Joint mobilization is a

manual therapy Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of mu ...

intervention, a type of straight-lined, passive movement of a skeletal joint that addresses arthrokinematic joint motion (joint gliding) rather than osteokinematic joint motion. It is usually aimed at a 'target' synovial joint with the aim of achieving a

therapeutic A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a medical diagnosis. As a rule, each therapy has indications and contraindications. There are many different ...

effect. These techniques are used by a variety of health care professionals with specific training in manual therapy assessment and treatment techniques. IFOMPT defines joint mobilization as "a manual therapy technique comprising a continuum of skilled passive movements that are applied at varying speeds and amplitudes to joints, muscles or nerves with the intent to restore optimal motion, function, and/or to reduce pain." The APTA Guide to Physical Therapist Practice defines mobilization/manipulation as “a manual therapy technique a continuum of skilled passive movements that are applied at varying speeds and amplitudes, including a small amplitude/ high velocity therapeutic movement.”

Classification and Mechanisms

Joint mobilization is classified by the Australian physiotherapist Geoffrey Douglas Maitland into five 'grades' of motion, each of which describes the range of motion of the target joint during the procedure.Maitland, G.D. ''Peripheral Manipulation'' 2nd ed. Butterworths, London, 1977. Maitland, G.D. ''Vertebral Manipulation'' 5th ed. Butterworths, London, 1986. They are generally divided into five grades. The different grades of manipulation are known to produce selective activation of different mechanoreceptors in the joint. * Grade I - Low amplitude, rhythmically oscillating joint glide near the resting position of the available arthrokinematic joint play. Activates Type I mechanoreceptors that inhibit nociception and provide information regarding joint position. They have a low threshold and respond to a few grams of tension. : Activates mechanoreceptors in the superficial layer of the joint capsule -

Bulbous corpuscle The Bulbous corpuscle or Ruffini ending or Ruffini corpuscle is a slowly adapting mechanoreceptor located in the cutaneous tissue between the dermal papillae and the hypodermis. It is named after Angelo Ruffini Angelo Ruffini (Pretare of Arquata ...

s. * Grade II - Relatively large amplitude, rhythmically oscillating joint glide that carries well into the available arthrokinematic joint play. Activates Type II mechanoreceptors that inhibit nociception and provide information about joint acceleration. They also have a low threshold and respond to a few grams of tension. : Activates mechanoreceptors in the deep layer of the joint capsule -

Pacinian Corpuscles Pacinian corpuscle or lamellar corpuscle or Vater-Pacini corpuscle; is one of the four major types of mechanoreceptors (specialized nerve ending with adventitious tissue for mechanical sensation) found in mammalian skin. This type of mechanorece ...

. * Grade III - Relatively large amplitude, rhythmically oscillating joint glide that carries to the end of the available arthrokinematic joint play. : Designed to physically stretch the joint capsule. * Grade IV - Low amplitude, rhythmically oscillating joint glide that is performed at the end of the available arthrokinematic joint play. : Designed to physically stretch the joint capsule. * Grade V - This grade refers to the use of a single high-velocity, low-amplitude thrust performed at the end of the available joint play. : Activates Golgi tendon organ-like endings that inhibit muscle tone and monitor the direction of joint motion. They have a higher threshold and respond to forces on the order of kilograms -

Golgi tendon organ The Golgi tendon organ (GTO) (also called Golgi organ, tendon organ, neurotendinous organ or neurotendinous spindle) is a proprioceptor – a type of sensory receptor that senses changes in muscle tension. It lies at the interface between a musc ...

References

{{reflist Guide to Physical Therapist Practice 3.0. Alexandria, VA: American Physical Therapy Association; 2014. Manual therapy Osteopathy Physical therapy Osteopathic manipulative medicine

Classification and Mechanisms

See also

References