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Joint Mobilization
860 Plays1 year ago
Miranda and Joyce discuss joint mobilization of the hand.
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Transcript
Introduction to Joint Mobilizations
00:00:06
Speaker
I'm Josh McDonald, and I'm a mandatory and we are hand therapy Academy. We're going to talk today about joint mobilizations and when we use them, what they look like, how they work, a bunch of that stuff. We're going to get into joint moves. Great.
When to Use Joint Mobilizations
00:00:20
Speaker
So I guess the first question is, what do you use joint mobilization for in your clinic? And are you doing most joints, some joints kind of tell me what, when you use them and when you don't.
Techniques for Stiff Joints
00:00:30
Speaker
I'll use them, I'd say sparingly. It's not a go-to for me, as much because it's just not what I kind of came up relying on a ton when I was learning from other therapists. But I do use it at times. I'll use it, for example, on stiff or immobile wrists. I feel like post-historase fracture, that kind of stuff.
00:00:51
Speaker
I'll use it on PIP joints, maybe MCP joints. Sometimes just a gentle distraction is enough to kind of relieve some tension on the joint. It can feel like a good release for that patient. Then they can feel like they can move a little bit better after without the pain. But I do want to make sure the patient is a good candidate for it. I want to make sure they're not hypersensitive to pain. Make sure that they are obviously fractures are healed and they're far enough out that there's no contraindications for it.
00:01:16
Speaker
And I want to make sure it's something that they would be comfortable with. And you kind of get that vibe from a patient like, hey, this is maybe a little bit more than they're prepared to handle. I want to make sure that they're ready for it and it's not something I'm jumping into too early.
Gentle Mobilization Techniques
00:01:31
Speaker
I think that's a good point. I think when we think of joint mobilization, we sometimes think it has to be this really aggressive thing that chiropractors do or more manual therapists, not that we're not manual therapists, but more people that consider themselves manual therapists do. I think there's a lot of gentle ones we can do like joint distraction. That is a joint mobilization technique and it usually feels good for patients. Just opening up that joint a little bit.
00:01:56
Speaker
Also, while doing the joint distraction and moving that over just a rate of fractures, you can actually improve range of motion, and that isn't necessarily more painful. I think most of the time it feels good for patients.
Grades of Joint Mobilization
00:02:09
Speaker
And so that kind of leads us into the different grades of joint mobilization. We'll get into the mechanics of it a little bit in a couple of minutes, but let's talk about the grades. I in general will hang out in the two, maybe three grade of joint mobilizations, but there's also value in some of the others as well. So you've got a grade one joint mobilization.
00:02:30
Speaker
which is like a small amplitude movement at the beginning of the available range of motion. So without any resistance, just kind of like moving back and forth gliding, volar or dorsal, depending within that early mid-range. A grade 2 is a larger amplitude, so I'm putting a little bit more force through
00:02:49
Speaker
throughout the middle of the range of motion. So I'm just traveling a greater amount throughout the slack of that joint's mobility. Grade three is still large amplitude, but it's performed from the middle to the limit. So now I'm bumping up against the edges of that patient's available mobility of that joint. Not really range of motion because it's not flexing or extending, but that joint has some slack to it. Grade three, I'm kind of bumping up against the boundaries of
Avoiding Aggressive Mobilizations
00:03:18
Speaker
that.
00:03:18
Speaker
Grade four is small amplitude performed at the end. So now I'm just hanging out at the end, bumping up against in a volor or dorsal glide with a small travel, but all at the end range. And then grade five is that
00:03:35
Speaker
small amplitude, but high velocity. That's more that like cracking the neck, cracking the back kind of thing that may help with the release on some body structures, but I'm real hesitant. I don't intentionally do that on patients. It's not something that is a goal of mine when I set out with a patient to do joint modes. I'm usually more in that maybe one to three. Sometimes I'm using a one just to relieve some pain and discomfort around the joint, but a two or a three to see if we can gain some range of motion as that patient's moving.
