The document discusses principles of joint mobilization including using lower grades to reduce pain and higher grades to increase mobility. It outlines convex-concave rules for determining glide direction in different joints. Treatment glides are described to improve range of motion in various joints like the shoulder, knee, ankle and elbow. Open-packed positions and grades of movement are also defined. The goal of a joint mobilization treatment is to increase range of motion through appropriate gliding techniques.

1. Joint Mobilization Review Casey Christy, MA, ATC, CSCS

2. Principles Use Grades I and II to reduce pain. Use Grades III and IV to increase mobility. Begin and end all mobilization sessions with Grade I and II mobilizations to facilitate relaxation and to relieve pain. Initial mobilization techniques should be performed in the loose-packed position.

3. Principles Perform 2 to 3 oscillations per second for 20-60 seconds for joint tightness, 1-2 minutes for pain. Sustained joint mobilization techniques: 10 second hold for painful joints; 10-30 sec hold for joint tightness. Repeat 3-5 times. Understand the indications and contraindications of joint mobilization before implementing any techniques.

4. Convex-Concave Rule Fixed concave surface, moving convex surface Glide occurs in opposite direction Example: glenohumeral joint Fixed concave glenoidfossa, moving convex humeral head As the glenohumeral joint abducts, the humeral head glides inferiorly Mobilize humeral head in inferior direction to increase abduction ROM

5. Convex-Concave Rule Fixed convex surface, moving concave surface Glide occurs in same direction Example: tibiofemoral (knee) joint Fixed convex femoral condyles, moving concave tibialplateau As the knee extends the tibia glides anteriorly Mobilize tibia in anterior direction to increase extension ROM; posterior direction to increase flexion ROM

6. Convex-Concave Rule

7. Convex-Concave Rule Joints with fixed concave and moving convex surfaces: Glenohumeral Hip joint Talocrural (ankle) Subtalar (concave inferior talus, convex calcaneus) Radiocarpal Apply glide in opposite direction

8. Convex-Concave Rule Joints with fixed convex and moving concave surfaces: Knee (tibiofemoral joint) Elbow (humeral-radial joint, humeral-ulnar joint) MCP and IP joints of thefingers and toes Apply glide in same direction

9. Grades of Movement Grade I: Small amplitude movement performed at the beginning of the available ROM. Grade II: Large amplitude movement through the middle of the ROM. Grade III: Large amplitude movement performed from the middle to the limit of the ROM. Grade IV: Small amplitude movement performed at the end of the ROM. Grade V: Small amplitude, manipulative movement performed beyond the end range of motion. Manipulation requires advanced training and is not commonly used by athletic trainers.

10. Open-Packed Positions Subtalar joint: Neutral Talocrural joint: 10 degrees plantar flexion Knee: 25 degrees of flexion for tibiofemoral joint; full extension for patellofemoral joint Hip: 30 degrees hip flexion, 30 degrees hip abduction, slight external rotation

11. Open-Packed Positions Elbow joint: humeral–ulnar joint: elbow flexed 70 degrees, forearm supinated 10 degrees; humeral-radial joint: full extension, supination Shoulder joint: 55 degrees abduction, horizontally adducted 30 degrees, rotated so forearm is in horizontal plane Wrist: neutral for radiocarpal joint MCP and IP joints of the hand and fingers: slight flexion MCP joint of thumb: midway between flexion and extension; midway between abduction and adduction

12. Treatment Glides To improve glenohumeral flexion: apply posterior glide To improve glenohumeral extension: apply anterior glide To improve glenohumeral internal rotation: apply posterior glide To improve glenohumeral external rotation: apply anterior glide To improve glenohumeral abduction: apply inferior glide

13. Treatment Glides To improve tibiofemoral flexion: apply posterior glide To improvetibiofemoral extension: apply anterior glide Patellofemoral glides: apply superior glide to improve extension; inferior glide to improve flexion

14. Treatment Glides To improve ankle plantarflexion: apply anterior glide (talocrural joint) To improve ankle dorsiflexion: apply posterior glide (talocrural joint) To improve inversion: apply lateral glide (subtalar joint) To improveeversion: apply medial glide (subtalar joint)

15. Treatment Glides To improve wrist flexion: apply dorsal (posterior) glide To improve wrist extension: applyvolar (anterior) To improve radial deviation: apply medial glide To improveulnar deviation: apply lateral glide

16. Treatment Glides To improve elbow flexion: apply humeral-ulnar distal glide (scooping motion) To improve elbow extension: apply humeral-radial posterior glide

17. A Unique Joint Sterno-clavicular Joint The proximal articulating surface of the clavicle is convex superiorly/inferiorly; concave anteriorly/posteriorly Mobilize clavicle inferiorly to improve abduction ROM Mobilize clavicle posteriorly to improve retraction ROM

18. Reference Kisner and Colby. Therapeutic Exercise: Foundations and Techniques, 4th ed.