Introduction

Hip Mobilizations

Research Corner Summary

Hip Mobilization and Efficacy

Comparing and Combining Interventions

Muscle Activity and Self-Administered Hip Mobilizations

Research Corner: Knee 

Comparing Interventions for the Knee

Combining Interventions for the Knee

Self-Administered Mobilizations and Taping for the Knee

Joint Mobilization: Hip Joint and Knee Joint

AOTA

TPTA

AUSPHYSIO

NYPT

PACE

<h2>For <a href="https://brookbushinstitute.com/article/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">Lumbo Pelvic Hip Complex Dysfunction</a> and <a href="https://brookbushinstitute.com/article/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Extremity Dysfunction</a>:</h2>
For an introduction to joint mobilization and manipulation and review of literature on reliability:
<ul>
 <li>Joint Mobilization and Manipulation: Introduction (coming soon)</li>
 <li>Joint Mobilization and Manipulation: <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">Reliability</a> (coming soon)</li>
</ul>
<h3>Signs of correlated dysfunction:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/article/introduction-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat Assessment:</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown" target="_blank" rel="noopener">Knees Bow In</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-7-knees-bow-out" target="_blank" rel="noopener">Knees Bow Out</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-9-anterior-pelvic-tilt-excessive-lordosis" target="_blank" rel="noopener">Anterior Pelvic Tilt</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-8-excessive-forward-lean" target="_blank" rel="noopener">Excessive Forward Lean</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift" target="_blank" rel="noopener">Asymmetrical Weight Shift</a></li>
 </ul>
 </li>
 <li><a href="https://brookbushinstitute.com/article/introduction-to-goniometry" target="_blank" rel="noopener">Goniometry</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/goniometry-hip-internal-rotation-in-prone" target="_blank" rel="noopener">Hip Internal Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">Prone</a> &lt;40 - 50&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/video/goniometry-hip-internal-rotation-at-90-degree-of-hip-flexion-9090-hip-ir" target="_blank" rel="noopener">Hip Internal Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">Supine</a> &lt;35 - 45&#xB0;
 <ul>
 <li>Although it is counter-intuitive to think that over-active internal rotators would restrict internal rotation, in practice this is not only common, it may be the norm. The most likely <a id="hypothesis" data-tip="1446" target="_blank" href="/glossary-term/hypothesis" class="glossary">hypothesis</a> is related to alterations in <a id="arthrokinematics" data-tip="1859" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematics</a>.</li>
 </ul>
 </li>
 <li><a href="https://brookbushinstitute.com/video/goniometry-hip-external-rotation-in-prone" target="_blank" rel="noopener">Hip External Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">Prone</a> &lt;40 - 50&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/video/goniometry-hip-external-rotation-at-90-degrees-of-hip-flexion-9090-hip-er" target="_blank" rel="noopener">Hip External Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">Supine</a> &lt;35 - 45&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/video/knee-extension-goniometry" target="_blank" rel="noopener">Knee Extension Goniometry</a> &lt; 0 - -5&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/video/knee-flexion-goniometry" target="_blank" rel="noopener">Knee Flexion Goniometry</a> &lt;135 - 150&#xB0;</li>
 </ul>
 </li>
 <li><a href="https://brookbushinstitute.com/article/introduction-manual-muscle-testing-active-population" target="_blank" rel="noopener">Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing MMT:
 <ul>
 <li><a href="https://brookbushinstitute.com/video/gluteus-maximus-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Gluteus Maximus Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) - Weak or With Compensation (Lumbar extension and/or knee flexion)</li>
 <li><a href="https://brookbushinstitute.com/video/gluteus-medius-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Gluteus Medius Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) - Weak or With Compensation (Lumbar <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> flexion and/or hip flexion)</li>
 </ul>
 </li>
</ul>
<h3>Sample Intervention (Limited Rotation ROM)</h3>
<ul>
 <li>Manual Release
 <ul>
 <li><a href="https://brookbushinstitute.com/video/tfl-manual-release" target="_blank" rel="noopener">Tensor Fascia Latae and Gluteus Minimus Static Manual Release</a></li>
 <li><a href="https://brookbushinstitute.com/video/vastus-lateralis-manual-release" target="_blank" rel="noopener">Vastus Lateralis Static Manual Release</a></li>
 <li><a href="https://brookbushinstitute.com/video/anterior-adductors-static-manual-release" target="_blank" rel="noopener">Anterior Adductors Static Manual Release</a></li>
 </ul>
 </li>
 <li>Mobilization or Manipulation
 <ul>
 <li><a href="https://brookbushinstitute.com/video/hip-joint-lateral-manual-mobilization" target="_blank" rel="noopener">Hip Mobilization</a></li>
 </ul>
 </li>
 <li>Manual Lengthening
 <ul>
 <li><a href="https://brookbushinstitute.com/video/manual-adductor-stretch" target="_blank" rel="noopener">Manual Adductor Stretch</a></li>
 <li><a href="https://brookbushinstitute.com/video/manual-hip-flexor-stretch-thomas-test-position" target="_blank" rel="noopener">Manual Hip Flexor Stretch</a></li>
 </ul>
 </li>
 <li>Instrument Assisted Soft Tissue Mobilization
 <ul>
 <li><a href="https://brookbushinstitute.com/article/iastm-fascia-lata-thigh" target="_blank" rel="noopener">Fascia Lata</a></li>
 </ul>
 </li>
 <li>Activation
 <ul>
 <li><a href="https://brookbushinstitute.com/article/gluteus-maximus-activation" target="_blank" rel="noopener">Gluteus Maximus Activation</a></li>
 <li><a href="https://brookbushinstitute.com/article/gluteus-medius-activation-progression" target="_blank" rel="noopener">Gluteus Medius Activation</a></li>
 </ul>
 </li>
 <li>Reactive Activation
 <ul>
 <li><a href="https://brookbushinstitute.com/video/gluteus-medius-reactive-activation-side-hop-progression" target="_blank" rel="noopener">Lateral hop to balance</a></li>
 </ul>
 </li>
 <li>Integration
 <ul>
 <li><a href="https://brookbushinstitute.com/article/posterior-oblique-subsystem-pos" target="_blank" rel="noopener">Posterior Oblique Subsystem</a></li>
 </ul>
 </li>
</ul>

