Professional Documents
Culture Documents
“Mobilization”
Mazyad Alotaibi
Introduction
To maintain normal ROM, it important to move the segments through
their available joint range or muscle range periodically.
Factors leads to decreased ROM:
1- systemic
2- Joint
3- neurologic
4- muscular
5- surgical or traumatic insult
6- inactivity or immobilization
Types of ROM Exercises
Passive Active
Exercises Exercises
1-Relaxation:
A brief explanation of the procedure is given to the patient, who
is asked to relax as much as possible. The selection of a
suitable starting position ensures comfort and support.
Describe the plane and method to meet the goals. Free the
region from restrictive clothing, linen, splint and dressing.
2-Fixation:
Good fixation near the joint to be moved as close to the joint
line as possible to ensure that the movement is localized to
that joint, and to control movement.
3-Support:
Full and comfortable support to the moved part and to the areas of poor
structural integrity such as a hypermobile joint or paralyzed limb
segment, so that the patient has confidence and will remain relaxed. The
physiotherapist grasps the part firmly but comfortably in his hand, or it
may be supported by axial suspension in slings.
4-Traction:
Many joints allow the articular surfaces to be drawn apart by traction,
which is always given in the long axis of a joint, the fixation of the bone
proximal to the joint providing an opposing force to a sustained pull on
the distal bone. Traction is thought to facilitate the movement by
reducing inter- articular friction.
5-Range:
Move the segment through its complete pain –free range to point of
tissue In normal joints slight over pressure can be given to ensure full
range, but in flail joint care is needed to avoid taking the movement
beyond the normal anatomical limit.
6-Speed and Duration:
As it is essential that relaxation is maintained throughout the
movement, the speed must be slowly, smoothly and rhythmically. The
number of repetitions depends on the objectives of the program and
the patient's condition.
Forced Passive Movements
Joint Mobilization & Manipulation
• Nutritional effects :
– Distraction or small gliding movements – cause synovial fluid
movement
– Movement can improve nutrient exchange due to joint swelling &
immobilization
• Mechanical effects :
– Improve mobility of hypomobile joints (adhesions & thickened CT from
immobilization – loosens)
– Maintains extensibility & tensile strength of articular tissues
Indications for Joint Mobilization
●Malignancy
●Bone disease detected on X-ray
● unhealed fracture
● Elderly individuals with weakened connective tissue.
● Osteoarthritis
●Total joint replacement
● Poor general health
● Patient’s inability to relax
Patient Response
• May cause soreness
• Perform joint mobilizations on alternate days to
allow soreness to decrease & tissue healing to
occur
• Patient should perform ROM techniques
• Patient’s joint & ROM should be reassessed
after treatment, & again before the next
treatment
• Pain is always the guide
II- MANIPULATION OF JOINTS BY PHYSIOTHERAPIST
Definition
These are accurately localised, single, quick movements of small amplitude
and high velocity completed before the patient can stop it.
MANIPULATION OF JOINT BY SURGEON /PHYSICIAN
Definition: Manipulations performed by a surgeon or
physician are usually given under a general or local
anaesthetic which eliminates pain and protective spasm,
and allows the use of greater force.
Even well-established adhesions can be broken down; but
when these are numerous, it is usual to regain full range
progressively, by a series of manipulations, to avoid
excessive trauma and marked exudation. Maximum effort
on the part of the patient and the physiotherapist must be
exerted after manipulation to maintain the range of
movement gained at each session, otherwise fibrous
deposits from the invertible exudation will form new
adhesions.
Procedures Steps
1. Evaluation and Assessment
2. Determine grades and dosage
3. Patient position
4. Joint position
5. Stabilization
6. Treatment force
7. Direction of movement
8. Speed and rhythm
9. Initiation of treatment
10. Reassessment
Maitland Joint Mobilization Grading Scale
• Grading based on amplitude of movement & where within
available ROM the force is applied.
• Grade I
– Small amplitude rhythmic oscillating movement at the
beginning of range of movement
– Manage pain and spasm
• Grade II
– Large amplitude rhythmic oscillating movement within
midrange of movement
– Manage pain and spasm
• Grades I & II – often used before & after treatment with grades III
& IV
• Grade III
– Large amplitude rhythmic oscillating movement up to
point of limitation (PL) in range of movement
– Used to gain motion within the joint
– Stretches capsule & CT structures
• Grade IV
– Small amplitude rhythmic oscillating movement at very
end range of movement
– Used to gain motion within the joint
• Used when resistance limits movement in absence
of pain