Joint Mobilization, Indications, Contraindication, Precautions and application on various joints.

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Introduction-

• Joint Mobilization is also knows as Manipulation, refers to manual therapy technique. It is used to physically affect a joint , The techniques are used to modulate pain and treat joint impairment that limits the range of motion. Joint mobilization is a stretching technique which is different from other forms of passive or self-stretching because it minimize abnormal compressive stress on the articular cartilage in joints. This often take place with the individual in a relax position.
• High velocity thrust (HVT) technique typically called manipulation. Mobilization is less aggressive than manipulation. The most important thing to remember before giving any mobilization or manipulation that is identifying rate, range and direction of force application as well as target ,relative structure movement and position of the patient.
• The therapist should know about the anatomy, Arthrokinematics and pathology of the neuromusculoskeletal system. Manipulation and mobilization are manual therapy technique that helps to improve joint mobility and relief pain.
• The altered joint mechanics may be due to pain and muscle guarding, joint effusion, contractures or adhesion in the joint capsules or supporting ligaments or aberrant joint motion.

Principles of Joint Mobilization/Manipulation-

• Manipulation- A high velocity, low amplitude thrust applied to a joint . This technique is also referred as Chiropractic adjustment.
• Mobilization- A passive movement technique that involves moving a joint within it’s normal range of motion, which increases the range of joint of a person as the person become more comfortable.

Indication of Manipulation and Mobilization-

• It can be used to treat pain and muscle guarding, where as stretching technique are used to treat restricted movement in order to improve the functional mobility of the joints. They can also be used to treat a variety of musculoskeletal problems such as Neck problems, Back problems, Pelvis, Upper and Lower Extremities, Rib cage and thorax.
• Pain, Muscle guarding and Spasm- Gentle joint play technique is used for treating the painful joints, reflex muscle guarding and muscle spasm by stimulating neurophysiological and mechanical effect.
• Neurophysiological effects-are small amplitude oscillatory and distraction movement are used to inhibit the perception of pain. It stimulates the mechano-receptors that then inhibit the transmission of nociceptive stimuli at the spinal cord or brain stem level which is also knows as [Pain Gait Theory].
• Mechanical Effects- Small amplitude distraction of gliding movement of the joint are used to cause Synovial fluid motion, which is the vehicle for nutrients to the avascular portion of the articular cartilage, Gentle joint play techniques helps to maintain the nutrient exchange and thus prevent the painful and degenerating effect of stasis. When a joint is swollen or painful and cannot move through the range of motion.
• Progressive Limitation- Diseases that are progressively limit movement can be treated with the joint play technique to maintain Range of Motion.
• Positional fault/Subluxation- Positional fault can occurs with traumatic injury, after periods of immobility or muscle imbalance. Thrust techniques are used to reposition and obvious subluxation, such as pulled elbow or capitate- lunate subluxation.
• Reversible joint hypomobility- Reversible joint hypomobility can be treated with the joint play stretching technique to elongate hypomobile capsular and ligamentous connective tissues. Sustained or Oscillatory stretch forces are used to distend the shorten tissues.
• Functional Immobility- When a patient cannot functionally move a joint for a period of time, the joint can be treated with non-stretch gliding or distraction technique. It prevent the degenerating and restricting effect of immobility.

Limitations of Joint Mobilization Technique-

• Joint techniques cannot change the disease process of disorders such as Rheumatoid Arthritis or inflammatory process of injury. In these cases, treatment is directed toward minimizing pain, maintain joint play, and reducing the effect of any mechanical limitation.
• If Joint play techniques are applied too vigorously for the condition, joint trauma or hypermobility may result.

Contraindications of joint Manipulation and Mobilization Techniques-

The only true contraindication to mobilization/manipulation stretching techniques are hypermobility, Joint effusion and inflammation-

• Hypermobility- The joint of patient with necrosis of the ligament or capsule should not be mobilize with stretching techniques. Patient with painful hypermobile joints may benefit from gentle joint play technique if kept within the limits of motion stretching is not done.
• Joint Effusion- It is the swelling due to trauma or disease. Rapid welling of a joint usually indicate bleeding in the joint and may occur with trauma or disease such as Hemophilia.

Inflammation- whenever inflammation is present, stretching increase and muscle guarding and result in greater tissue damages. Gentle oscillating or distraction motions may temporarily inhibit the pain response.

Precautions for Stretching-

Joint mobilization/manipulation techniques are safer than passive angular stretching.

Mobilization may used with extreme care in the following condition and if the signs and the patient response favorable:-

• Malignancy.
• Bone disease.
• Unhealed fracture.
• Hypermobility in associated joint.
• Excessive pain.
• Total joint replacement.
• Systemic Connective tissue disease.
• Newly formed or weakened connective tissues.

Application of Mobilization technique to Shoulder Joint-

Peripheral joint Mobilization Technique-

Shoulder Girdle complex- Joint of the shoulder girdle consist of three synovial articulation that is sternoclavicular joint, acromioclavicular joint and Glenohumeral joint.

• Glenohumeral Joint- The concave glenoid fossa received the convex humeral head .
• Resting position- The shoulder is abducted 55degree,horizontally adducted 30degree and rotated so the forearm is in the horizontal plane with respect to the body.
• Treatment Plane- The treatment plane is in the glenoid fossa and moves with the scapula as it rotates.
• Stabilization- Fixate the scapula with a belt or have an assistant help.

Therapist Position and Hand Placement-

• Stand at the patient’s side, facing toward his or her head.
• Use the hand nearer the part being treated and place it in the patient’s axilla with your limb just distal to the joint margin anteriorly and fingers posteriorly. Support the foramen between your trunk and elbow.
• Your other hand supports the humerus from the lateral surface.

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