Joint mobilization: Difference between revisions

Joint mobilization
Joint mobilization
Specialty	Physical therapy
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Joint mobilization is a manual therapy intervention, a type of straight-lined, passive movement of a skeletal joint that addresses arthrokinematic joint motion (joint gliding) rather than osteokinematic joint motion. It is usually aimed at a 'target' synovial joint with the aim of achieving a therapeutic effect. These techniques are used by a variety of health care professionals with specific training in manual therapy assessment and treatment techniques.

The APTA Guide to Physical Therapist Practice defines mobilization/manipulation as “a manual therapy technique comprised of a continuum of skilled passive movements that are applied at varying speeds and amplitudes, including a small amplitude/ high velocity therapeutic movement.”

Classification and Mechanisms

Joint mobilization is classified by the Australian physiotherapist Geoffrey Douglas Maitland into five 'grades' of motion, each of which describes the range of motion of the target joint during the procedure.^[1] They are generally divided into five grades. The different grades of manipulation are known to produce selective activation of different mechanoreceptors in the joint.^[2]

Grade I - Low amplitude, rhythmically oscillating joint glide near the resting position of the available arthrokinematic joint play. Activates Type I mechanoreceptors with a low threshold and which respond to very small increments of tension.

Activates mechanoreceptors in the joint capsule - Meissner's and Pacinian Corpuscles.

Grade II - Relatively large amplitude, rhythmically oscillating joint glide that carries well into the available arthrokinematic joint play.

Similar effect as Grade I.

Activates mechanoreceptors in the joint capsule - Meissner's and Pacinian Corpuscles.

Grade III - Relatively large amplitude, rhythmically oscillating joint glide that carries to the end of the available arthrokinematic joint play.

Grade IV - Low amplitude, rhythmically oscillating joint glide that is performed at the end of the available arthrokinematic joint play.

Grade V - This grade refers to the use of a single high-velocity, low-amplitude thrust performed at the end of the available joint play.

Activates Type III mechanoreceptors (Maitland) and provides a reflex muscle relaxation.

References

^ Maitland, G.D. Peripheral Manipulation 2nd ed. Butterworths, London, 1977. Maitland, G.D. Vertebral Manipulation 5th ed. Butterworths, London, 1986.

^ How Manipulation Works ^{[unreliable medical source?]}

Guide to Physical Therapist Practice 3.0. Alexandria, VA: American Physical Therapy Association; 2014. Mintken PE, et al. A Model for Standardizing Manipulation Terminology in Physical Therapy Practice. J Orthop Sports Phys Ther 2008;38(3):A1-A6.

[1] Maitland, G.D. Peripheral Manipulation 2nd ed. Butterworths, London, 1977. Maitland, G.D. Vertebral Manipulation 5th ed. Butterworths, London, 1986.
Parts of this article (those related to ISBN 9780702040665) need to be updated. Please help update this article to reflect recent events or newly available information. (February 2015)

[2] How Manipulation Works ^{[unreliable medical source?]}

[1]

[2]

