MOBILIZATION

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Mobilization is a passive, skilled manual therapy technique applied to joints and related soft tissues at varying speeds and amplitudes using physiological or accessory motions for therapeutic purpose.

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Manipulation maybe a rapid thrust or a passive stretch using physiological or accessory movements used to restore full ROM by breaking adhesions around a joint while the patient is anesthetized.

Physiological movements – They are movements patient can do voluntarily. (such as flexion , abduction and rotations)

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Accessory movements – They are movements in the joint and surrounding tissues that are necessary for normal ROM but cannot be actively performed by the patient.(such as roll, slide, spin)

 

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• Roll – New points of one surface meet new points on the opposing surface. 

• Slide –The same point of one surface comes into contact with new points on the opposing surface. 

• Spin –There is rotation of a segment about a stationary mechanical axis.

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Concave - Convex Rule 

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If a concave joint surface is moving on a fixed convex surface, glide and roll occurs in the same direction of physiological movement.

If a convex joint surface is moving on a fixed concave surface, glide occurs in the opposite direction and roll occurs in the same direction of physiological movement.

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Two systems of grading dosages for mobilization are used i.e. Maitland and Kaltenborn. 

 

Indications

• Pain 

• Muscle guarding

• Muscle spasm

• Reversible joint hypomobility

• Positional faults in the joint due trauma after periods of immobility or muscle imbalances

• Progressive Limitations

• Functional immobility

• Adhesions formation

• Medial or Lateral epicondylitis

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Contraindications

• Hypermobile joints with potencial necrosis of ligaments or capsule

• Joint effusion due to trauma or disease 

• Inflammation

• Use with extreme care if signs are favourable or avoid in conditions like –

  • Malignancy

  • Bone disease

  • Unhealed fracture

  • Excessive pain

  • Hypermobility

  • Total joint replacements

  • Newly formed or weaken connective tissue such as immediately after injury, surgery or disuse

  • When the patient is taking certain medications like corticosteroids

  • Connective tissue disease like rheumatoid arthritis

  • Elderly individuals with weakened connective tissue and diminished circulation

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REFERENCES

Carolyn Kisner, Lynn Allen Colby, Therapeutic Exercises Foundation and Techniques, 5th Edition, Page no. -110 -116