References
Spinal, Visceral and extremity mobilizations
Treatment goals of mobilization:· Reduce Pain- Stimulates joint receptors
· Improve mobility/arthrokinematics
· Decrease muscle guarding
· Stretching and lengthening contractile and non-contractile tissues around joint
· Inhibit muscle tone or stretch reflex
· Improve joint proprioception and postural kinesthetic awareness
Maitland’s 5 Grades
Grade I
· Small amplitude movement at the beginning range of joint play
· Used when pain and spasm limit movements early in ROM
Grade II
· Large amplitude movement at the midrange of joint play
· Used for pain control, spasm reduction which inhibit movement
Grade III
· Large amplitude movement at the end-range of joint play
· Reduce pain, increase periarticular extensibility, correct positional faults, and release meniscoid tissue in the spine
Grade IV
· Small amplitude movement at the end-range of joint play
· Reduce pain, increase periarticular extensibility, correct positional faults, and release meniscoid tissue in the spine
Grade V
· Manipulation of high velocity and low amplitude to the anatomical end point of a joint
Oscillations - Joint Mobilization
· Performed at a rate of 2-3/sec for 1 min (Edmond)
· Stone suggested to perform 20-100 mobs in 2-5 sets
· Quillen and Gieck recommended mobs for 20-60 sec and repeated up to 4-5 times
· Prentice advocated a series of 3-6 sets lasting 20-60 sec each at a rate of 1-3/sec
· Gould suggested mobilization for 20-60 sec and repeated 4-5 times
· General- 3 sets of 30 sec to 1 min (2-3 oscillations /sec)
· Traction techniques are held for 10 seconds
· Treat with oscillations/traction for several minutes and re-assess
Joint mobilization/manipulation corrects arthrokinematic restrictions
PROM/stretching corrects osteokinematic restrictions
Items to Remember:
· Apply traction/distraction with joint mobilizations
· Treatment determined by end feel, Overpressure is a gentle passive motion at the end of active range of motion, and is used to assess end feel
· Muscle tendinous unit limitation is addressed with flexibility
· Establish a comparable sign / asterisk sign
· Most apply joint mobilizations with too much force
· Mobilization increases pain, apply the technique the opposite direction or decrease grade
· Joint mobilization is a passive movement with no active muscle tone
· Mobilization can confirm diagnosis
Visceral Mobilization
Restore the mobility to internal movement of organs with breathing there is a dropping down and a forward movement to abdominal organs decreases show a impairment to organ functionality.