Chapter 5: Peripheral Joint Mobilization/Manipulation

Introduction

Joint mobilization, also known as manipulation, refers to manual therapy techniques that are used to modulate pain and treat joint impairments that limit range of motion (ROM) by specifically addressing the altered mechanics of the joint. The altered joint mechanics may be due to pain and muscle guarding, joint effusion, contractures or adhesions in the joint capsules or supporting ligaments, or aberrant joint motion. Joint mobilization stretching techniques differ from other forms of passive or self-stretching (described in Chapter 4) in that they specifically address restricted capsular tissue by replicating normal joint mechanics while minimizing abnormal compressive stresses on the articular cartilage in the joint.¹⁷

Historically, mobilization has been the preferred term to use as therapists began using the passive, skilled joint techniques because mobilization had a less aggressive connotation than manipulation. High-velocity thrust (HVT) techniques, typically called manipulation, were not universally taught or used by most practitioners. However, with the increased level of education^3,5 and current practice of physical therapy,² both non-thrust and thrust manipulation techniques are skills that therapists are learning and safely using in many practice settings. The Manipulation Education Manual for Physical Therapist Professional Degree Programs² as well as the Guide to Physical Therapist Practice⁸ couple the terms "mobilization" and "manipulation" in order to demonstrate their common usage.

An editorial²⁵ described problems with using the terms interchangeably without clear definitions. The authors cited confusion in interpreting research and describing outcomes when the techniques used are not specifically described. They also indicated possible confusion in communicating with patients and with referral sources. It is therefore critical that the practitioner clearly understands and defines the characteristics of the techniques used when referring to manipulative techniques.

In this text, the terms "mobilization" and "manipulation" will be used interchangeably, with the distinction made between non-thrust and thrust techniques. The procedures section in this chapter describes documentation and the importance of identifying rate, range, and direction of force application, as well as target, relative structural movement, and patient position whenever referring to mobilization/ manipulation intervention techniques.²⁴ This information should be used in all documentation and communication in order to minimize discrepancies in interpretation of outcomes.

To use joint mobilization/manipulation techniques for effective treatment, the practitioner must know and be able to examine the anatomy, arthrokinematics, and pathology of the neuromusculoskeletal system and to recognize when the techniques are indicated or when other techniques would be more effective for regaining lost motion. Indiscriminate use of joint techniques, when not indicated, could lead to potential harm to the patient's joints. We assume that, prior to learning the techniques presented in this text, the student or therapist has had (or will be concurrently learning) orthopedic examination and evaluation and therefore will be able to choose appropriate, safe techniques for treating the patient's impairments. The reader is referred to several resources for additional ...