Joint Mobilization & Traction Techniques

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

2. Joint Mobilization (JM) & Traction • Slow, 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 & Traction • Regain 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 Motion • 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 • Physiological • Result of concentric or eccentric muscle action • Bone can move about axis of rotation • Also called osteokinematics • Voluntary

5. Physiological & Accessory Motion • Accessory 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 glide • Spin: 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 • 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 • Closed-Packed position • Maximal contact of articulating surfaces • Joint capsule and ligaments tight or tense • No joint play

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 Techniques • Indications/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 Techniques • Patient 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 grades • Amplitude: 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 20-60 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 grades • Grade 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 & Contraindications Contraindications • Pain with mobilization technique • Inflammatory arthritis • Malignancy • Bone disease • Neurological involvement • Bone fractures/deformities • Vascular disorders Indications • Pain • 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

20. Equipment • Manual technique • May 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 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 • Grade I • Traction neutralizes pressure w/o actual separation • Used w/all JM • Pain relief

23. Kaltenborns 3 Grades

24. Equipment for Traction • Manual 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