Joint Mobilization

Joint Mobilization: A passive force applied to a joint with the intent of increasing passive arthrokinematic range and/or achieving a therapeutic effect. Generally, mobilizations are performed with a slow, oscillatory motion (1 - 2 cycles per second). For example, types of joint mobilizations include:

• Cyriax/Maitland: Appropriate force is dependent on the "Grade" used (described above), the grade is dependent on the patient/client's presentation and progress, force is applied using an oscillatory technique (1-2 oscillations/second is ideal for most scenarios). The technique is continued until there is a change in symptoms or tissue stiffness (generally, 15 -120 seconds).
• Stanley Paris: Stanley Paris taught and published many refinements to these commonly used techniques; however, the protocol used (grade, force, and oscillations) is similar to the Maitland protocols described above.
• Kaltenborn: Static pressure is applied for 6-10 seconds, for 3-4 cycles, with 3-4 second intervals between cycles. The technique is continued until there is a change in symptoms or tissue stiffness (generally, 4 - 7 cycles).
• Mulligan: Brian Mulligan is most well known for mobilizations with movement (MWM). These techniques apply a force with the intent of causing a desired arthrokinematic motion , while actively or passively moving the joint through a desired osteokinematic range. Often the pressure intended to impart arthrokinematic motion is created with the help of a mobilization belt. Recommendations are to perform 6-10 repetitions, and only perform 1-set during initial sessions. Additional sets may be added in subsequent sessions if the initial intervention did not result in an exacerbation of symptoms and the range of motion (ROM) is still limited.
• McKenzie: The McKenzie method differs from the other protocols because the technique does not usually include a practitioner-applied force. The protocol for McKenzie techniques generally includes repeated osteokinematic motions up to the initiation of pain. Repetitions are continued until no further decrease in pain is gained, and/or a normal pain-free range of motion is restored.