<table>
 <tbody>
 <tr>
 <td>
 <h3>Summary</h3>
 <h3>Hip Mobilization</h3>
 <ul>
 <li>Validity: Studies have demonstrated <a id="arthrokinematics" data-tip="1863" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the <a href="https://brookbushinstitute.com/article/hip-joint" target="_blank" rel="noopener">hip</a> during mobilization and during normal joint motion (hip flexion).</li>
 <li>Efficacy: Several studies have demonstrated the efficacy of hip mobilizations for the treatment of low back, hip, or knee pain, especially when signs of hip dysfunction occur in conjunction with patient complaints.</li>
 <li>Comparing Interventions: Based on current research, it may be reasonable to conclude that hip mobilization should be prioritized over exercise for the initial treatment of hip osteoarthritis, the addition of hip internal rotation to hip mobilization may result in additional benefits, and larger amounts of force may be necessary to reliably improve ROM.</li>
 <li>Combining Interventions: The combination of mobilization and exercise is more effective than either intervention alone, especially for improving hip ROM; and further, the addition of hip mobilization and strengthening to a program for low back pain is likely to improve outcomes.</li>
 <li>Muscle Activity: Studies suggest that hip mobilization alone may have a significant effect on <a href="https://brookbushinstitute.com/article/gluteus-medius" target="_blank" rel="noopener">gluteus medius</a> and <a href="https://brookbushinstitute.com/article/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> activity and strength, which may have important implications for improving functional outcomes.</li>
 </ul>
 <h3>Knee Mobilization</h3>
 <ul>
 <li>Efficacy: Knee mobilizations for the treatment of knee dysfunction (osteoarthritis, PFPS, post-ACL surgery) may improve knee pain, knee ROM, knee ROM during gait, and functional tasks.</li>
 <li>Comparing Interventions:
 <ul>
 <li>Mobilizations versus Exercise/Conventional Physical Therapy: Studies suggest that knee mobilizations are equally effective, or more effective than commonly recommended therapeutic interventions, including exercise.</li>
 <li>Mobilizations versus Taping: Knee mobilizations are likely more effective than taping alone; however, additional benefits can be achieved by combining knee mobilizations and taping.</li>
 <li>Comparing Mobilizations: Research suggests that mobilization with movement (MWM), Maitland mobilizations (like those taught below), and McKenzie exercises (self-administered mobilizations) are similarly effective for treating knee dysfunction; and further, that 3 sets of 1 minute may be <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> to 1 set of 3 minutes of mobilization for immediate improvements in knee ROM.</li>
 </ul>
 
 </li>
 <li>Combining Interventions:
 <ul>
 <li>Mobilization and Exercise: The addition of manual therapy (including knee mobilization) to exercise enhances outcomes including pain, function, patient satisfaction, functional outcomes like strength, and 6-minute walk <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> distance, and is likely the reduce the need for pain medication and surgical intervention.</li>
 <li>Mobilization and Conventional Physical Therapy: Similar to studies investigating the addition of mobilization to exercise, the addition of mobilization to conventional physical therapy treatments significantly improves outcomes for pain, ROM, function, and 6-minute walk <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> distance.</li>
 <li>Mobilization and Taping: While knee mobilization likely has a larger effect size than taping, the combination of mobilization and taping results in better outcomes for those with knee dysfunction.</li>
 </ul>
 
 </li>
 <li>Systemic Effects: Knee mobilization results in nervous system-mediated changes in pain, reflex, and <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and strength.</li>
 </ul>
 </td>
 </tr>
 </tbody>
</table>

Research Corner: Hip

Two studies have investigated the amount of <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> that may occur between the femoral head and acetabulum. A cadaveric study by Harding et al. demonstrated that forces similar to those used by manual therapists may result in up to 1.5 mm of <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> (1). And, Loubert et al. demonstrated that the average amount of hip <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> during hip flexion in living subjects was about 2.o mm (range .8 - 4.2 mm), accounting for a small, but significant percentage of total hip motion (2). These two studies suggest that the intent to &quot;glide&quot; the hip during mobilization has <a id="validity" data-tip="1511" target="_blank" href="/glossary-term/validity" class="glossary">validity</a>.
<h3>Efficacy</h3>
Several studies have demonstrated the efficacy of hip mobilization for the treatment of low back, hip, and knee pain. An experimental study by Ju et al. investigated the treatment of low back pain, comparing conventional physical therapy (exercise and modalities) with and without hip mobilization, demonstrating that both groups exhibited improvements in pain, ROM, function, and psychological factors; however, the mobilization group exhibited larger improvements in all measures (3). An RCT by Beselga et al. demonstrated that treating hip osteoarthritis with mobilization with movement (MWM) for the hip resulted in immediate, and significant improvements in pain and ROM (hip flexion and internal rotation) when compared to a sham mobilization technique (4). Cliborne et al. demonstrated that patients with knee osteoarthritis exhibited significant changes in pain, ROM, and hip clinical <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> findings (including squat <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>) following a single session of hip mobilization (5). Last, Currier et al. investigated the ability to predict which individuals with knee pain would benefit from a hip mobilization by correlating outcomes 48 hours after participants received 4 hip mobilizations. The resulting clinical prediction rule (CPR) suggested the presence of 1 sign had a 92% chance of a successful response, and 2 signs had a 97% chance of a successful response. The signs included hip/groin pain or paresthesia, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> thigh pain, passive knee flexion less than 122 degrees, passive hip <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> (internal) rotation less than 17 degrees, and pain with hip <a id="distraction" data-tip="1589" target="_blank" href="/glossary-term/distraction" class="glossary">distraction</a> (6). It may be worth noting that 4 of the 5 signs predicting successful treatment of knee pain with hip mobilization could also be categorized as signs of hip dysfunction. In summary, several studies have demonstrated the efficacy of hip mobilizations for the treatment of low back, hip, or knee pain, especially when signs of hip dysfunction occur in conjunction with patient complaints.

