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LEARNING OBJECTIVES
Upon completion of this chapter, the learner should be able to demonstrate the following competencies and proficiencies concerning joint mobilizations:
Define joint mobilization
Determine factors that cause altered joint mechanics
Determine factors that cause joint hypomobility
Understand osteokinematic and arthrokinematic movement
Distinguish between mobilization and manipulation
Understand and apply the convex–concave rule to specific joints
Understand the concepts of roll, slide, compression, distraction, and swing
Determine the loose and closed packed position of each joint
Determine capsular patterns for each joint
Understand the effects of joint mobilization on joint function
Define mobilization with movement and muscle energy
Define and apply the different grades of mobilizations to the human body
Determine when and how to apply joint mobilizations to specific joints
Understand the indications, precautions, and contraindications for joint mobilization
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Joint mobilization involves the passive movement of a joint through the application of manual therapy techniques. Joint mobilizations are slow, passive movements of articulating surfaces to modulate pain or increase joint mobility.1 Joint mobilizations are used to treat limitations in joint range of motion by specifically addressing the altered mechanics of the joint.2 Altered joint mechanics may be the result of any number of factors following joint injury. Box 6-1 outlines potential causes of altered joint mechanics, and Box 6-2 lists common factors contributing to joint hypomobility. If untreated, joint hypomobility will result in decreased joint nutrition and early joint degeneration.3
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BOX 6-1 Factors Causing Alterations in Joint Mechanics2,7
Pain
Muscle guarding/muscle spasm
Joint effusion
Joint contractures
Joint capsule adhesions
Ligamentous contractures
Malalignment of bony joint surfaces
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BOX 6-2 Factors Contributing to Joint Hypomobility
Immobilization
Tissue trauma
Muscle imbalance
Neuromuscular disease
Limited mobility (such as confinement to a wheelchair after spinal cord injury)
Postural malalignment (such as rounded shoulders)
Congenital deformities (e.g., thoracic scoliosis)
Acquired deformities (e.g., excessive thoracic kyphosis)
Sedentary lifestyle/inactivity
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Joint mobilizations differ from passive range of motion techniques (see Chapter 4) and stretching techniques (see Chapter 4) in that joint mobilizations specifically address intra-articular tissues that are causing limitations in joint range of motion or normal joint mobility. The goal of joint mobilization techniques is to normalize joint mechanics by addressing joint capsule restrictions.4,5 Joint mobilizations, however, are rarely used in isolation to treat range of motion limitations. In most cases, joint mobilizations accompany the application of range of motion and stretching exercises to address soft tissue limitations that effect joint range of motion (see Box 6-1).
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The appropriate application of joint mobilization techniques depends on the clinician's knowledge of normal joint anatomy and biomechanics. Additionally, the clinician must fully understand the role of the concave–convex rule with regard to joint osteokinematics and joint arthrokinematics prior to applying joint mobilization techniques in the clinical setting.5 Joint mobilizations, when applied correctly, are safe ...