Spine and extremity joint mobilization is a technique which is an integral part of manual therapy. It is passively taking a joint through a range to improve motion.
Joints are points in the body where two bones move in conjunction with one another.
Joints are supported and encased by soft tissue like muscles, ligaments and other types of connective tissue. The soft tissue structures around the joint are susceptible to injury or dysfunction with poor posture, trauma to a body part, chronic overuse or imbalance of muscle function. When this happens, the joint can fall into a position contributing to less than optimal function.
Consider the analogy of a door that doesn’t swing all the way open but is caught on something. Each time you try to open or close the door fully, you catch the same snag. In the case of the body, the snag could be caused by tight tissue or the joint itself could be limiting the motion. Sometimes the door can have no stopper however which often leads to damage to the wall or in the body’s case, the surrounding tissue.
When joints behave in a dysfunctional manner, they can be overly mobile which is termed hypermobility or joints can be hypermobile meaning that they are functioning with less than full range of motion. In either case, it is important to have someone skilled in assessment of the joints to determine whether joint mobilization is appropriate.
Joint mobilization is a technique that is often used in physical therapy to assist with improving the body’s awareness for optimal joint positioning which then allows for overall improved function. This is used in the case of the hypomobile joint.
Mobilizations or mobs as they are often termed are performed to relieve pain, muscle spasms, and tissue tension while improving the movement of the joint.
When an individual is made aware of the correct position of the joint by simulating smooth joint function, joint mobilization improves range of motion and mobility not just in the joint but in the connective tissue around it as well.
Joint mobs are performed using small, passive movements. In other words, the therapist moves the client’s joint while the client relaxes their body. The manual movement is performed in gentle fashion working it through a natural level of resistance.
These motions stretch and strengthen the tissue surrounding the bone, which helps:
Every joint is classified on a five grade scale for range of motion. Grades I and II are used predominantly to reduce pain and stiffness. Grades III through V are used to increase mobility and joint play.
Joint mobilization should not be confused with joint manipulation, a similar manual technique for strengthening joints. With joint manipulation, the physical therapist applies a forceful thrust to the joint movement, which stretches the tissue and restores joint play. (Miller, 2019)
Joint mobilization is prescribed and utilized on an individual basis. First, the therapist evaluates whether a client is appropriate for joint mobilizations. In the case of a hypermobile or lax joint, alternative treatments aside from joint mobilizations will be used.
However if the therapist does determine that a client with a hypomobile or tight joint would benefit from joint mobilizations, the grade of mobilization is determined by the amount of restrictions that exists in the joint and the amount of soft tissue restriction that exists around the joint.
It is also dosed based on the client’s ability to tolerate the treatment. Additional co-morbitiies or medical diagnoses related to bone health such as osteoporosis are considered in such case alternative treatments may need to used in lieu of joint mobilizations.
A physical therapist assesses the appropriateness of joint mobilization based on all of this information.
Often joint mobilizations are used in conjunction with manual therapy to the connective tissue. First the connective tissue is treated with techniques to assist in tissue relaxation. Once the tissues are relaxed and less resistant, the joint mobilization can then be performed with greater success.
The focus of joint mobilizations are to attain normal pain-free joint motion. As mentioned above, the therapist evaluates the appropriateness of the client for this treatment based on their medical history as well as their pain.
Joint mobilization is one strategy among many that physical therapists use to create a neuromuscular change in movement. Please refer to other techniques to better understand the host of options that are available for treatment.