<h3>Comparing Interventions</h3>
Comparative studies have highlighted opportunities to refine practice. An RCT by Hoeksma et al. compared manual therapy to an exercise protocol for the treatment of hip osteoarthritis. Following 9 sessions in 5 weeks, success rates (patient report of improvement) were 81% in the manual therapy group, and only 50% in the exercise group; further, patients in the manual therapy group had significantly better outcomes on pain, stiffness, hip function, and ROM, and the difference between groups was still present during a 29-week follow-up (7). An RCT by Darnell et al. demonstrated that the addition of hip internal rotation to manual hip mobilization resulted in larger improvements in pain and ROM when compared to controls, and an insignificant trend toward larger improvements when compared to conventional <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> to <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> hip mobilization (note, all groups also performed strengthening exercises) (8). A larger study should be considered to determine if the trend toward additional benefits from added hip internal rotation during mobilizations were significant findings. An interesting RCT by Vaarbakken et al. compared <a id="distraction" data-tip="1813" target="_blank" href="/glossary-term/distraction" class="glossary">traction</a> mobilization of unknown force to large load <a id="distraction" data-tip="1813" target="_blank" href="/glossary-term/distraction" class="glossary">traction</a> (800N) in conjunction with exercise for the treatment of hip disability, demonstrating large load <a id="distraction" data-tip="1813" target="_blank" href="/glossary-term/distraction" class="glossary">traction</a> resulted in better outcomes for most patients, including improvements in pain, stiffness, function, and quality of life (9). Est&#xE9;banez-de-Miguel et al. compared high, medium, and low mobilizations forces for patients with hip osteoarthritis, demonstrating that only the high force mobilization group exhibited improvements in hip ROM (10). The studies by Vaarbakken et al. and Est&#xE9;banez-de-Miguel et al. may imply that there is a threshold force required to achieve ROM benefits. In summary, it may be reasonable to conclude that hip mobilization should be prioritized over exercise for the initial treatment of hip osteoarthritis, the addition of hip internal rotation to hip mobilization may result in additional benefits, and larger amounts of force may be necessary to reliably improve ROM.
<h3>Combining Interventions</h3>
Combining hip mobilizations with other effective interventions may result in <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> outcomes. Bade et al. compared the treatment of low back pain with a combination of a low back protocol and a hip mobilization and strengthening protocol, to the same low back protocol alone. The study demonstrated that the combination group outcomes were significantly better at discharge, including better disability index scores, and larger improvements in pain, patient symptoms, and patient satisfaction (11). A pilot RCT by Blackman et al. compared a strengthening program with and without hip mobilization for the treatment of hip osteoarthritis, demonstrating that both interventions were effective; however, larger improvements in ROM were exhibited by the mobilization group. No additional differences were noted between groups; however, the study was underpowered (12). These studies suggest that the combination of mobilization and exercise is more effective than either intervention alone, especially for improving hip ROM; and further, the addition of hip mobilization and strengthening to a program for low back pain may improve outcomes.

<h3>Muscle Activity</h3>
Similar to mobilization for other joints, hip mobilization may result in an immediate change in <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and force production. Yerys et al. demonstrated that grade IV <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> hip mobilizations resulted in an immediate increase in&#xA0;<a href="https://brookbushinstitute.com/article/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>&#xA0;strength when compared to sham mobilization (grade I mobilizations) (13). In a similar study by Makofsky et al., Grade IV <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> hip mobilizations resulted in an immediate increase in hip abductor (<a href="https://brookbushinstitute.com/article/gluteus-medius" target="_blank" rel="noopener">gluteus medius</a>) <a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a> when compared to sham hip mobilization (grade I mobilizations) (14). These studies suggest that hip mobilization alone may have a significant effect on&#xA0;<a href="https://brookbushinstitute.com/article/gluteus-medius" target="_blank" rel="noopener">gluteus medius</a>&#xA0;and&#xA0;<a href="https://brookbushinstitute.com/article/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>&#xA0;muscle activity and strength, which may have important implications for improving functional outcomes.
<table>
 <tbody>
 <tr>
 <td>
 <h3>Self-administered Hip Mobilization</h3>
 A pilot RCT by Walsh et al. compared self-administered and manual hip mobilization techniques, demonstrating that hip internal rotation restriction could be effectively addressed with manual hip mobilization with movement (MWM). The self-administered hip mobilizations did not result in significant improvements in hip internal rotation ROM; however, a trend toward improvement was noted, and this study was an under-powered pilot study. A larger study should be conducted, and perhaps include a combination group that could identify whether the use of self-administered techniques in a home exercise program could augment the results attained using a manual mobilization (15). Self-administered hip mobilization is discussed further in the article -&#xA0;<a href="https://brookbushinstitute.com/article/joint-mobilization-lower-body-self-administered" target="_blank" rel="noopener">Joint Mobilization (Self-administered): Lower Body</a>.
 </td>
 </tr>
 </tbody>
</table>

Knee mobilization has demonstrated efficacy for the treatment of knee osteoarthritis, patellofemoral pain syndrome (PFPS), and post ACL surgical reconstruction. An RCT by Moss et al. compared knee mobilization, sham mobilization, and non-contact controls for the treatment of knee osteoarthritis, demonstrating that knee mobilization improved pain, pain pressure threshold at a <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> site, and the timed up-and-go <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> (16). Zemadanis et. al demonstrated that the combination of knee MWM in conjunction with hip or knee strength exercise was significantly more effective than physical therapy modalities for the treatment of patellofemoral pain syndrome (PFPS) (17). Hunt et al. investigated the effect of knee joint mobilizations on knee extension ROM during gait in patients following <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> cruciate ligament (ACL) reconstruction. The study demonstrated that mobilization had a significant effect on passive knee joint ROM, as well as ROM during gait, and improved function including step length, stride length, and gait speed (18). These studies demonstrate that treating knee dysfunction (osteoarthritis, PFPS, post-ACL surgery) with knee mobilization may improve knee pain, knee ROM, knee ROM during gait, and functional tasks.

