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Joint Mobilization

  1. What is the Joint play?
    1. Joint play techniques are passive joint mobilizations.
    2. The technique is used to both assess and treat a dysfunctional joint
    3. Rules of the joint play
      • Before joint play techniques are used for treatment, the soft tissue surrounding the joint is prepared with heat or massage
      • The client mest be relaxed
      • The joint is stabilized proximally
      • The movement should never go into or past the point of pain
    4. The effects of the joint play
      • Assess joint dysfunctions
      • increase range of motion
      • stretch tight joint capsule
      • reduce adhesions, pain and spasm
  2. Indication
    • The most common indication for the joint play is decreased range of motion due to immobilization
      • fracture
      • ligamentous sprains
      • tendonitis
      • adhesive capsulitis
    • Any condition involving fibrosis or pseudo fibrosis(relative capsule fibrosis) of the joint capsule
  3. Contraindication
    • Recent fracture
    • Neoplasm
    • Acute inflammatory disease
    • Joint sepsis
    • Bacterial infection
    • Acute pain response to the manipulation
    • Advanced Osteoporosis
    • Joint restricted by pins, screws, rods or surgical reduction of ligaments
    • Joint hypermobility
    • Pregnancy
    • Spondylolisthesis
    • Rheumatoid arthritis
    • Vertebrobasilar insufficiency
  4. Techniques by Joint
    1. GH joint(Convex on Concave)
      1. CPOR : Abduction, external rotation, internal rotation > Adduction, flexion, extension
      2. Open packed position : 60° abduction + 60° horizontal abduction
      3. Cloded packed position : maximum horizontal abductino + maximum external rotation
      4. Joint play : Move humerus bone, with open packed position Joint Play: Shoulder – YouTube
        1. Axial distraction(longisic distraction) : increase overall ROM
        2. Lateral distraction(short axis distraction) : increase overall ROM
        3. Posterior glide : increae flexion and internal rotation
        4. Anterior glide : increse extension and external rotation
        5. inferior glide : increase abduction and flexion
    2. Sternoclavicula joint
      1. Open packed position : Arm resting by side
      2. Closed packed postition : the clavicle is maximally (posteriorly) rotated, as occurs during maximum arm elevation and full scapular rotation
      3. Joint paly : Move clavicel with open packed position Sternoclavicular (SC) joint mobilizations – YouTube
        1. Superior glide : increase depression
        2. Inferior glide : increase elevation
        3. Anterior glide : increase protraction(abduction)
        4. Posterior glide : increase retraction(addction)
    3. Humeroulnar joint (Concave on Convex)
      1. CPOR : Flexion > Extension
      2. Open packed position : 70° flexion
      3. Closed packed postion : Full extension
      4. Joint play : Move unlar bone, with open packed position Joint mobilization of Humeroulnar Joint – Distraction, Medial Gap, Lateral Gap, Anterior Glide – YouTube
        1. Distraction : increase overall ROM
        2. Lateral Gap : increse flexion and extension
        3. Medial Gap : increse flexion and extension
        4. Lateral glide : increse flexion and extension
        5. Medial glide : increse flexion and extension
    4. Humeroradial joint(Concave on Convex)
      1. ROM : flexion(150°), extension(0-10°)
      2. CPOR : Flexion > Extension
      3. Open packed position : Full extension and supination
      4. Closed packed postion : 90° flexion
      5. Joint play
        1. Distraction : increase overall ROM
        2. Posterior glide : increse extension
        3. Anterior glide : increse flexion
    5. Proximal Radioulnar joint (Convex on Concave)
      1. ROM : Supination(90°), Pronation (90°)
      2. CPOR : Supination =Pronation
      3. Open packed position : 35° supination at 70° flexion
      4. Closed packed postion : 5° supination
      5. Joint play
        1. Anterior glide : increase supination of the frorearm
        2. Posterior glide : increse pronatio of the forearm
    6. Distal Radioulnar joint (Concave on Convex)
      1. ROM : Supination(90°), Pronation (90°)
      2. CPOR : Supination =Pronation
      3. Open packed position : 10° supination
      4. Closed packed postion : 5° supination
      5. Joint play
        1. Anterior glide : increase Pronation of the frorearm
