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Physiotherapy


Mobilization and Manipulation

introduction:

Joint mobilization/Manipulation is a treatment technique involving the application of passive force/gliding movements to the joint surfaces to restore its function achieving therapeutic effect. Joint mobilization/Manipulation is a safe and effective treatment technique in restoring joint movements,

manipulating muscles, ligaments and other soft tissues, but within the range.

Note: Mobilization/Manipulation techniques are performed by physiotherapist/Trained professio

nal only.

Types of movements in a joint

    • Physiological movements like Flexion, Extension, Abduction, Adduction, Internal rotation, External   rotation. They are done voluntarily (motions of bones).

    • Accessory movements like Spins, Glides, and Rolls. These movements are within the joints and surrounding tissues to provide normal range of motion and cannot be done voluntarily.

         - Component movements are done along with active physiological movements without               voluntary control.

         - Joint play is movements within the joint seen by joint capsule’s laxity and done                    passively but not actively.

Principle of joint mobilization/Manipulation:

Joint mobilization/Manipulation technique is based on concave convex rule.

Concave-convex rule: If concave part is moving on the convex part, glide occurs in same direction of roll, but if convex part moves on concave part, then glide occurs in opposite direction of roll.

Spinning: Rotation of a part around a stable axis. (E.g. Radioulnar joint).

Glides: One point of the articulating part gets in touch with many points of the other articulation part. (E.g. Ankle joint).

Rolling: Many points on one articulating part comes in touch with many points of the other articulating parts. (E.g. Knee joint).
Mobilizations are Gentle, Slow and Small amplitude movements done within the available range. These are done when range of motion is lacking in a particular joint.
Manipulations are quick movements beyond the available range and are done to increase the available range of motion of the joint and also break joint capsule adhesions.

Benefits

•  It decreases pain by stimulation of mechanoreceptors.

•  Decreases muscle spasm and muscle guarding (nociceptive stimulation).

•  Improves nutritional exchange due to joint swelling and immobilization.

•  Improves range of motion, break downs adhesions.

•  Maintains extensibility.

Indications

•    Soft tissue (ligaments, joint capsule, fascia, tendons) adhesions/Loss of extensibility of soft tissues.

•    Fibro-fatty depositions, Shortened muscles, cartilage stiffness.

Contraindications

•    Osteoarthritis/Osteoporosis of spine.

•    Malignant areas, Degenerative joints.

•    Inflammatory arthritis, Tuberculosis, Rupture of ligaments.

•    If patient had joint replacement surgery at that part.

•    Bleeding joints, Loose joints and Joint pain with unusual symptoms.

•    Congenital deformities, Neurological impairments.

Precautions to be taken care

• These techniques if not performed with care, Fractures, Dislocations, Muscle, Tendon, Ligament, Joint capsule, Nerve injury/damage/tearing may occur.

• While performing the treatment, the therapist must have good body mechanics and should not over exceed the patient’s pain limits.
Grading system of joint mobilization based on the joint play

• Grade 1: The therapist should apply small range of passive force, only till 15-25% of joint play.

• Grade 2: Passive force application is up to half the joint range i.e. 50%  of the joint play is available

•  Grade 3: Here passive range is applied by moving one bone on the other to the end of the joint mobility range i.e. joint play is 100%.

Technique

• Patient and the mobilizing part should be positioned in relaxed manner. Then stabilize one joint (mostly proximal) with hand/belt/assistant to prevent unwanted movement and stretch.

• During traction pulling one articulating surface away from another is to be done creating slight separation of two bones.

• The treatment techniques are performed in the direction either parallel/perpendicular to the treatment plane.

• Traction techniques are applied perpendicular to the treatment plane. Gliding technique is performed parallel to the treatment plane.

Shoulder joint mobilization                                                 Knee joint mobilization

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