<h4>Mobilizations versus Exercise</h4>
Research has compared knee mobilization to various common interventions for knee pain and dysfunction. Narang et al. compared Kaltenborn knee mobilizations to&#xA0;<a href="https://brookbushinstitute.com/video/quad-sets-and-progressions" target="_blank" rel="noopener">quad sets</a>&#xA0;and heat, during 15 consecutive days of treatment, demonstrating that the Kaltenborn knee mobilization group exhibited larger improvements in pain and function (19). A double-blind RCT by Raghav et al. investigated the treatment of post-traumatic stiffness of the knee joint, comparing continuous passive motion and flexibility exercises to MWM for the knee, demonstrating that MWM for the knee resulted in better pain and ROM scores following 4 weeks of treatment (20). An RCT by Lalit et al. compared Maitland mobilizations, MWM, and exercise for knee osteoarthritis, following 3 sessions in 5 days, demonstrating that all interventions were equally effective for improving pain, proprioception, and weight-bearing ability (21). These studies suggest that knee mobilizations are equally effective, or more effective than commonly recommended therapeutic exercises for knee pain.
<h4>Mobilizations versus Conventional Physical Therapy</h4>
Additional studies have compared mobilization to conventional physical therapy interventions. Sambandam et al. investigated the treatment of knee osteoarthritis, comparing MWM for the knee, Mulligan mobilizations for the knee, and conventional physiotherapy (exercise and modalities). All groups had significant improvement in pain, ROM, and function; however, the MWM group had significantly better results than the other two groups (22). A multi-center study by Kostov et al. investigated treatment plans following partial meniscectomy, demonstrating that manual therapy including knee joint mobilization resulted in better outcomes than manual therapy without knee joint mobilization or conventional physical therapy including exercise and modalities (23). These studies may imply that knee mobilizations have a larger effect size than conventional physical therapy interventions.
<h4>Mobilizations versus Taping</h4>
Further studies have compared the effects of knee mobilization and taping. Oskay et al. compared knee MWM, to taping, to the combination of MWM and taping for the treatment of knee osteoarthritis, demonstrating that the best results for pain, stair climbing, repeated sit-to-stand, and straight-line walking were exhibited by the combined group, followed by the mobilization group, with the smallest changes in outcomes noted in the taping alone group (24). Demirci et al. compared home exercise in conjunction with either MWM or Kinesiotraping for treatment of patellofemoral pain, demonstrating both groups exhibited similar improvements in pain, function, and <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a> scores; however, the mobilization group exhibited <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> benefits for hamstring flexibility and pain at rest (25). Giri et al. compared MWM and Mulligan taping to Maitland mobilizations and kinesiotaping, demonstrating both were effective for improving pain and function in patients with knee osteoarthritis; however, MWM and Mulligan taping did result in slightly better outcomes (26). Considering these studies, it may be reasonable to conclude that mobilizations are more effective than taping alone; however, additional benefits can be achieved by combining knee mobilizations and taping.
<h4>Comparing mobilizations</h4>
Several studies have been conducted comparing mobilizations in an attempt to refine practice. As mentioned above, Sambandam et al. demonstrated that MWM was <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> to Maitland mobilizations and conventional physiotherapy; however, this is the only study to demonstrate a difference in the efficacy of these techniques (22). The RCT by Lalit et al. (also mentioned above) demonstrated that Maitland mobilizations, MWM were equally effective for improving symptoms associated with knee osteoarthritis (21). Further, an RCT by Multa et al. compared MWM to Maitland mobilization for the treatment of knee osteoarthritis, demonstrating that both mobilization techniques resulted in similar outcomes for pain, ROM, and function (27). Another single-blind RCT by Multu et al. investigated the treatment of knee osteoarthritis comparing knee MWM, Maitland knee mobilizations, and electrotherapy, demonstrating that both mobilization treatments were equally effective and <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> to electrotherapy, including improvement in pain pressure threshold, function, ROM, and&#xA0;<a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">quadriceps</a>&#xA0;strength (28). A cross-over RCT by Rao et al. compared Maitland and MWM mobilizations for the treatment of knee osteoarthritis, demonstrating both mobilization techniques were equally effective for improving pain, timed up-and-go, and pain-free squat angle (29). Jadhav et al. compared self-administered McKenzie knee exercises to manual knee MWM in conjunction with conventional physiotherapy for the treatment of knee osteoarthritis, demonstrating that both techniques were effective for improving pain, timed up-and-go, ROM, and manual <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> testing. The self-administered McKenzie exercises did result in slightly better scores on manual <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> testing (30). Despite the small differences noted in the studies by Sambandam et al. and Jadhav et al., the body of research as a whole suggests that MWM, Maitland mobilizations (like those taught below), and McKenzie exercises (self-administered mobilizations) are similarly effective. An additional study by Rangey et al. compared 3 minutes of continuous mobilization to 3 intermittent bouts of 1 minute of mobilization (with 1 minute rest periods), for the treatment of knee osteoarthritis (31). Results suggest that both protocols were equally effective for pain; however, 3 sets of 1 minute was more effective for immediate improvements in ROM.

<h4>Mobilization and Exercise</h4>
Similar to research investigating mobilizations for other joints, the combination of knee mobilization and exercise may provide additional benefits. An RCT by Razek et al. compared a conventional physical therapy program with and without knee joint MWM for the treatment of knee osteoarthritis, demonstrating that the addition of MWM resulted in larger improvements in pain and ROM (32). Ko et al. compared exercise with and without manual therapy (including knee mobilization) for the treatment of knee osteoarthritis in a group of elderly women. Both groups exhibited improvements in&#xA0;<a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">quadriceps</a>&#xA0;strength; however, the manual therapy group improved by twice as much, and only the manual therapy group had significant changes in proprioception and 6-minute walk <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> distance (33). In a pilot RCT by Dwyer et al., exercise and manual therapy (including knee mobilization) resulted in better outcomes in pain, function, and therapy satisfaction, than exercise alone during follow-up 5 weeks after collecting baseline data (34). Kappetijn et al. compared exercise with and without knee mobilization for the treatment of knee osteoarthritis, demonstrating that the addition of mobilization resulted in <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> outcomes for pain, ROM, and 6-minute walk <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> distance (35). Singh et al. demonstrated that the combination of isometric exercise and knee mobilization was more effective than isometric exercises alone for improving pain and 6-minute walk <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> distance in patients with knee osteoarthritis (36). An RCT by Deyle et al. compared manual therapy and exercise to sub-therapeutic ultrasound (placebo) for the treatment of knee osteoarthritis, demonstrating large improvements at 4 and 8 weeks in the therapeutic manual therapy and exercise group including pain, function, and 6-minute walk <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> distance. Further, at 1-year follow-up, only 5% of individuals had undergone surgery in the therapeutic intervention group, compared to 20% in the placebo group (37). Another RCT by Deyle et al. compared supervised clinical treatment including individualized manual therapy and a home exercise program for 4-weeks, to a home treatment group that included a home exercise program reinforced by 2 clinic visits. Pain and function scores had improved by 52% in the clinic treatment group and by 26% in the home-exercise group, and although outcomes measures were similar at 1-year follow-up, the clinical treatment group reported taking far less medication for pain (38). These studies ubiquitously demonstrate that the addition of manual therapy (including knee mobilization) to exercise enhances outcomes including pain, function, patient satisfaction, functional outcomes like strength, and 6-minute walk <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> distance, and is likely the reduce the need for pain medication and surgical intervention.
<h4>Mobilization and Conventional Physical Therapy</h4>
Studies have also investigated the potential benefits of adding knee mobilization to conventional physical therapy for the treatment of knee pain. A study by Nora et al. demonstrated that the addition of knee mobilization to conventional physical therapy (20 minutes of exercise and thermal therapy) resulted in significant improvements in pain, but did not result in improvements in stair-climbing (39). Kulkarni et al. comparing outcomes following 3 treatments of conventional therapy (TENS and exercise program) with and without knee MWM for the treatment of knee osteoarthritis. Both groups demonstrated significant improvements; however, the MWM group exhibited the largest improvements in pain and 6-minute walk <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> distance (40). &#xB0A8;&#xC6A9;&#xC774; et al. compared conventional physical therapy with and without manual knee joint mobilization, demonstrating that following 4 weeks (12 sessions) of treatment, the addition of mobilization significantly improved pain, ROM, and function (41). An RCT by Pollard et al. demonstrated that soft tissue therapy and manual <a id="distraction" data-tip="1813" target="_blank" href="/glossary-term/distraction" class="glossary">traction</a> (Macquarie Injury Management Group Knee Protocol) resulted in larger improvements in self-reported pain and knee-related function following two weeks of treatment (6 sessions) and during 2-week follow-up when compared to a control group (42). An RCT by Fish et al. investigated the treatment of knee osteoarthritis, comparing capsaicin cream, knee mobilization, and a combination of both, demonstrating that both groups that included knee mobilization significantly improved pain, function, and ROM (43). Finally, an experimental study by Lluch et al. investigated treatment for knee osteoarthritis, comparing knee joint mobilization and pain science education to knee joint mobilization and biomedical education, demonstrating no difference between the groups for pain and disability scores, with the pain science group only demonstrating <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> results for psychosocial variables related to pain catastrophizing and kinesiophobia (44). Similar to studies investigating the addition of mobilization to exercise interventions, the addition of mobilization to conventional physical therapy treatments significantly improves outcomes including pain, ROM, function, and 6-minute walk <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> distance.

