JOINT MOBILIZATION 3

Dr.Javeria Aslam PT
BSPT,PP-DPT/M-PHILL,MS-OMPT*
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 PERIPHERAL JOINT MOBILIZATION TECHNIQUES
• Glenohumeral Joint
• The concave glenoid fossa receives the convex humeral head.
• Resting Position
• The shoulder is abducted 55, horizontally adducted 30, and rotated so the forearm is
in the horizontal plane.
• Treatment Plane
• The treatment plane is in the glenoid fossa and moves with the scapula.
• Stabilization
• Fixate the scapula with a belt or have an assistant help.
• Glenohumeral Distraction (Fig. 5.14)
• Indications
• Testing; initial treatment (sustained grade II); pain control (grade I or II oscillations);
general mobility (sustained grade III).
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• Patient Position
• Supine, with arm in the resting position. Support the forearm between
your trunk and elbow.
• Hand Placement
• Use the hand nearer the part being treated (e.g., left hand if treating
the patient’s left shoulder) and place it in the patient’s axilla with your
thumb just distal to the joint margin anteriorly and fingers posteriorly.
• Your other hand supports the humerus from the lateral surface.
• Mobilizing Force
• With the hand in the axilla, move the humerus laterally
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Glenohumeral joint: distraction in resting position. Note that the force is perpendicular to the
treatment plane in the glenoid fossa.

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 Glenohumeral Caudal Glide, Resting
Position
• Indications
• To increase abduction (sustained grade III); to reposition the humeral
head if superiorly positioned.
• Patient Position
• Same as for distraction.
• Hand Placement
• Place one hand in the patient’s axilla to provide a grade I distraction.
• The web space of your other hand is placed just distal to the
acromion process.

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• Mobilizing Force
• With the superiorly placed hand, glide the humerus in an inferior
direction.
• GH Caudal Glide: Alternate
• Hand Placement
• Same as for distraction (see Fig. 5.14).
• Mobilizing Force
• The force comes from the hand around the arm,pulling caudally as you
shift your body weight inferiorly.
• N O T E : This glide is also called long-axis traction
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Glenohumeral joint: caudal glide in the resting position. Note that the distraction force is applied by the
hand in the axilla, and the caudal glide force is from the hand superior to the humeral head.

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 Glenohumeral Caudal Glide
Progression
• Indication
• To increase abduction
• Patient Position
• Supine or sitting, with the arm abducted to the end of its available range.
• External rotation of the humerus should be added to the end-range
position as the arm approaches and goes beyond 90.
• Therapist Position and Hand Placement
• With the patient supine, stand facing the patient’s feet and stabilize the
patient’s arm against your trunk with the hand farthest from the patient.
Slight lateral motion
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 Cont..

• of your trunk provides grade I distraction. With the patient

sitting, face the patient and cradle the distal humerus with
the hand closest to the patient; this hand provides a grade I
distraction.
• Place the web space of your other hand just distal to the
acromion process on the proximal humerus.
• Mobilizing Force
• With the hand on the proximal humerus, glide the humerus
in an inferior direction.
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Glenohumeral joint: caudal glide with the shoulder near 90 .

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 Glenohumeral Elevation Progression

• Indication
• To increase elevation beyond 90 of abduction
• Patient Position
• Supine or sitting, with the arm abducted and externally rotated to the
end of its available range.
• Therapist Position and Hand Placement
• Hand placement is the same as for caudal glide progression.
• Adjust your body position so the hand applying the mobilizing force is
aligned with the treatment plane. With the hand grasping the elbow,
apply a grade I distraction force.
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 Cont..

• Mobilizing Force
• With the hand on the proximal humerus, glide the
humerus in a progressively anterior direction against
the inferior folds of the capsule in the axilla.
• The direction of force with respect to the patient’s body
depends on the amount of upward rotation and
protraction of the scapula.

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Glenohumeral joint: elevation progression in the sitting position. This is used when the range
is greater than 90. Note the externally rotated position of the humerus; pressure against the
head of the humerus is toward the axilla.

