Now that we have gone through a general overview of the different physical therapy specializations, we will move on to discussing various treatment options that physical therapists use. We'll start with joint mobilization.
Joints are the points in the body where two or more bones meet. There are different types of joints in the human body - hinge joints at the elbow and knee, ball and socket joints at the shoulder and hip, and more kinds, depending on the surfaces of the bones and the function of the joint. Bones are a big component of a joint, but not the whole picture. Joints are also made up of cartilage, joint (synovial) fluid, ligaments, nerves, and blood vessels, and they are usually surrounded by soft tissue like muscles and tendon.
Joints are a common site of injury and/or disease - such as ankle sprains, hip osteoarthritis, or rheumatoid arthritis. Musculoskeletal and neuromuscular conditions can benefit from joint mobilization to relieve pain and muscle spasms, release tension surrounding a joint, and increase range of motion in order to improve someone’s function. Joint mobilization is a manual therapy (or hands-on) treatment technique in which the PT can apply different levels of force to a joint in a desired direction, typically trying to mimic the normal movements that happen in between the bones.
Joint mobilizations can be small, gentle movements to help reduce pain in a joint, or they can be larger, stronger movements intended to stretch the joint and increase range of motion. This technique is considered “skilled”, as the PT decides on a number of factors in order for the patient to gain maximum benefit. These factors include which joint(s) to mobilize, what “grade” (pressure/force) to use, what direction to mobilize in, for how long, and how the patient is responding to treatment.
There are two major approaches to manual joint mobilization: Maitland and Kaltenborn. These approaches are named after Geoffrey Maitland and Freddy Kaltenborn, who each developed techniques for testing “joint play” - the amount of movement or mobility in a joint. They used different scales for describing the force and the amount of movement used during joint testing and treatment, so PTs may differ slightly in their approach to joint mobilization depending on their background and training. The Maitland Concept can be applied to peripheral joints (shoulder, knee, finger, etc.) or spinal joints (such as the neck, ribs, low back). Maitland has provided a framework of grades 1-5, which describe mobilizations (and Grade 5 manipulation) based on the depth within the joint’s range of motion that force is applied.
Grades 1-2 = within the range of joint that is free of resistance
Grades 3-4 = passive movements that moves up to point of resistance
Grade 5 = known as manipulation, when joint is positioned near its end range of motion during manual therapy, high velocity and low amplitude force is applied
Another joint mobilization approach is called Mobilization with Movement (MWM), which was developed by Brian Mulligan. MWM combines a passive joint mobilization applied by the PT, with active movement or range of motion performed by the patient. With MWM, the patient is therefore a more active participant in their rehab. A key tenet of MWM is that the technique should never cause pain and should be adjusted to find the pain-free direction and motion.
As mentioned earlier, joint mobilization is a very valuable tool used by therapists. It can improve range of motion, reduce pain, and improve the mechanics of a joint to help a patient to perform activities such as lifting their arm, bending their pine, or walking. This technique is commonly used for joint stiffness or pain (like frozen shoulder), spine pain or stiffness, and after immobilization (like after a fracture or surgery) that has caused the joint to tighten up. On the other hand, it’s typically not used on patients with joint hypermobility (or increased joint flexibility) or on fused joints. The PT will determine if this technique would be helpful in a patient’s treatment plan after performing an initial evaluation.
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