Samantha Calvet

Joint Mobilizations
Physiological Movement is movement as a result of concentric or eccentric
muscle action. Also called osteokinematics and it is voluntary.
Accessory motion is the manner in which an articulating joint surface
moves relative to another. Also called arthrokinematics. This cannot
occur alone but can be produced by an external force.
Spin, Glide, Roll
o Spin: Around stationary axis (radial head during
pronation/supination)
o Roll: Series of points on 1 articulating surface come in contact
with series of points on another (femoral condyles on tibial
plateau)
o Glide/Translation: Specific point on 1 articulating surface
comes in contact with a series of points on another (tibial
plateau on fixed femoral condyles during anterior drawer test)
Convex-Concave Rule:
If concave surface is moving on a stationary convex surface, gliding will
occur in the same direction as the rolling motion. Knee, Elbow, MCP and
IP Joints.
EG/ Tibiofemoral joint; Fixed convex femoral condyles and
moving concave tibial plateau. Knee extends & tibia glides
anteriorly. Mobilize tibia in the anterior direction to increase
extension ROM.
If a convex surface is moving on a stationary concave surface, gliding will
occur in opposite direction to rolling. GH, Hip, Ankle, Radiocarpal
EG/ GH joint. Fixed concave glenoid fossa, moving convex
humeral head. As GH abducts, humeral head glides inferiorly.
So mobilize humeral head in inferior direction to increase the
abduction ROM
Joint Positions
Closed packed position: Maximal contact of articulating surfaces; no joint
play
Loose-packed position: Resting position, joint surfaces maximally
separated; best for evaluation of joint play, traction and Joint Mob
Initial mob techniques should be done in loose-packed position.
o Subtalar: Neutral
o Talocrural: 10 degrees PF
o Knee: 25 degrees Flexion for tibiofemoral; full extension for
patellofemoral
o Hip: 30 degrees flexion, 30 abduction, slight ER
o Elbow: Humeral-ulnar; elbow flexed 70 degrees, supinated 10
degrees. Humeral-radial; full extension, supination.
o GH: 55 degree abduction, horizontally adducted 30 degrees.

Samantha Calvet
o Wrist: Neutral
Maitlands 5 mobilization grades
Amplitude: Distance joint moves passively within total range
Oscillations: Movement that glides or slides articulating surface in
appropriate direction
3-6 sets of 20-60 second oscillations w/1-3 oscillations/second
1. Grade I: Small amplitude movement at beginning of ROM.
i. Pain and spasm limit movement early in ROM
2. Grade II: Large amplitude movement within midrange of movement
i. Pain and spasm occur toward mid-ROM
3. Grade III: Large amplitude movement from mid-range to the limit of
ROM
i. Pain, spasm or tissue tension/compression limit
movement near end range
4. Grade IV: Small amplitude movement at end range of motion
i. Go to end range and perform small-amplitude
oscillations
5. Grade V: Small amplitude, manipulative movement performed
beyond the end range of motion.

WHEN TO USE WHICH ONE:

Reduce pain
o Grade I and II. Pain treated first and stiffness second.
Stimulate the mechanoreceptors that limit transmission of
pain perception. Treated daily.
Hypomobility
o Grade III and IV
3-4 times a week
Indications:
Reduce pain
Improve joint function
Decrease muscle guarding
Stretch/lengthen the tissue around joint (capsular and ligamentous)
Proprioceptive effects to improve postural and kinesthetic
awareness
Contraindication
Pain with mobilization technique
Inflammatory arthritis
Malignancy
Bone disease

Samantha Calvet

Neurological development
Bone fracture
Vascular disorders