MANUAL THERAPY [SHS.

405]
DR. MUHAMAD RIZWAN
LECTURER
 CONTENT
 Goals of joint mobilization
 Mobilization techniques

 Pain relief mobilization

 Pain-relief traction mobilization (grade i -iisz)
 Vibrations and oscillations
 Relaxation mobilization

 Stretch mobilization
 Stretch-traction mobilization
 Stretch-glide mobilization
 Manipulation

 Avoiding high-risk manual treatment

 Rotation mobilization

 Joint compression
 JOINT MOBILIZATION

 Joint mobilization is perhaps the most important

component of OMT practice.

 Hands-on skill in joint mobilization enhances both

diagnostic acumen and treatment effectiveness.
JOINT MOBILIZATION
1. Pain-relief mobilization
- Grade I - IISZ in the (actual) joint resting position

2. Relaxation mobilization
- Grade I - II in the joint (actual) resting position

3. Stretch mobilization
- Grade 3 in the joint (actual) resting position
- Grade 3 at the point of restriction

4. Manipulation
 GOALS OF JOINT MOBILIZATION
 Mobilization treatment is based on a specific
biomechanical assessment of joint hypo mobility and
hyper mobility.

 If the patient's symptoms are associated with an

abnormal end-feel and a slight or significant hypo
mobility (Class 1 or 2), use Grade II relaxation-
mobilization or Grade III stretch-mobilization techniques
to improve joint function.

 Class 0 ankylosed joints are not mobilized.

 GOALS OF JOINT MOBILIZATION
 If the patient's symptoms are associated with a slight or
significant Hyper mobility (Class 4 or 5), apply
stabilizing (limiting) treatment to normalize joint
function.

 Complete instabilities (Class 6) dislocations or

ligamentous laxity with instability) usually require
surgical intervention .
MOBILIZATION TECHNIQUES
 PAIN-RELIEF MOBILIZATION
GRADE I - IISZ
 If the patient has severe pain or other symptoms (e.g.,
spasm, paraesthesia) such that the biomechanical status
of the joint cannot be confirmed or that Grade III
stretching techniques cannot be tolerated, direct
treatment toward symptom control.

 Grade I and II Slack Zone mobilizations help to

normalize joint fluid viscosities and thus improve joint
movement when movement is restricted by joint fluids
rather than by shortened peri articular tissues.
 PAIN-RELIEF-TRACTION
MOBILIZATION
GRADE I - IISZ
 Intermittent Grade I and II traction-mobilizations in the
Slack Zone, applied in the resting position or actual
resting position is the initial trial treatment of choice for
symptom control.
 VIBRATIONS AND OSCILLATIONS
 Short amplitude, oscillatory joint movements other than
traction are also used for the treatment of pain.

 These movements are usually applied manually, but the

use of mechanical devices such as vibrators may also be
effective in the application of very high frequency and
very short amplitude movement.
 RELAXATION MOBILIZATION
GRADE I - II
 Relaxation mobilizations differ from pain-relief
mobilizations in that they can be applied anywhere in the
Grade I-II range, including both the Slack Zone and
through the increasing resistance of the Transition Zone.

 Apply relaxation joint mobilizations as intermittent

Grade I and II movements in the actual resting position
to decrease pain and relax muscles.
 RELAXATION MOBILIZATION
GRADE I - II
 Relaxation mobilizations should not produce or increase
pain.

 Relaxation mobilizations are also useful as preparation

for more intensive treatments (for example, a Grade III
stretch mobilization) which can be more effective when
the patient's muscles are fully relaxed.
 RELAXATION-TRACTION
MOBILIZATION
GRADE I - II
 Apply intermittent traction-mobilizations in the actual
joint resting position within the Grade I or II range,
including the Transition Zone.
 STRETCH MOBILIZATION
GRADE III
 Grade III stretch mobilizations are one of the most
effective means for restoring normal joint play.

