Joint Mobilization

Joint Mobilization by the Physiotherapy UG second year Student for online seminar

1. Joint mobilization HEMA LATHA MAHATMA GANDHI MEDICAL COLLEGE & RESEARCH INSTITUTE SRI BALAJI VIDYAPEETH DEEMED TO BE UNIVERSITY PONDICHERRY

2. objectives.. Define mobilization, Self-Mobilization, Mobilization with Movement, physiologic movements, accessory movements, arthrokinematics , thrust. Describe Joint Shapes & Arthrokinematics Explain Convex-Concave & Concave-Convex Rule Describe Effects of Joint Mobilization Enumerate INDICATION & Contraindications for Mobilization Describe Maitland Joint Mobilization Grading Scale Describe kaltenborn grading scale

3. What is joint mobilization ?🤔🤔 “ skilled passive movement of the articular surfaces performed by a physical therapist to decrease pain or increase joint mobility ”

4. DEFINITION OF TERMS…. Self mobilization: self-stretching techniques that specifically use joint traction or glides that direct the stretch force to the joint capsule . mobilization with movement: Concurrent application of a sustained accessory mobilization applied by a clinician, Physiotherapist to end range and physiological movement applied by the Patient.

5. Physiologic Movements : – movements done voluntarily Osteokinematics – motions of the bones Accessory Movements : movements within the joint & surrounding tissues that are necessary for normal ROM, but can not be voluntarily performed Component motions : motions that accompany active motion, but are not under voluntary control Joint play : motions that occur within the joint Determined by joint capsule’s laxity Can be demonstrated passively, but not performed actively

6. Arthrokinematics : – motions of bone surfaces within the joint 5 motions ­ Roll, Slide, spin,Compression,Distraction Thrust : – high-velocity, short-amplitude motion that the patient can not prevent – Performed at end of pathologic limit of the joint (snap adhesions, stimulate joint receptors)

7. Shapes of joint

8. Basic concepts of joint motion : Arthrokinematics Types of joint motion – Roll – Slide – Spin – Compression – Distraction Joint motion usually often involves a combination of rolling, sliding & spinning

9. Effects of Joint Mobilization • Neurophysiological effects – Stimulates mechanoreceptors to decrease 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

10. • Mechanical effects – Improve mobility of hypo-mobile joints (adhesions & thickened Connective tissue from immobilization – loosens) – Maintains extensibility & tensile strength of articular tissues

11. Concave ans convex charecteristic convex surfaces have more cartilage at the center • concave surfaces have more cartilage on the periphery • where surfaces appear flat - the larger articular surface is considered convex

12. Rules of mobilization Convex-Concave & Concave-Convex Rule • Basic application of correct mobilization techniques • 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

13. 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 .

14. Rules of motion….. because their is always incongruent surfaces, there must be some combination of glide and roll • arthrokinematic roll always occurs in the same direction as bony movement regardless of whether the joint surface is convex or concave in shape.

15. indications Pain, muscle spasm, muscle guarding Neurophysiologic effects:­ small amplitutde oscillatory and distraction movements are used to stimulate the mechanoreceptors that may inhibit the transmission of nociceptive stimuli at spinal cord or brain stem levels. Mechanical effects:­ gliding and distraction movements are used to cause synovial fluid motion, which brings nutrition to the avascular portions of articular cartilage, thus preventing from painful and degenerating effects of stasis.

16. Indications…… Reversible joint hypomobility Positional faults/subluxation Progressive limitation Functional immobility

17. contraindications Inflammatory arthritis Malignancy Tuberculosis Osteoporosis Ligamentous rupture Herniated disks with nerve compression Bone disease Neurological involvement Bone fracture Congenital bone deformities Vascular disorders

18. Contraindications….. hypermobility : ­ joints of the patient with potential necrosis of ligaments or capsule should not be stretched. Joint effusion : there may be swelling from traumaor diesease. Rapid swelling­ bleeding within the joints.(hemophilia). Medical interventions required for aspiration of blood to minimize necrotizing effect on articular cartilage. Inflammation : stretching will increase pain and muscle guarding and will result in greater tissue damage. Gentle oscillation or distraction motion may temporarily inhibit the pain response.

19. Grades of mobilization Non thrust oscilation techniques(maitland) Grade-1 Grade-2 Grade-3 Grade-4

20. Non thrust sustained joint play techiniques(kaltenborn) grade-1(loosen) grade-2(tighten) grade-3(stretch)

21. Indications for Mobilization Maitland: Grades I and II -­ primarily used for pain . Grades III and IV- ­ primarily used to increase motion. Kaltenborn : Grade I- used for relief of pain. Grades II – used for initial treatment to determine the sensitivity of pain. Grades III- used to stretch the joint structure.

22. Joint Positions Resting position Loose- packed position Close- packed position General rule

23. Joint Mobilization Application Positioning & Stabilization Treatment Force & Direction of Movement

24. References.. Carolyn kisner□lynn allen colby(therapeutic exercises foundations and techniques) Maitland GD. Peripheral Manipulation. Kaltenborn FMM, et al. Manual Mobilization of the Joints: The Kaltenborn Method of Joint Examination and Treatment

25. Thank you SPECIAL THANKS TO EXRX ORGANIZING TEAM FOR THIS WONDERFUL PLATFORM