A prospective case series by Takasaki et al. investigated the treatment of knee osteoarthritis with a combination of manual knee MWM and self-administered knee MWM, demonstrating immediate and short-term improvements in pain, ROM, and function (51). Although this study does not allow for a comparison of manual mobilization to self-administered mobilization, or an analysis of the efficacy of self-administered mobilization alone, the study does demonstrate that the combination of manual and self-administered mobilization is likely effective. Self-administered knee mobilization is discussed further in the article -&#xA0;<a href="https://brookbushinstitute.com/article/joint-mobilization-lower-body-self-administered" target="_blank" rel="noopener">Joint Mobilization (Self-administered): Lower Body</a>.
<h4>Taping</h4>
As mentioned above, the combination of taping and mobilization may provide additional benefits for those with knee dysfunction. In two RCTs by Park et al., it was demonstrated that both mobilization and <a id="kinesiology" data-tip="1692" target="_blank" href="/glossary-term/kinesiology" class="glossary">kinesiology</a> taping were effective for improving pain, <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a> (static and dynamic), and ROM deficits associated with knee osteoarthritis; however, the combination of the two treatments resulted in <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> outcomes (45, 46). Altmis et al. compared knee MWM with knee taping, knee MWM with placebo taping, and placebo taping interventions for the treatment of knee osteoarthritis. The MWM and taping group exhibited significant improvements in pain, lifting, picking-up, sit and stand-up, and socket tests in addition to climbing up and downstairs, ten-meter walk, and timed up-and-go (TUG) tests, whereas the MWM and placebo taping group exhibited improvements on fewer <a id="assessment" data-tip="1480" target="_blank" href="/glossary-term/assessment" class="glossary">assessments</a>, including pain, sit and stand-up, ten-meter walk, and TUG tests. Both interventions demonstrated significant improvements when compared to the placebo group (47). These studies suggest that while knee mobilization likely has a larger effect size than taping, the combination of mobilization and taping results in better outcomes for those with knee dysfunction.