        2. Posterior glide : increase supination of the forearm
    7. Radiocarpal joint/Ulnocarpal joint(Convex on Concave)
      1. ROM : Flexion(80°), Extension(70°), Ulnar deviation(30°), Radila deviation(20°)
      2. CPOR : flexion = extension
      3. Open pack position : netural with slight ulnar deviation
      4. Closed paced position : Full extension and radial deviation
      5. Joint play
        1. Dorsal(posterior) glide : increase extension of the wrist
        2. Palmar(Anterior) glide : increase flexion of the wrist
    1. Iliofemoral joint(Convex on Concave)
      1. Joint play
        1. Long axis distraction : increase overall ROM, decrease muscle spasm and pain
        2. Anterior glide : increase extension and lateral rotation
        3. Posterior glide : increase flexion and medial rotation
        4. Lateral glide : increase adduction and medial rotation
        5. Medial glide : increase abduction
        6. Inferior glide : increase flexion
    2. Tibiofemoral joint (Concave on Convex)
      1. Joint play
        1. Anterior glide : increase extension
        2. Posterior glide : increase flexion
    3. Proximal Tibiofubular joint ( Convex on Concave)
      1. Assist with dorsiflexion (Only a small amount of gliding movement)
      2. Joint play
        1. Anteirior glide : decrease pain, correct positional faults, increase dorsiflexion
        2. Posterior glide : decrease pain, correct positional faults, increase dorsiflexion
    4. Distal Tibiofibular joint (Concave on Concave)
      1. It is a fibrous joint, the only joint in appendicular skeleton which is not synovial. There is not much movement allowed, however, a small amount may take place during movements at the ankle joint.
      2. Joint play
        1. Anterior glide
        2. Posterior glide
    5. Talocrural joint(Convex on Concave)
      1. CPOR : Plantar>Dorsi
      2. Open packed position : 10° plantar flexion with slight inversion
      3. Closed packed postion : full dorsiflexion and full eversion
      4. Joint play
        1. Distraction : increase overall ROM
        2. Anterior glide : Increase plantar flexion
        3. Posterior glide : Increase dorsi flexion
    6. Subtalar joint
  5. Grades of Oscillations
    • Grade I : Small amplitude rhythmic oscillations at the beginning of ROM. 5cycles per sec
    • Grade II : Large amplitude rhythmic oscillations  within the ROM, but not reaching the limitation(full AROM). 2-3 cycles per sec
    • Grade III : Large amplitude rhythmic oscillations up to the limit of available motion  & stressed into tissue resistance(Full PROM). 2-3 cycles per sec
    • Grade IV : Small amplitude rhythmic oscillations, up to the limit of the available motion & stressed into tissue resistance. 2-3 sycles per sec
    • Grade V : Small amplitude, high velocity, thrust technique. Performed to break adhesions at the level of available motion  (manipulation or chiropractic).
      • Grade I and II are non-corrective manipulations and are used for pain management, warm up or introductory techniques.
      • Grade III and IV are generally used as corrective techniques to mobilized and stretch the joint capsule.
      • Grade V thrust manipulations are generally used to reduce subluxations, osseous positions faults, facet locks, and disc hernications.
  6. Grades of Sustained Glides or Traction Manipulations
    • Grade I : The initiation of movement of the joint surfaces. Non-corrective grade of mobilization. Pain relief. Joint play assessment techniques
    • Grade II : Movement of the joint surfaces up to the first tissue stop. Non-corrective grade of mobilization. Pain relif. Joint play assessment techniques
    • Grade III : Movement of the joint surfaces up to, and through, the first tissue stop. Corrective grade of mobilization and therefore stretchs the joint capsule. Perform this grade with caution. Increase ROM. Restore the glides within the joint.

If the moving joint surface is CONVEX, sliding is in the OPPOSITE direction of the angular movement of the bone. If the moving joint surface is CONCAVE, sliding is in the SAME direction as the angular movement of the bone.

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Massage Techniques 1 - Test for Massage Therapist
3 years ago

[…] G2 Post glide for Superior tibiofibular joint : Proximal Tibiofibular Joint | Joint Play – YouTube […]

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