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
 No joint play relaxed
 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  Neurological
pain perception
involvement
 Treated daily
 Bone
 Hypomobility
 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