Lecture-11

JOINTS MOBILIZATION
Basic Concepts

Dr.Asad khan
Outlines
What is Joint Mobilization?
Terminology
Relationship Between Physiological & Accessory Motion
Basic concepts of joint motion : Arthrokinematics
Effects of Joint Mobilization
Contraindications for Mobilization
Precautions

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 What is Joint Mobilization?
“Joint Mobs”

Manual therapy technique

– Used to modulate pain
– Used to increase ROM
– Used to treat joint dysfunctions that limit ROM by specifically
addressing altered joint mechanics

Factors that may alter joint mechanics:

– Pain & Muscle guarding
– Joint hypomobility
– Joint effusion
– Contractures or adhesions in the joint capsules or supporting
ligaments
– Malalignment or subluxation of bony surfaces
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 Terminology
Mobilization – passive skilled manual therapy technique used to
increase ROM or decrease pain
– Applied to joints & related soft tissues at varying speeds & amplitudes
using physiologic or accessory motions
– Force is light enough that patient’s can stop the movement
Manipulation – passive joint movement for increasing joint
mobility
– Incorporates a sudden, forceful thrust that is beyond the patient’s control
– Thrust is High velocity and low amplitude not under control of patient
– Performed at end of pathologic limit of the joint ( break adhesions, stimulate joint
receptors and to alter positional relationship)
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 Terminology

Self-Mobilization (Auto-mobilization) – self-

stretching techniques that specifically use joint traction
or glides that direct the stretch force to the joint capsule

Mobilization with Movement (MWM) – concurrent

application of a sustained accessory mobilization
applied by a therapist & an active physiologic movement
to end range applied by the patient
– Applied in a pain-free direction

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 Terminology
Physiologic Movements –
– Osteokinematics – motions of the bones
– movements done voluntarily
– “traditional” movements such as flexion, extension, adduction,
abduction, rotation
– Accessory Movements – movements within the joint & surrounding
tissues that are necessary for normal ROM, but can not be actively performed
by the patient
• Component motions – motions that accompany active motion, but are
not under voluntary control.
• Ex: Upward rotation of scapula & rotation of clavicle that occur with shoulder
flexion
• Joint play – the accessory movement available within the joint which
is not under control
• Determined by joint capsule’s laxity
• Can be demonstrated passively, but not performed actively
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 Terminology

Arthrokinematics – motions of bone surfaces within the joint

– 5 motions - Roll, Slide, Spin, Compression, Distraction

Muscle energy – use an active contraction of deep muscles that

attach near the joint & whose line of pull can cause the desired
accessory motion
– Therapist stabilizes segment on which the distal aspect of the muscle attaches;
command for an isometric contraction of the muscle is given, which causes the
accessory movement of the joint

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Relationship Between Physiological & Accessory
Motion
Biomechanics of joint motion
– Physiological motion
• Result of concentric or eccentric active muscle contractions
• Bones moving about an axis or through flexion, extension,
abduction, adduction or rotation

– Accessory Motion
• Motion of articular surfaces relative to one another
• Generally associated with physiological movement
• Necessary for full range of physiological motion to occur
• Ligament & joint capsule involvement in motion
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 Terminology

Concave – hollowed or rounded inward

Convex – curved or rounded outward

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 Basic concepts of joint motion :
Arthrokinematics
1. Joint Shapes
Type of motion is influenced by the
shapes of the joint surfaces
Ovoid – one surface is convex, other
surface is concave
– What is an example of an ovoid
joint?

