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Joint Mobilization & Traction Techniques

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Shivani Singh
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76 views31 pages

Joint Mobilization & Traction Techniques

Uploaded by

Shivani Singh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Re h a b i l i t a t i o n

JOINT MOBILIZATION &


Techniques for
Sports Medicine &
A th l e t i c T r a i n i n g

TRACTION TECHNIQUES William E.


P re n ti c e
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
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
PHYSIOLOGICAL & ACCESSORY MOTION

Physiological Accessory
 Result of concentric or  Manner in which one
eccentric muscle articulating joint surface
action moves relative to
another
 Bone can move about
 Normal accessory
axis of rotation movement must occur
 Also called for full range
osteokinematics physiological mvmt. to
 Voluntary occur
 Also called joint
arthrokinematics
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
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
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
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
CONVEX-CONCAVE RULE
JOINT POSITIONS

Closed-Packed Loose-packed
position position
 Maximal contact of  Resting position
articulating surfaces  Joint surfaces
 Joint capsule and maximally separated
ligaments tight or  Joint capsule and
tense ligaments most relaxed
 No joint play  Most appropriate for
eval of joint play,
traction, and JM
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
JOINT POSITIONS
JOINT POSITIONS
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
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
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
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
MAITLANDS 5 MOBILIZATION GRADES
JM INDICATIONS & CONTRAINDICATIONS

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

Grade I Grade II
 Traction neutralizes  Effectively separates
pressure w/o actual articulating surfaces
separation  “Takes up slack” or
eliminates play in joint
 Used w/all JM capsule
 Pain relief Grade III
 “Stretch” traction that
involves actual stretching
of surrounding soft tissue
 Increase mobility
KALTENBORNS 3 GRADES
EQUIPMENT FOR TRACTION

 Manual technique
 Towel sometimes used to assist pull

 Traction Tables
 Cervical and Lumbar

 Home Devices
 Cervical and lumbar
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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