Motions you see”- motion you measure with goniometer
 Arthrokinematic
o Accessory motion between adjacent joint surface
 Roll
 New points on one surface come in contact with new points on another
surface
 Glide
 Interchangeable with slide and translation
 Translatory motion
 One point on one surface contacts new points on another surface
 Spin
 Rotation around a single point of contact
 CW or CCW direction
 Not as common as roll and glide
o “Motions you feel”- mall pieces that help osteokinematic mvovements happen
o Assessed with joint play assessment
 Joint play is passive movement that cannot be achieved by active muscle
contraction
o Occur with all A/PROM
o Component Movement
 Involuntary obligatory joint motion
 Occurs with active motion
 Ex: scapular upward rotation (component movement) with shoulder flexion
(active movement)
o Arthrokinematic Motion
 Concave on convex
 Osteokinematic and arthrokinematic motion in same direction
o Ex: knee flexion  tibia moves posteriorly (osteokinematics),
femur posteriorly glides (arthrokinematics)
 Convex on concave
 Osteokinematic and arthrokinematic motions in opposite directions

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o Ex: shoulder flexion  arm moves superiorly (osteokiematics),

humerus rolls superiorly, humeral head slides inferiorly
(arthrokinematics)
 Rolling and gliding occur simultaneously
 Obligate translation
o Restricted capsular mobility will cause translation away from
tightness
 Ex: tight posterior GH capsule results in anterior
translation of humerus

Assessment and Treatment

 Treatment plane = perpendicular to the axis and parallel to the joint surface
 Traction = separation of joint surfaces perpendicular to treatment plane
o Grade I  unweighted
 Literally just taking up some of the slack and supporting joint
 Best for people in a lot of pain – separating the joint surfaces without putting
load on surrounding tissues
 Will not increase mobility
o Grade II  taking up the slack
 Start to feel some resistance
 Getting tension as you take up slack
o Grade III  capsule and ligaments stretched
 Motion is stopped
 Gets into restriction
 Increases mobility
 Gliding = joint surfaces displaced parallel to treatment plane

 Joint Mobility Assessment

o Difficult to assess
o Quantity graded in millimeters
o Quality graded by “end feel”
o Poor intra/intertester reliability
o Comparison to uninvolved side

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o Handling Technique:
 Soft hands
 Hands should be close to the joint line
 Palpate the joint line to increase your sensitivity to the motion occurring
 Patient must be relaxed
o Quality of Motion:
 Onset of resistance and/or muscle guarding
 End feel
 Pain provocation
o Classification of joint mobility:

Mobilization:
 Indications:
o Pain, muscle guarding and spasm
 Gentle techniques stimulate mechanoreceptors to inhibit transmission of
nociceptive stimuli
o Reversible hypomobility
 Progressively vigorous techniques
o Positional fault/subluxation
o Goal is to achieve full, unrestricted, pain-free ROM
 Effects:
o Neurophysiological
 Stimulation of mechanoreceptors
 Decrease nociceptive stimulation of the brain stem / spinal cord
 Proprioceptive and kinesthetic awareness
o Mechanical
 Increase blood supply and nutrients to the area

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 Stretch or elongate hypomobile structures such as capsular or ligamentous

tissue
 Break adhesions
 Contraindications:
o Malignancy in area
o Infectious arthritis
o Metabolic bone disease
o Fusion / Ankylosis (but can mobilize joints around fused joints)
o Osteomyelitis
o Fracture
o Ligament rupture
 Precautions:
o Excessive pain/swelling
 Lower grades may still be appropriate but higher probably not
o Arthroplasty
 Depending on surgical approach
o Pregnancy
 More laxity in later stages
 Depends on impairment region, positioning and how far along
o Hypermobility
o Sponylolisthesis
o Rheumatoid Arthritis
o Vertebrobasilar insufficiency
 Grades:
o I = small amplitude at the beginning of range
o II = large amplitude within available range
 Grade 1-2 not helpful to increase emotion because you don’t get to end range 
better for pain
o III = large amplitude that reaches end range
 Starts to increase motion
o IV = small amplitude movement at the very end range
 Oscillations are at end range  increases range/motion
o V = high velocity thrust manipulation
 AKA manipulation
 Get to end point, give quick thrust vs. oscillation
 Can make any mobilization a manipulation, just take them to end point and
perform high velocity thrust
o If pain is only at end range and is only 2-3/10 can start with grade 3-4, don’t have to
always start with 1-2 and work your way up. Start with 1 or 2 if patient guards and has
significant pain with motion.
 Procedure
o Explain what you are going to do
o Patient position and therapist position
o Joint position
o Stabilization

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o Direction of force
o Amount of force
o Patient response
 Mobilization Treatment Variables
o Grade of the technique
o Rhythmic or sustained
o Position of the joint
o Direction of the movement
o Symptomatic response will guide your selection of techniques
o Always re-examine the joint for change in range
 Considerations
o Grades I & II:
 Neurophysiological effect to treat pain
 Neuromodulation on sensory innervation of joint mechanoreceptors and
pain receptors
 Neutralizes joint pressures
o Grades III & IV:
 Mechanical effect to treat stiffness/hypomobility
 Plastic deformation of capsule

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