Video Demonstration

Knee Mobilizations

<ol>
 <li>Harding, L., Barbe, M., Shepard, K., Marks, A., Ajai, R., Lardiere, J., &amp; Sweringa, H. (2003). Posterior-anterior glide of the femoral head in the acetabulum: a cadaver study. Journal of Orthopaedic &amp; Sports Physical Therapy, 33(3), 118-125.</li>
 <li>Loubert, P. V., Zipple, J. T., Klobucher, M. J., Marquardt, E. D., &amp; Opolka, M. J. (2013). In vivo ultrasound measurement of posterior femoral glide during hip joint mobilization in healthy college students. journal of orthopaedic &amp; sports physical therapy, 43(8), 534-541.
 <ul>
 <li>Efficacy</li>
 </ul>
 </li>
 <li>Ju, T., Choi, W., Yang, Y., &amp; Lee, S. (2015). Effects of Hip Mobilization on Pain and Function for Chronic Low Back Pain Individuals with Limited Range of Hip Joint Motion. Indian Journal of Science and Technology, 8(26), 1-6.</li>
 <li>Beselga, C., Neto, F., Alburquerque-Send&iacute;n, F., Hall, T., &amp; Oliveira-Campelo, N. (2016). Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: a randomised controlled trial. Manual therapy, 22, 80-85.</li>
 <li>Cliborne, A. V., Wainner, R. S., Rhon, D. I., Judd, C. D., Fee, T. T., Matekel, R. L., &amp; Whitman, J. M. (2004). Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mobilization. Journal of Orthopaedic &amp; Sports Physical Therapy, 34(11), 676-685.</li>
 <li>Currier, L. L., Froehlich, P. J., Carow, S. D., McAndrew, R. K., Cliborne, A. V., Boyles, R. E., &hellip; &amp; Wainner, R. S. (2007). Development of a clinical prediction rule to identify patients with knee pain and clinical evidence of knee osteoarthritis who demonstrate a favorable short-term response to hip mobilization. Physical Therapy, 87(9), 1106-1119.
 <ul>
 <li>Comparing Interventions</li>
 </ul>
 </li>
 <li>Hoeksma, H. L., Dekker, J., Ronday, H. K., Heering, A., Van Der Lubbe, N., Vel, C., &hellip; &amp; Van Den Ende, C. H. (2004). Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis Care &amp; Research: Official Journal of the American College of Rheumatology, 51(5), 722-729.</li>
 <li>Darnell, K., Harland, J., Casner, A., Kimball, T., &amp; Tuong, D. (2017). A comparison between hip internal rotation mobilization to posterior glide and their effects on hip internal rotation.</li>
 <li>Vaarbakken, K., &amp; Elisabeth Ljunggren, A. (2007). Superior effect of forceful compared with standard traction mobilizations in hip disability?. Advances in physiotherapy, 9(3), 117-128.</li>
 <li>Est&eacute;banez-de-Miguel, E., Fort&uacute;n-Agud, M., Jimenez-del-Barrio, S., Caudevilla-Polo, S., Bueno-Gracia, E., &amp; Tric&aacute;s-Moreno, J. M. (2018). Comparison of high, medium and low mobilization forces for increasing range of motion in patients with hip osteoarthritis: A randomized controlled trial. Musculoskeletal Science and Practice, 36, 81-86.
 <ul>
 <li>Combining Interventions</li>
 </ul>
 </li>
 <li>Bade, M., Cobo‐Estevez, M., Neeley, D., Pandya, J., Gunderson, T., &amp; Cook, C. (2017). Effects of manual therapy and exercise targeting the hips in patients with low‐back pain&mdash;A randomized controlled trial. Journal of evaluation in clinical practice, 23(4), 734-740.</li>
 <li>Blackman, F., &amp; Atkins, E. (2014). The effect of adding grade B hip mobilization to a muscle strengthening home exercise programme on pain, function, and range of movement in adults with symptomatic early-stage hip osteoarthritis: A pilot study for a randomized controlled trial. International Musculoskeletal Medicine, 36(2), 54-63.
 <ul>
 <li>Muscle Activity</li>
 </ul>
 </li>
 <li>Yerys, S., Makofsky, H., Byrd, C., Pennachio, J., &amp; Cinkay, J. (2002). Effect of mobilization of the anterior hip capsule on gluteus maximus strength. Journal of Manual &amp; Manipulative Therapy, 10(4), 218-224.</li>
 <li>Makofsky, H., Panicker, S., Abbruzzese, J., Aridas, C., Camp, M., Drakes, J., &hellip; &amp; Sileo, R. (2007). Immediate effect of grade IV inferior hip joint mobilization on hip abductor torque: a pilot study. Journal of Manual &amp; Manipulative Therapy, 15(2), 103-110.
 <ul>
 <li>Self-administered</li>
 </ul>
 </li>
 <li>Walsh, R., &amp; Kinsella, S. (2016). The effects of caudal mobilisation with movement (MWM) and caudal self-mobilisation with movement (SMWM) in relation to restricted internal rotation in the hip: A randomised control pilot study. Manual therapy, 22, 9-15.
 <ul>
 <li>Knee Efficacy</li>
 </ul>
 </li>
 <li>Moss, P., Sluka, K., &amp; Wright, A. (2007). The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Manual therapy, 12(2), 109-118.</li>
 <li>Zemadanis, K., Sykaras, E., Athanasopoulos, S., &amp; Mandalidis, D. (2015). Mobilization-with-movement prior to exercise provides early pain and functionality improvements in patients with patellofemoral pain syndrome. International Musculoskeletal Medicine, 37(3), 101-107.</li>
 <li>Hunt, M. A., Di Ciacca, S. R., Jones, I. C., Padfield, B., &amp; Birmingham, T. B. (2010). Effect of anterior tibiofemoral glides on knee extension during gait in patients with decreased range of motion after anterior cruciate ligament reconstruction. Physiotherapy Canada, 62(3), 235-241.
 <ul>
 <li>Comparing Knee Interventions</li>
 </ul>
 </li>
 <li>Narang, S., &amp; Ganvir, S. (2014). Efficacy of Kaltenbohn Mobilization on Patients with Osteoarthritis of Knee Joint. Indian Journal of Physiotherapy and Occupational Therapy, 8(3), 162.</li>
 <li>Raghav, S., Singh, A., Tyagi, G. P., &amp; Rastogi, K. The Effect of Mobilization with Movement versus Conventional Treatment on Range of Motion in Patients with Post-Traumatic Stiffness of Knee Joint: A Randomized Clinical Trial.</li>
 <li>Lalit, S. Y., Suhas, M. B., &amp; Amita, M. (2012). Effect of Manual Therapy Techniques on knee Proprioception in Patients with Osteo-arthritis of knee. Indian Journal of Physiotherapy and Occupational Therapy, 6(3), 285.</li>
 <li>Sambandam, C. E., Sailor, S. N., &amp; Alagesan, J. (2011). Effect of Mulligan Mobilization and Maitland Mobilization in Subjects with Unilateral Tibiofemoral Osteoarthritis-Randomized Controlled Trial. Journal of Pharmaceutical and Biomedical Sciences, 11(11), 1-4.</li>
 <li>Kostov, R., &amp; Ilieva, B. (2016). Results of implementation of the joint mobilization techniques to restore mobility of the knee complex in patients after partial meniscectomy. Scripta Scientifica Medica, 48(1), 30-35.</li>
 <li>Oskay, D., Altmış, H., D&uuml;zg&uuml;n, I., &amp; Elbasan, B. (2015). THU0618-HPR Immediate Effects of Mulligan's Concept Mobilization with Movement on Knee Pain and Functions in Patients with Knee Osteoarthritis.</li>