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-'''Joint mobilization '''is a [[manual therapy]] intervention, a type of passive movement of a skeletal joint. It is usually aimed at a 'target' [[synovial joint]] with the aim of achieving a [[therapeutic]] effect. When applied to the spine, it is known as [[spinal mobilization]]. These techniques are often used by [[Chiropractic|chiropractors]], [[Osteopathy|osteopaths]], [[occupational therapists]], and [[Physical therapy|physical therapists]].
+'''Joint mobilization '''is a [[manual therapy]] intervention, a type of straight-lined, passive movement of a skeletal joint that addresses arthrokinematic joint motion (joint gliding) rather than osteokinematic joint motion. It is usually aimed at a 'target' [[synovial joint]] with the aim of achieving a [[therapeutic]] effect. These techniques are used by a variety of health care professionals with specific training in manual therapy assessment and treatment techniques.
+The APTA Guide to Physical Therapist Practice defines mobilization/manipulation as “a manual therapy technique comprised of a continuum of skilled passive movements that are applied at varying speeds and amplitudes, including a small amplitude/ high velocity therapeutic movement.”
 == Classification and Mechanisms ==
-Joint mobilization is classified by Geoffrey Douglas Maitland into five 'grades' of motion, each of which describes the [[range of motion]] of the target joint during the procedure.<ref>Maitland, G.D. ''Peripheral Manipulation'' 2nd ed. Butterworths, London, 1977.
+Joint mobilization is classified by the Australian physiotherapist Geoffrey Douglas Maitland into five 'grades' of motion, each of which describes the [[range of motion]] of the target joint during the procedure.<ref>Maitland, G.D. ''Peripheral Manipulation'' 2nd ed. Butterworths, London, 1977.
-Maitland, G.D. ''Vertebral Manipulation'' 5th ed. Butterworths, London, 1986.{{update|{{ISBN|9780702040665}}|date=February 2015}}</ref> They are generally called Grade I through Grade V. The different grades of mobilization are believed to produce selective activation of different [[mechanoreceptors]] in the joint.<ref>[http://hkjo.lib.hku.hk/archive/files/b6a0216ae4024e1a3c831ab4a498aca0.pdf How Manipulation Works] {{medrs|date=February 2015}}</ref>
+Maitland, G.D. ''Vertebral Manipulation'' 5th ed. Butterworths, London, 1986.{{update|{{ISBN|9780702040665}}|date=February 2015}}</ref> They are generally divided into five grades. The different grades of manipulation are known to produce selective activation of different [[mechanoreceptors]] in the joint.<ref>[http://hkjo.lib.hku.hk/archive/files/b6a0216ae4024e1a3c831ab4a498aca0.pdf How Manipulation Works] {{medrs|date=February 2015}}</ref>
-* Grade I - Activates Type I mechanoreceptors with a low threshold and which respond to very small increments of tension.
+* Grade I - Low amplitude, rhythmically oscillating joint glide near the resting position of the available arthrokinematic joint play. Activates Type I mechanoreceptors with a low threshold and which respond to very small increments of tension.
+: Activates mechanoreceptors in the joint capsule - [[Meissner's corpuscle|Meissner's]] and [[Pacinian corpuscle|Pacinian Corpuscles]].
-: Activates cutaneous mechanoreceptors.
-: Oscillatory motion will selectively activate the dynamic, rapidly adapting receptors, i.e., [[Meissner's corpuscle|Meissner's]] and [[Pacinian corpuscle|Pacinian Corpuscles]]. The former respond to the rate of skin indentation and the latter respond to the acceleration and retraction of that indentation.
+* Grade II - Relatively large amplitude, rhythmically oscillating joint glide that carries well into the available arthrokinematic joint play.
-* Grade II - Similar effect as Grade I.
-* Grade III - Similar to Grade II.
+Similar effect as Grade I.
+: Activates mechanoreceptors in the joint capsule - [[Meissner's corpuscle|Meissner's]] and [[Pacinian corpuscle|Pacinian Corpuscles]].
+* Grade III - Relatively large amplitude, rhythmically oscillating joint glide that carries to the end of the available arthrokinematic joint play.
-: Selectively activates more of the muscle and joint mechanoreceptors as it goes into resistance, and less of the cutaneous ones as the slack of the subcutaneous tissues is taken up.
+* Grade IV - Low amplitude, rhythmically oscillating joint glide that is performed at the end of the available arthrokinematic joint play.
-* Grade IV - Similar to Grade III.
+* Grade V - This grade refers to the use of a single high-velocity, low-amplitude thrust performed at the end of the available joint play.
-: With its more sustained movement at the end of range will activate the static, slow adapting, Type I mechanoreceptors, whose resting discharge rises in proportion to the degree of change in joint capsule tension.
+:Activates Type III mechanoreceptors (Maitland) and provides a reflex muscle relaxation.
-* Grade V - This is the same as [[joint manipulation]]. Use of the term 'Grade V' is only valid if the joint is positioned near to its end range of motion during mobilization. Evans and Breen<ref>{{cite journal |vauthors=Evans DW, Breen AC | title = A biomechanical model for mechanically efficient cavitation production during spinal manipulation: prethrust position and the neutral zone. | journal = J Manipulative Physiol Ther | volume = 29 | issue = 1 | pages = 72–82 | year = 2006 | pmid = 16396734 | doi = 10.1016/j.jmpt.2005.11.011}}</ref> contested this assumption, in fact arguing that an individual synovial joint should be positioned near to its resting, neutral position.
 == See also ==
@@ Line 52: / Line 53: @@
 == References ==
 {{reflist}}
+Guide to Physical Therapist Practice 3.0. Alexandria, VA: American Physical Therapy Association; 2014.
+Mintken PE, et al. A Model for Standardizing Manipulation Terminology in Physical Therapy Practice. J Orthop Sports Phys Ther 2008;38(3):A1-A6.
 [[Category:Manual therapy]]
-[[Category:Chiropractic treatment techniques]]
 [[Category:Osteopathy]]
 [[Category:Physical therapy]]