 Stretching shortened connective tissues in muscles, joint

capsules and ligaments can increase and maintain
mobility and delay progressive stiffness and loss of
range of movement in chronic musculoskeletal disorders.
 STRETCH MOBILIZATION
GRADE III
 Fixation of one joint partner is absolutely essential for an
effective stretch mobilization.

Sustain a stretch mobilization for a minimum of seven

seconds, up to a minute or longer, as long as the patient
can comfortably tolerate.

 In viscoelastic structures, the longer a stretch is sustained

the greater and more lasting the mobility gain.

 For greatest effect, continue the treatment for 10-15

minutes in a cyclic manner.
 STRETCH MOBILIZATION
GRADE III
 Normally the time a stretch is sustained is more critical
than the amount of force used.

 A sensation of stretching in the form of slight local

discomfort is a normal response to stretch-mobilization.

Grade III stretch-mobilizations usually produce immediate

improvement within the first treatment session.
STRETCH-TRACTION MOBILIZATION
GRADE III
 Apply stretch-traction mobilization at a right angle to the
treatment plane.

Grade III traction mobilization in the (actual) resting

position can stretch any soft tissue that crosses the joint
and limits joint movement, including muscle connective
tissues, joint capsules and ligaments.
STRETCH-TRACTION MOBILIZATION
GRADE III
 Grade III traction mobilization at the point of
restriction is applied with the joint pre-positioned near
the limit of range in the restricted movement direction.
This maneuver will increase joint mobility primarily in
the pre-positioned direction
 STRETCH-GLIDE MOBILIZATION
GRADE III
 Stretch-glide mobilization directly stretches the tissues
restricting joint movement.

 Apply stretch-glide mobilizations parallel to the

treatment plane.

 Glide-mobilizations produce some intra-articular

compression, more so with stiffer joints. To facilitate the
glide mobilization and reduce these compressive forces
acting on the joint, combine it with a Grade I traction
movement.
 MANIPULATION
a high velocity, small amplitude, linear movement in the
actual resting position, applied with a quick impulse
("thrust") to a joint showing a suitable end-feel, to effect
joint separation and restore translatoric glide.
AVOIDING HIGH-RISK MANUAL
TREATMENT
 AVOIDING HIGH-RISK MANUAL
TREATMENT
If traction exacerbates symptoms:
 Adjust joint positioning:

Continuously monitor changes in the

actual resting position and adjust the joint's three-
dimensional positioning as needed.

 Reduce traction force: Early in the healing process a

patient may tolerate only minimal forces.
 AVOIDING HIGH-RISK MANUAL
TREATMENT
 Correct an underlying positional fault:
A positional fault can occur in
both hypo mobile and hyper mobile joints.

 It is a condition in which joint partners are in an

abnormal position, most often involving a hyper mobile
joint stuck in an unusual joint position.
 AVOIDING HIGH-RISK MANUAL
TREATMENT
 Discontinue traction treatment :
In some cases, for instance with
certain acute soft tissue lesions (e.g., ligamentous strain),
traction treatment may be contraindicated along with any
form of stretch to the injured fibers.
 JOINT COMPRESSION
 Do not do joint compression techniques because they can
too easily aggravate a joint condition.

 Passive manual joint compression can stimulate cartilage

nutrition and regeneration.
 JOINT COMPRESSION
 Rolling, gliding, and compression are physiological
stresses joints experience with normal movement.

 In fact, these stresses are necessary for the maintenance

of articular cartilage.

 When there is an imbalance of rolling, gliding and

compression, joints begin to show the effects of wear
and tear, marking the onset of degenerative joint disease
(DID).
 JOINT COMPRESSION
 For example, too much compression may occur with
excessive running or jumping activities which can lead
to DID. On the other hand, not enough stress to the joint,
as with prolonged immobilization in a cast or bed rest,
can also lead to DID.
Thank You