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 Glenohumeral Posterior Glide
• Indications
• To increase flexion; to increase internal rotation.
• Patient Position
• Supine, with the arm in resting position.
• Therapist Position and Hand Placement
• Stand with your back to the patient, between the patient’s trunk and arm.
• Support the arm against your trunk, grasping the distal humerus with your lateral
hand. This position provides grade I distraction to the joint. Place the lateral
border of your top hand just distal to the anterior margin of the joint, with your
fingers pointing superiorly. This hand gives the mobilizing force.
• Mobilizing Force
• Glide the humeral head posteriorly by moving the entire arm as you bend your
knees.
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Glenohumeral joint: posterior glide in the resting position

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 Glenohumeral Posterior Glide
Progression
• Indications
• To increase posterior gliding when flexion approaches 90; to increase horizontal adduction.
• Patient Position
• Supine, with the arm flexed to 90 and internally rotated and with the elbow flexed. The arm
may also be placed in horizontal adduction.
• Hand Placement
• Place padding under the scapula for stabilization. Place one hand across the proximal surface
of the humerus to apply a grade I distraction. Place your other hand over the patient’s elbow.
A belt placed around your pelvis and the patient’s humerus may be used to apply the
distraction force.
• Mobilizing Force
• Glide the humerus posteriorly by pushing down at the elbow through the long axis of the
humerus.

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 Glenohumeral joint: posterior glide progression.
One hand (A)or a belt (B) is used to exert a grade 1 distraction force.

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 Glenohumeral Anterior Glide,

• Indications
• To increase extension; to increase external rotation.
• Patient Position
• Prone, with the arm in resting position over the edge of
the treatment table, supported on your thigh. Stabilize
the acromion with padding. Supine position may also
be used.

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• Therapist Position and Hand Placement
• Stand facing the top of the table with the leg closer to the table in a forward
stride position.
• Support the patient’s arm against your thigh with your outside hand; the arm
positioned on your thigh provides a grade I distraction.
• Place the ulnar border of your other hand just distal to the posterior angle of
the acromion process, with your fingers pointing superiorly; this hand gives
the mobilizing force.
• Mobilizing Force
• Glide the humeral head in an anterior and slightly medial direction. Bend
both knees so the entire arm moves anteriorly.
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Glenohumeral joint: anterior glide in the resting position

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 Glenohumeral External Rotation
Progressions

• Indication
• To increase external rotation
• Techniques
• Because of the danger of subluxation when applying an anterior glide
with the humerus externally rotated, use a distraction progression or
elevation progression to gain range.
• Distraction progression: Begin with the shoulder in resting position;
externally rotate the humerus to end range and then apply a grade III
distraction perpendicular to the treatment plane in the glenoid fossa.
• Elevation progression (see Fig. 5.17). This technique incorporates
end-range external rotation.
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 Glenohumeral joint: distraction for external rotation progression. Note that the
humerus is positioned in the resting position with maximum external rotation prior to
the application of distraction stretch force.

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 Acromioclavicular Joint: Anterior
• Indication
• To increase mobility of the joint Glide
• Stabilization
• Fixate the scapula with your more lateral hand around the acromion process.
• Patient Position
• Sitting or prone.
• Hand Placement
• With the patient sitting, stand behind the patient and stabilize the acromion process
with the fingers of your lateral hand.
• The thumb of your other hand pushes downward through the upper trapezius and is
placed posteriorly on the clavicle, just medial to the joint space.
• With the patient prone, stabilize the acromion with a towel roll under the shoulder.
• Mobilizing Force
• Your thumb pushes the clavicle anteriorly
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Acromioclavicular joint: anterior glide

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 Sternoclavicular Posterior Glide and Superior Glide

• Indications
• Posterior glide to increase retraction; superior glide to increase
depression of the clavicle.
• Hand Placement
• Place your thumb on the anterior surface of the proximal end of the
clavicle.
• Flex your index finger and place the middle phalanx along the caudal
surface of the clavicle to support the thumb.
• Mobilizing Force
• Posterior glide: Push with your thumb in a posterior direction.
• Superior glide: Push with your index finger in a superior direction
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Sternoclavicular joint: posterior and superior glides. (A) Press down with the thumb for
posterior glide. (B) Press upward with the index finger for superior glide.

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