Joint Mobilization Techniques

Mobilization may be applied as an oscillatory movement or a sustained stretch intended to decrease pain or increase mobility.

It can be broadly classified into two types

  • Physiological and
  • Accessory movement

Physiological movements are visible movements by different parts of body and can be done voluntarily by an individual e.g. Flexion-extension.

Accessory movements are intra-articular movements. It can be further divided into 2 types,

  • Component motion and
  • Joint play

Component motion

These are movements within the joint and surrounding tissues which are necessary for normal range of motion but cannot be actively performed by the patients i.e. not under voluntary control of an individual.

Joint play

Motion that occurs between the joint surfaces as well as distensibility in the joint capsule which allows the bones to move e.g. distraction, sliding, compression, rolling and spinning of joint surfaces.

Mobilization

What are the indications of joint mobilisation?

1) Pain, muscle guarding and spasm

  • Neuro-physiological effect
    Small amplitude oscillatory and distraction movements are used to stimulate the mechanoreceptors that may inhibit transmission of nociceptive stimuli at spinal cord and brain stem level.
  • Mechanical effect
    Small amplitude distraction or gliding movement of a joint are used to cause synovial fluid motion, which in turn brings nutrition to avascular portion.
  • 2) Reversible joint hypo-mobility

    It can be treated with progressive vigorous joint play technique to elongate hypomobile ligaments and capsular connective tissue.

    3) Progressive limitation (chronic stage of hypomobility)

    This can again be treated with joint play technique at a higher grade of mobilization and integration of other special and advance techniques.

    4) Functional immobility

    This can be treated with non stretch gliding or distraction techniques.

    5) Positional faults

    CONTRA-INDICATIONS OF MOBILISATION

    • Hyper-mobility
    • Fractures (acute)
    • Joint effusion
    • Inflammation of joint

    Precautions of joint mobilization:

    Under following conditions mobilization should be either not done too vigorously or not done at all to nearby joints.

    • Malignancy
    • Bone disease
    • Unhealed fractures
    • Excessive pain
    • Total joint replacement
    • Newly formed or weakened connective tissue such as following surgery, injuries.
    • Disuse injury or when patient is on corticosteroid.
    • Rheumatoid arthritis
    • Elderly individuals with weakened bone.

    MANIPULATION

    These are skilled, gentle precise passive movement of a joint either within or beyond its active range of motion (or physiological limits). This is often accompanied by an audible ‘crack’.

    Mobilization-01

    This can be categorised into

    • Thrust manipulation (HVT- High velocity thrust) – performed at high velocity, small amplitude at end range.
    • Manipulation under anaesthesia – performed under anaesthesia by an orthopaedic surgeon to increase the range.

    We at pain free physiotherapy clinic are specialized in treating hypomobile joints post-fracture or post immobilization. Any flexible positional faults or movement restriction of spine or other joints can be effectively treated post careful evaluation. Contact us to get free from movement restriction.

    Various manual joint mobilization techniques used are mentioned and discussed briefly under manual therapy.

dr roshan jha

Dr Roshan Jha

Dr. Roshan Jha (PT) BPT, MPT(Ortho/P), MIAP Dr Roshan Jha worked with leading Hospitals of Delhi like Batra Hospital...

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