Sellar (saddle) – one surface is

concave in one direction & convex in
the other, with the opposing surface
convex & concave respectively
– What is an example of a sellar
joint?
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 Types of Motion
The movement of the bony lever is called swing
and is classically described as flexion,
extension, abduction,adduction, and rotation.
Motion of the bone surfaces in the joint is a
variable combination of rolling and sliding, or
spinning.
For the rolling, sliding, or spinning to occur,
there must be adequate capsule laxity or joint
play.
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 Roll
A series of points on one articulating surface
come into contact with a series of points on
another surface
– Ball rolling on ground
– Example: Femoral condyles rolling on tibial plateau
– Roll occurs in direction of movement
– Occurs on incongruent (unequal) surfaces
– Usually occurs in combination with sliding or spinning

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 Slide/translation
The same point on one surface comes into contact
with the new points on the opposing surface.
Pure sliding does not occur in joints, because the
surfaces are not completely congruent.
The direction in which sliding occurs depends on
whether the moving surface is concave or convex.
Sliding is in the opposite direction of the angular
movement of the bone if the moving joint surface is
convex (Fig. 5.5 A).
Sliding is in the same direction as the angular
movement of the bone if the moving surface is
concave (Fig. 5.5 B)..

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 Combined rolling-sliding in a joint
– The more congruent the surfaces are, the more
sliding there is
– The more incongruent the joint surfaces are, the
more rolling there is
– When muscles actively contract to move a bone, some of the
muscles may cause or control the sliding movement of the
joint surfaces. For example, the caudal sliding motion of the
humeral head during shoulder abduction is caused by the
rotator cuff muscles, and the posterior sliding of the tibia
during knee flexion is caused by the hamstring muscles.
– If this function is lost, the resulting abnormal joint mechanics
may cause microtrauma and joint dysfunction
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 Spin

Occurs when one bone rotates around a

stationary longitudinal mechanical axis
• Same point on the moving surface creates an
arc of a circle as the bone spins
• Spinning rarely occurs alone in joints but in
combination with rolling and sliding.
• Three examples of spin occurring in joints of the body
are the shoulder with flexion/extension, the hip with
flexion/ extension, and the radiohumeral joint with
pronation/ supination
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Compression –
– Decrease in space between two joint surfaces
– Compression normally occurs in the extremity and spinal joints
when weight bearing.
– Some compression occurs as muscles contract, which
– provides stability to the joints.
– Normal reaction of a joint to muscle contraction
Distraction -
– Two surfaces are pulled apart
– Often used in combination with joint mobilizations to
increase stretch of capsule.
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 Convex-Concave & Concave-Convex Rule
Basic application of correct mobilization techniques -
– Relationship of articulating surfaces associated with
sliding/gliding

One joint surface is MOBILE & one is STABLE

Concave-convex rule: concave joint surfaces slide in

the SAME direction as the bone movement (convex is
STABLE)
– If concave joint is moving on stationary convex surface –
glide occurs in same direction as roll

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Convex-concave rule: convex joint
surfaces slide in the OPPOSITE
direction of the bone movement
(concave is STABLE)
If convex surface in moving on
stationary concave surface – gliding
occurs in opposite direction to roll

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RULE OF CONCAVE-CONVEX

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 Effects of Joint Mobilization
Neurophysiological effects –
– Stimulates mechanoreceptors to  pain
– Affect muscle spasm & muscle guarding – nociceptive stimulation
– Increase in awareness of position & motion because of afferent nerve impulses

Nutritional effects –
– Distraction or small gliding movements – cause synovial fluid movement
– Movement can improve nutrient exchange due to joint swelling & immobilization

Mechanical effects –
– Improve mobility of hypomobile joints (adhesions & thickened CT from
immobilization – loosens)
– Maintains extensibility & tensile strength of articular tissues

Cracking noise may sometimes occur

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 Contraindications for Mobilization
Should not be used haphazardly

Avoid the following:

– Inflammatory arthritis – Neurological involvement
– Malignancy – Bone fracture
– Tuberculosis – Congenital bone deformities
– Osteoporosis – Vascular disorders
– Ligamentous rupture – Joint effusion
– Herniated disks with nerve compression • May use I & II
– Bone disease mobilizations to relieve
pain

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 Precautions
Osteoarthritis old age
Pregnancy
Total joint replacement
Severe scoliosis
Poor general health
Patient’s inability to relax

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 Thank you
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