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LEARNING OBJECTIVES

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

INTRODUCTION

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

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

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

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).

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 and effective ...

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