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After completion of this chapter, the physical therapist should be able to do the following:

  • Differentiate between physiologic movements and accessory motions.

  • Discuss joint arthrokinematics.

  • Discuss how specific joint positions can enhance the effectiveness of the treatment technique.

  • Discuss the basic techniques of joint mobilization.

  • Identify Maitland’s five oscillation grades.

  • Discuss indications and contraindications for mobilization.

  • Discuss the use of various traction grades in treating pain and joint hypomobility.

  • Explain why traction and mobilization techniques should be used simultaneously.

  • Demonstrate specific techniques of mobilization and traction for various joints.

Following injury to a joint, there will almost always be some associated loss of motion. That loss of movement may be attributed to a number of pathologic factors, including contracture of inert connective tissue (eg, ligaments and joint capsule), resistance of the contractile tissue or the musculotendinous unit (eg, muscle, tendon, and fascia) to stretch, or some combination of the two.7,8 If left untreated, the joint will become hypomobile and will eventually begin to show signs of degeneration.30

Joint mobilization and traction are manual therapy techniques that are slow, passive movements of articulating surfaces.33 They are used to regain normal active joint range of motion, restore normal passive motions that occur about a joint, reposition or realign a joint, regain a normal distribution of forces and stresses about a joint, or reduce pain—all of which collectively improve joint function.25 Joint mobilization and traction are 2 extremely effective and widely used techniques in injury rehabilitation.3

Relationship Between Physiologic and Accessory Motions

For the therapist supervising a rehabilitation program, some understanding of the biomechanics of joint movement is essential. There are basically 2 types of movements that govern motion about a joint. Perhaps the better known of the 2 types of movements are the physiologic movements that result from either concentric or eccentric active muscle contractions that move a bone or a joint. This type of motion is referred to as osteokinematic motion. A bone can move about an axis of rotation, or a joint into flexion, extension, abduction, adduction, and rotation. The second type of motion is accessory motion. Accessory motions refer to the manner in which one articulating joint surface moves relative to another. Physiologic movement is voluntary, while accessory movements normally accompany physiologic movement.2 The 2 movements occur simultaneously. Although accessory movements cannot occur independently, they may be produced by some external force. Normal accessory component motions must occur for full-range physiologic movement to take place.11 If any of the accessory component motions are restricted, normal physiologic cardinal plane movements will not occur.23,24 A muscle cannot be fully rehabilitated if the joint is not free to move and vice versa.30

Traditionally in rehabilitation programs, we have tended to concentrate more on passive physiologic movements without paying much attention to accessory motions. ...

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