 <li>Demirci, S., Kinikli, G. I., Callaghan, M. J., &amp; Tunay, V. B. (2017). Comparison of short-term effects of mobilization with movement and Kinesiotaping on pain, function and balance in patellofemoral pain. Acta orthopaedica et traumatologica turcica, 51(6), 442-447.</li>
 <li>Giri, P. (2019). THE EFFECT OF MULLIGAN TECHNIQUE IN COMPARISON WITH MAITLAND MOBILIZATION AND KINESIO TAPING IN PATIENTS WITH OSTEOARTHRITIS OF KNEE JOINT.</li>
 <li>Mutlu, E. K., Ozdincler, A. R., &amp; Ercin, E. (2015). Comparison of two different mobilization techniques in the management of osteoarthritis of the knee: A randomized clinical trial. Osteoarthritis and Cartilage, 23, A391-A392.</li>
 <li>(also used below) Kaya Mutlu, E., Ercin, E., Razak Ozdıncler, A., &amp; Ones, N. (2018). A comparison of two manual physical therapy approaches and electrotherapy modalities for patients with knee osteoarthritis: a randomized three arm clinical trial. Physiotherapy theory and practice, 34(8), 600-612.</li>
 <li>Rao, R. V., Balthillaya, G., Prabhu, A., &amp; Kamath, A. (2018). Immediate effects of Maitland mobilization versus Mulligan Mobilization with Movement in Osteoarthritis knee-A Randomized Crossover trial. Journal of bodywork and movement therapies, 22(3), 572-579.</li>
 <li>Jadhav, V. S., &amp; Anap, D. B. (2019). Effectiveness of Mulligan Mobilization Versus Mckenzie Exercises in Knee Osteoarthritis: A Single Blind Randomized Controlled Trial. Physiother Rehabil, 4(177), 2.</li>
 <li>Rangey, P. S., Sheth, M. S., &amp; Vyas, N. J. (2015). Comparison of Immediate Effect of Two Different Maitland Mobilization Protocols on Pain and Range Of Motion in Subjects with Osteoarthritis of Knee. Pain, 6, 8.
 <ul>
 <li>Mobilization and Exercise</li>
 </ul>
 </li>
 <li>Razek, R. A., &amp; Shenouda, M. M. (2014). Efficacy of mulligan's mobilization with movement on pain, disability, and range of motion in patients with knee osteoarthritis: A randomized controlled pilot study. Indian Journal of Physiotherapy and Occupational Therapy, 8(1), 242.</li>
 <li>Ko, T., Lee, S., &amp; Lee, D. (2009). Manual therapy and exercise for OA knee: effects on muscle strength, proprioception, and functional performance. Journal of Physical Therapy Science, 21(4), 293-299.</li>
 <li>Dwyer, L., Parkin-Smith, G. F., Brantingham, J. W., Korporaal, C., Cassa, T. K., Globe, G., &hellip; &amp; Tong, V. (2015). Manual and manipulative therapy in addition to rehabilitation for osteoarthritis of the knee: assessor-blind randomized pilot trial. Journal of manipulative and physiological therapeutics, 38(1), 1-21.</li>
 <li>Kappetijn, O., van Trijffel, E., &amp; Lucas, C. (2014). Efficacy of passive extension mobilization in addition to exercise in the osteoarthritic knee: an observational parallel-group study. The Knee, 21(3), 703-709.</li>
 <li>Singh, D. (2012). An Experimental Study on effects of Mulligan Mobilization Technique and Isometric Exercises in Patients with Osteoarthritis Knee. Indian Journal of Physiotherapy &amp; Occupational Therapy, 6(4).</li>
 <li>Deyle, G. D., Henderson, N. E., Matekel, R. L., Ryder, M. G., Garber, M. B., &amp; Allison, S. C. (2000). Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled trial. Annals of internal medicine, 132(3), 173-181.</li>
 <li>Deyle, G. D., Allison, S. C., Matekel, R. L., Ryder, M. G., Stang, J. M., Gohdes, D. D., &hellip; &amp; Garber, M. B. (2005). Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Physical therapy, 85(12), 1301-1317.
 <ul>
 <li>Mobilization and Conventional Physical Therapy</li>
 </ul>
 </li>
 <li>MN, N. A., &amp; LYN, K. (2011). Effects of passive joint mobilization on patients with knee osteoarthritis. Sains Malaysiana, 40(12), 1461-1465.</li>
 <li>Kulkarni, A. V., &amp; Kamat, M. M. (2017). A Study to Determine the Effectiveness of Mobilization with Movement Techniques in Knee Osteoarthritis Pain. International Journal of Health Sciences and Research, 7(4).</li>
 <li>남용이, 춘숙권, &amp; 현승송. (2015). The effect of manual joint mobilization on pain, ROM, body function and balance in patients with knee osteoarthritis. Korean Society of Physical Medicine, 10(4), 91-99.</li>
 <li>Pollard, H., Ward, G., Hoskins, W., &amp; Hardy, K. (2008). The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. The Journal of the Canadian Chiropractic Association, 52(4), 229.</li>
 <li>Fish, D., Kretzmann, H., Brantingham, J. W., Globe, G., Korporaal, C., &amp; Moen, J. R. (2008). A Randomized Clinical Trial to Determine the Effect of Combining a Topical Capsaicin Cream and Knee-Joint Mobilization in the Treatment of Osteoarthritis of the Knee. Journal of the American Chiropractic Association, 45(6).</li>
 <li>Lluch, E., Duenas, L., Falla, D., Baert, I., Meeus, M., Sanchez-Frutos, J., &amp; Nijs, J. (2018). Preoperative pain neuroscience education combined with knee joint mobilization for knee osteoarthritis. The Clinical journal of pain, 34(1), 44-52.
 <ul>
 <li>Taping</li>
 </ul>
 </li>
 <li>Park, S. J., &amp; Lee, J. H. (2016). Effect of joint mobilization and kinesio taping on pain, range of motion, and knee function in patients with knee osteoarthritis. The Journal of Korean Physical Therapy, 28(5), 279-285.</li>
 <li>Park, S. J., &amp; Kim, D. D. (2017). The impact of joint mobilization with an elastic taping on immediate standing balance in patients with knee osteoarthritis. Journal of the Korea Convergence Society, 8(7), 295-304.</li>
 <li>Altmış, H&uuml;lya, Deran Oskay, B&uuml;lent Elbasan, İrem D&uuml;zg&uuml;n, and Zeynep Tuna. "Mobilization with movement and kinesio taping in knee arthritis&mdash;evaluation and outcomes." International orthopaedics 42, no. 12 (2018): 2807-2815.
 <ul>
 <li>Knee Mobilization and Analgesia</li>
 </ul>
 </li>
 <li>Courtney, C. A., Steffen, A. D., Fern&aacute;ndez-De-Las-Pe&ntilde;as, C., Kim, J., &amp; Chmell, S. J. (2016). Joint mobilization enhances mechanisms of conditioned pain modulation in individuals with osteoarthritis of the knee. journal of orthopaedic &amp; sports physical therapy, 46(3), 168-176.</li>
 <li>Courtney, C. A., Witte, P. O., Chmell, S. J., &amp; Hornby, T. G. (2010). Heightened flexor withdrawal response in individuals with knee osteoarthritis is modulated by joint compression and joint mobilization. The Journal of Pain, 11(2), 179-185.
 <ul>
 <li>Knee Mobilization and Muscle Activity</li>
 </ul>
 </li>
 <li>Ghanbari, A., &amp; Kamalgharibi, S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences (IJHRS), 2(4), 186-91.
 <ul>
 <li>Self-administered Knee Mobilization</li>
 </ul>
 </li>
 <li>Takasaki, H., Hall, T., &amp; Jull, G. (2013). Immediate and short-term effects of Mulligan's mobilization with movement on knee pain and disability associated with knee osteoarthritis&ndash;A prospective case series. Physiotherapy theory and practice, 29(2), 87-95.</li>
</ol>

