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Joint Mobilization

Joint Mobilization. Definition. Peripheral joint mobilization (PJM) is the use of skilled graded forces to mobilize joints to improve motion & to normalize joint function. Mobilization Techniques are used to.

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Joint Mobilization

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  1. Joint Mobilization

  2. Definition Peripheral joint mobilization (PJM) is the use of skilled graded forces • to mobilize joints • to improve motion • & to normalize joint function.

  3. Mobilization Techniques are used to • Improve jt. nutrition. • Improve m. spasm & tension • Reduce pain. • Reverse jt. hypomobility. • Improve or restore motion. • Treat jt. dysfunction as stiffness.

  4. A. Joint Mobilization • Is a type of passive movement performed by the PT at a speed slow enough that the patient can stop the movement. • The tech. may be applied with: 1. Oscillatory motion or 2. Sustained stretch to • ↓Pain or • ↑mobility. • The tech. may use: • Physiologic or • Accessory movs.

  5. Indications of Joint Mobilization • Pain, m. guarding & spasm All can be treated with gentle joint play technique to stimulate neurophysiological & mechanical effects. • Neurophysiological effect: Small amplitude oscillatory mov → stim mechanoreceptors →↓ transmission of nociceptive stimuli at spinal cord & brain stem levels. b. Mechanical effects: • Small-amplitude distraction or gliding mov →synovial fluid motion→ bring nutrients to the avascular portions of articular cartilage. (↓ pain of ischemia) • Gentle jt-play → maintain nutrient exchange → prevent painful effects of stasis when a jt is painful or swollen &can’t move through a ROM. (but not in acute or massive swelling)

  6. Precautions • In most cases jt mobilization is safer than passive angular stretching. But • Sometimes Jt mobilization can be used with extreme care in: • Malignancy-»spread & growth. • Excessive pain-»m. guarding, prevent mov. • Total jt. replacement -» disl. or loosen internal fixation. • Bone disease(Osteoporosis, TB, Rickets). • Unhealed #(site & stabilization) -» re-fracture. • Hypomobility(in associated jts & m. weak) -»↑ capsule laxity, lig. Weakness & jtdisl.

  7. Procedure for Applying Jt Mobilization Techniques

  8. Possibilities for pain While moving or mobilizing & found! • Before tissue limitation(after acute injury or active stage of a disease), use pain inhibiting jt. tech to relieve pain& maintain jt. play. • With tissue limitation as damaged tissue begins to heal) (subacute),use gradual gentle stretching tech to tight tissue, but Don’t exacerbate pain by injuring the tissues. • After tissue limitations (as stretching a tight capsule or a peri-articular tissue ofchronic stiff joints), use ↓ force of the stretching techniques.

  9. Grades of mov. (Dosage, Amplitude) systems of techniques: 1. Graded oscillation. 2. Sustained translatory joint Play.

  10. 1. Graded Oscillation Tech. Dosage

  11. Graded oscillation technique

  12. Techniques • Oscillations may be done using: 1- Physiologic (osteokinematic) motions. 2- Joint play (arthrokinematic) techniques.

  13. Sustained Translatory joint Play Technique • Grade I(Loosen): Small amplitude distraction, applied where no stress is placed on the capsule. . • Equalizes cohesive force, 2. M. tension 3. Atmospheric pressure acting on the jt. • Grade II(Till tightness): Distraction or glide applied to tightend tissues around jt. • Grade III: Distraction or glide with large enough amplitude to place a stretch on jt. capsule & surrounding peri-articular structures.

  14. Sustained translatory joint-play technique

  15. Uses • Grade I:Used with gliding motions to relieve pain. • Grade II:Used to determine how sensitive the jt is. • GradeIII: Used to stretch jt. structures & ↑ jt play. • Technique: This grading system describes jt. play techniques that separate or glide (slide) jt surfaces.

  16. N.B. • The consistency between the dosage of the two grading systems isgrade I (no tension on the jt capsule or surroundings). • Grade III (sustained stretch)& IV(oscillation)are similar in dosage as they are applied with a stretch force at the limit of the motion. • Using oscillating or sustained tech., depends on the pt’s response. • Pain management: use oscillating tech. • Loss of jt. play&↓function: use sustained stretch. • To maintain available R.:Use either grade II! oscillatingor II sustained technique.

  17. Patient Position Patient PositionThe pt. & treated extremity should be carefully positioned & relaxed. The jt. is positioned so that the capsule has greatest laxity.

  18. Stabilization • Firm & comfortable stabilization for proximal parts by using: • Belt. • PT hand. • External assistance.

  19. Force • Treatment force(gentle or strong) is applied as close to the opposing jt. surfaces as possible. • The larger the contact surface of PT hand → the more comfortable procedure will be. e.g. use flat surface of the hand instead of forcing with the thumb.

  20. Direction of Movement • Either parallel to, or perpendicular to treatment plane. • Joint traction: Perpendicular to ttt plane. The entire bone is moved → jt surfaces are separated. • Gliding technique: Parallel to the ttt plane. This is determined by using the convex-concave rule. • If the surface of moving bone is convex -→ opposite direction glide • If the surface of moving bone is concave → glide in the same direction. The entire bone is moved, so there’s gliding of one jt. surface on the other. No swing of the bone that causes rolling & compression of the jt. surfaces

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