As part of our ongoing effort to improve our relationships with our patients, the topic of this month's issue is joint mobilization. Joint mobilization is used on a daily basis by physical therapists. Below, we will briefly describe what they are with a few examples of when they might be used on patients.
Joint mobilization is a series of techniques that are used to improve the mobility of a hypomobile joint or joints. Joint movement is composed of both osteokinematic and arthrokinematic movement. Osteokinematic movement is defined as movement occurring between two bones relative to the three cardinal planes. Knee flexion and ankle dorsiflexion are examples of osteokinematic movements.
Arthrokinematic movement is defined as movement occurring between two joint surfaces. They have been described as the glide, spin, and roll that occur at joint surfaces with movement. Arthrokinematic movements are small in amplitude and generally cannot be reproduced independent of osteokinematic joint movement. One example of arthrokinematic movement is the posterior glide of the tibial plateau on the femoral condyles as the knee moves from an extended position into a flexed position.
A physical therapist might mobilize the knee joint by applying a posterior force on the tibia to facilitate the recovery of knee flexion.
Another example of arthrokinematic movement is the posterior glide of the talus on the tibiofibular joint of the ankle. This motion is often limited after an ankle sprain. Swelling, pain, and soft tissue adhesions can result in joint hypomobility. Limited dorsiflexion may decrease step length and have a negative impact on function.
Physical therapists often address limited dorsiflexion of the ankle by assessing the arthrokinematic movement of the joint. If limited, a posterior force may be applied to the talus which facilitates normal arthrokinematic movement and can assist in the recovery of dorsiflexion.
Similar techniques are applied to the shoulder joint. Adhesive capsulitis and post-surgical hypomobility are common. The application of anterior, posterior, or inferior joint mobilizations can loosen the joint capsule and facilitate ROM recovery.
There are dozens of joint mobilization techniques. While conceptually simple to understand, the intensity, amplitude, direction of force application, joint position, and the amount of discomfort the patient can tolerate are all important factors that have to be considered when using joint mobilization treatment techniques.