1 Joint Mobilization & Traction TechniquesRehabilitation Techniques for Sports Medicine & Athletic Training William E. Prentice

2 Joint Mobilization (JM) & TractionSlow, passive movements of articulating surfaces Following injury loss of motion may occur at a joint Contracture of connective tissue Resistance of contractile tissue to stretch Or some combination of the two If left untreated joint will become HYPO-mobile Motion stops at pathological point of limitation (PL) Caused by pain, spasm or tissue resistance

3 Indications for Joint Mobilization & TractionRegain normal active joint range of motion (AROM) Restore normal passive motions Reposition or realign a joint Regain normal distribution of forces and stresses about a joint Reduce pain All will help improve joint function Effective and widely used techniques in injury rehabilitation

4 Physiological & Accessory MotionResult of concentric or eccentric muscle action Bone can move about axis of rotation Also called osteokinematics Voluntary Accessory Manner in which one articulating joint surface moves relative to another Normal accessory movement must occur for full range physiological mvmt. to occur Also called joint arthrokinematics

5 Physiological & Accessory MotionAccessory motion cannot occur independently but can be produced by external force JM and Traction can be used if accessory motion is limited due to some restriction of the joint capsule or ligaments JM can be used at any point in the range of motion and in any direction in which movement is restricted

6 Include spin, roll and glideSpin: Around a stationary axis, clockwise or counterclockwise i.e.. Radial head at humeroradial joint during pronation/supination Roll: series of points on 1 articulating surface come in contact with series of points on another i.e.. Femoral condyles on tibia plateau during squat Will always occur in same direction as physiological movement

7 Accessory Motion Glide: when a specific point on 1 articulating surface comes in contact with series of points on another Also called translation Tibial plateau on fixed femoral condyles during anterior drawer test Occurs simultaneously with rolling in most joints Direction of glide will be determined by shape of articulating surface that is moving i.e.. Convex-rounded Concave-flat or divot

8 Convex-Concave rule If concAve surface is moving on a stationary convex surface, gliding will occur in the sAme direction as the rolling motion If a cOnvex surface is moving on a stationary concave surface, gliding will occur in Opposite direction to rolling JM for hypomobile joints use gliding technique Critical to know direction of glide

9 Convex-Concave rule

10 Joint Positions Closed-Packed position Loose-packed positionMaximal contact of articulating surfaces Joint capsule and ligaments tight or tense No joint play Loose-packed position Resting position Joint surfaces maximally separated Joint capsule and ligaments most relaxed Most appropriate for eval of joint play, traction, and JM

11 Joint Position JM and traction techniques use translational movement of one joint relative to another Treatment plane (TP): Perpendicular or at right angle to a line from axis of rotation on convex surface to center of concave surface TP lies within the concave surface If convex segment moves TP remains fixed If Concave surface moves TP moves with concave surface JM -parallel with treatment plane Traction-perpendicular to treatment plane

12 Joint Positions

13 Joint Positions

14 Joint Mobilization TechniquesIndications/Goals Reduce pain Decrease muscle guarding Stretching or lengthening tissue surrounding joint (capsular & ligamentous) Break adhesions and stretch tissue to permanent structural changes Reflexogenic effects that inhibit or facilitate muscle tone or stretch reflex Proprioceptive effects to improve postural and kinesthetic awareness

15 Joint Mobilization TechniquesPatient and AT positioned in a comfortable and relaxed manner AT should mobilize 1 joint at a time Hand positioning should be as close to the joint as possible Avoid long lever arm Short lever arm will allow stretch of capsule and ligaments w/o rolling Avoid rolling, move as 1 segment in appropriate plane Segment that is moving should be held in a firm and confident manner

16 Maitlands 5 mobilization gradesAmplitude: distance joint moves passively within total range From Beginning point in ROM (BP) to anatomical limit (AL) Oscillations: movement that glides or slides articulating surface in appropriate direction 3-6 sets of second oscillations w/ 1-3 oscillations/second Grade I: small amplitude movement at beginning of range of motion Pain and spasm limit mvmt early in ROM Grade II: large amplitude mvmt w/in midrange of mvmt Pain and spasm occur toward mid-ROM Grade III: Large amplitude mvmt. From mid-range to PL Pain, spasm or tissue tension/compression limit mvmt. Near end range

17 Maitlands 5 mobilization gradesGrade IV: small amplitude movement at end of range of motion. Got to PL and perform small-amplitude oscillations Resistance limits movement in absence of pain and spasm Grade V: small amplitude mvmt from PL to anatomical limit (AL) Manipulation (chiropractic) Usually accompanied w/ popping sound Velocity of thrust more important/effective that force of thrust Great deal of skill and judgment necessary for safe and effective treatment

18 Maitlands 5 mobilization grades

19 JM Indications & ContraindicationsPain Grades I & II Pain treated 1st and stiffness 2nd Stimulate mechanoreceptors that limit transmission of pain perception Treated daily Hypomobility Grades III & IV 3-4 x week Contraindications Pain with mobilization technique Inflammatory arthritis Malignancy Bone disease Neurological involvement Bone fractures/deformities Vascular disorders

20 Equipment Manual techniqueMay require strap for stabilization or traction Wedge or foam roll for stabilization Treatment table-preferably a high-low table Theraband may be used for grip

21 Traction Pulling 1 articulating segment to produce separation from another articulating segment Performed perpendicular to treatment plane Also used to decrease pain and reduce joint hypomobility Grade I traction techniques accompany JM techniques

22 Kaltenborns 3 Grades Grade I Grade II Grade IIITraction neutralizes pressure w/o actual separation Used w/all JM Pain relief Grade II Effectively separates articulating surfaces “Takes up slack” or eliminates play in joint capsule Grade III “Stretch” traction that involves actual stretching of surrounding soft tissue Increase mobility

23 Kaltenborns 3 Grades

24 Equipment for TractionManual technique Towel sometimes used to assist pull Traction Tables Cervical and Lumbar Home Devices Cervical and lumbar

25 Conclusion Should only be performed by or under direct supervision of trained healthcare professionals Can cause further injury if performed incorrectly

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