Bibliography

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Research demonstrates that knee mobilizations result in several <a id="nervous-system" data-tip="1690" target="_blank" href="/glossary-term/nervous-system" class="glossary">nervous system</a> mediated changes. An RCT by Courtney et al. demonstrated that knee joint mobilization to the affected side compared resulted in a decrease in deep tissue pressure <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> bilaterally, improved vibration sense acuity on the affected side, but no effect on cutaneous input on either side (48). In another RCT by Courtney et al. knee mobilization reduced <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> of flexor withdrawal reflex, primarily by reducing&#xA0;<a href="https://brookbushinstitute.com/article/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>&#xA0;activity and knee flexor <a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a> knee osteoarthritis patients (49). Additionally several studies have noted immediate changes in <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and strength. As mentioned above, a single-blind RCT by Multu et al. demonstrated that knee mobilization for the treatment of knee osteoarthritis had an immediate effect on&#xA0;<a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">quadriceps</a>&#xA0;strength (28). And, in another study mentioned above, Ko et al. compared exercise with and without manual therapy (including knee mobilization) for the treatment of knee osteoarthritis in a group of elderly woman. Both groups exhibited improvements in&#xA0;<a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">quadriceps</a>&#xA0;strength; however, the manual therapy group improved by twice as much (33). Further, Ghanbari et al. demonstrated that maximal voluntary isometric contraction of the&#xA0;<a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">quadriceps</a>&#xA0;was improved significantly and for 30 minutes following a knee joint mobilization on healthy participants (50). In summary, these studies demonstrate that knee mobilization results in <a id="nervous-system" data-tip="1690" target="_blank" href="/glossary-term/nervous-system" class="glossary">nervous system</a> mediated changes in pain, reflex and <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and strength.
<table>
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 <h3>Self-administered Knee Mobilization</h3>
 A prospective case series by Takasaki et al. investigated treatment of knee osteoarthritis with a combination of manual knee MWM and self-administered knee MWM, demonstrating immediate and short-term improvements in pain, ROM and function (51). Although this study does not allow for a comparison of manual mobilization to self-administered mobilization, or an analysis of the efficacy of self-administered mobilization alone, the study does demonstrate that the combination of manual and self-administered mobilization is likely effective. Self-administered knee mobilization is discussed further in the article -&#xA0;<a href="https://brookbushinstitute.com/article/joint-mobilization-lower-body-self-administered" target="_blank" rel="noopener">Joint Mobilization (Self-administered): Lower Body</a>.
 </td>
 </tr>
 </tbody>
</table>

Systemic Response to Knee Mobilization

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Accuracy - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

Adenosine triphosphatase (ATPase): is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

Adenosine triphosphate (ATP): The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

Algometry - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

All-or-none principle - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the anterior aspect of the head

Appendicular Skeleton - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

Arthrokinematic Motion - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

Assessment - is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li>"Clear" the Patient/Client for Intervention - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A Calf Squeeze (Thompson) Test is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li>Highlight Contraindications - Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li>Refine Exercise/Intervention Selection: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to Refine Exercise/Intervention Selection, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and Clearance to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of Contraindicated Activities from the physician. - "When in doubt, refer out!"

Axial Skeleton - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin axis "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

Balance - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

Base of support (BoS) - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

Case-control Study - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. American journal of epidemiology, 134(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed caudally.

Center of mass (CoM) - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

Center of gravity (CoG) - point where gravity appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed cephalad.

Cohort Study - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

Concave (Concavity) - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

Concordant Sign - The patient's specific pain, symptom or complaint. 
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

Conductivity: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Contractility: The ability to shorten (1).
<ul>
 	<li>Contractility: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

Convex (Convexity) - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

Correlational Research - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. J. Phys. Ther. Sci. 26: 961-964</a></li>
</ol>

Counter-nutation - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

Crossover (Study) Design - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. Journal of Human Kinetics, 58, 197-206. </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54</a></li>
</ol>

Cytokine - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength.  Journal of Manual &amp; Manipulative Therapy. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the distal end of the leg.

An arthrokinematic motion - a force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the dorsal surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an alteration of normal kinematics.

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

Elasticity: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). Anatomy &amp; physiology. New York (NY): WCB/McGraw-Hill.</li>
</ol>

Equilibrium - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0">Evidence-based medicine (practice) is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. Bmj, 312(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

Excitability: The ability of a cell to change in membrane conductance as a response to stimulation.

<ul>
 	<li>For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Excitation threshold: The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

Exercise Progression - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

Exercise regression - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

Experimental Research - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. Journal of Strength and Conditioning Research, 27(11), 2997-3000.</a></li>
</ol>
&nbsp;

Extensibility: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

False Negative - the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

False Positive - the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

Fibromyalgia - A loosely defined diagnosis that is associated with a combination of widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. PAIN®, 145(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

H-Band - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (biological holism) - (from Greek holos "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. Holism and evolution. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

Hormone: Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation, 60(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

Hyperplasia is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

Muscular hypertrophy is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

I-Band - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is inferior to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

Intermuscular Coordination - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

Example: Role of Muscles during Hip Extension
<ul>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: <a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An isoform, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior kinetic chain, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

Latent Trigger Point - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is lateral to the pectoralis major

Length/Tension Relationship - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. The Journal of physiology, 184(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. The Journal of Physiology, 183(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. Journal of neurophysiology, 71(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

Levels of Evidence - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.


The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. Western Journal of Medicine, 170(6), 348.</li>
</ol>

Likelihood Ratios - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li>Positive Likelihood Ratio (LR+) - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li>Negative Likelihood Ratio (LR-) - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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