00:04:05
Speaker
And then, another thank you for sharing that with us.
Understanding Orthokinematics
00:04:08
Speaker
So once you know the degree that you're going to do is you need to understand that you need to conduct on concave or concave on convex. You have to know the orthokinematics to know what you hope to achieve from this joint mobilization. If you hope to achieve more range of motion, then you really need to understand the orthokinematics. This is for pain relief and you're probably just doing a little distraction.
00:04:31
Speaker
Yeah. So this goes back to our early years in anatomy, kinesiology stuff. It goes in the way back machine.
Movement Principles in Mobilization
00:04:39
Speaker
And so we'll talk a little bit about convex on concave and concave on convex. Whichever one we list first is the distal member of that articular service. So if I have, let's say, an MCP joint, I have a concave surface that's the distal end, excuse me, the proximal end of P1.
00:04:58
Speaker
and a convex metacarpal head. So it's concave on convex. That moves the way you would intuitively think. So if I want that MCP to flex more, I need to glide volarily the direction it would make sense for flexion.
00:05:14
Speaker
If it's the opposite kind of joint, if it's convex on concave like a wrist joint because the distal radius is concave and that first carpal row is convex, that goes the opposite direction. So if I want more wrist flexion, I need to glide dorsally.
00:05:33
Speaker
So that one's the counterintuitive for us is upper extremity specialists. The only ones that are common for us in that situation of wrist and a shoulder are probably the most common that we'll run into where we have to mobilize the other direction. Elbows can be a little bit different if you go to a mobilization course, you're doing things in different positions. So you kind of learn some different techniques with mobilizing those. But wrists and shoulders are really the primary ones that we're looking at as as
00:05:59
Speaker
convex on concave kind of opposite orientation so if you want to move inflection for a digit chances are you need to do a polar glide.
Addressing Rotation Stiffness
00:06:06
Speaker
Right and i would say that's almost a little different because it moves in multiple planes so it actually has it's a saddle joint so you can do it depends on which direction you're trying to achieve it has two planes of motion and then the PRUJ and DRUJ
00:06:20
Speaker
are a little different than the flexion and extension plate. Yeah, yeah. And that's a good point to mention. I will do that joint mobilization, some differential gliding to help with patients who have stiffness with rotation, sometimes just to help with that interosseous membrane that may be getting tight down the length of that, the axis of the forearm, but even just to make sure that's not also getting bound up as well.
00:06:43
Speaker
So you've got to know your orthokinematics. If you don't know, you need to know the convex on concave rule and then look at the joint. Which one is it? So like with the DRUJ, we know that the radius moves around the ulna. So you're going to be mobilizing the radius.
Flexibility in Techniques
00:07:00
Speaker
Yeah. And look, Miranda said earlier, if I'm helping with pain, if I'm helping with dysfunction within the joint, I may go volar and dorsal. And I don't feel like there's much downside if I'm trying to get reflection. I know I need to glide dorsally.
00:07:17
Speaker
but I don't feel like there's much downside to saying like, you know, I might also do some like grade three into a volar glide because it's gonna help with joint mobility. It's gonna help with pain relief. It's gonna help with some distraction and just getting ligamentous laxity in back into that joint. So there's a way I need to start with, but then it doesn't necessarily hurt to do some of those other directions as long as it's not contraindicated.
00:07:44
Speaker
Yeah. And then you'll learn like how to position your body. I know sometimes we'll use the foam. What's the blue foam? Blue foam wedge. Yeah. Yeah. You can wedge it and wedge different like towels and stuff like that to improve your body position and the patients as well.
00:08:02
Speaker
Yeah, I'll also a lot of times use Dyson or something like that on smaller digits. If I'm trying to get, let's say PIP joint mobilization, I'm gonna take a little square of Dyson and wrap it around P2 and stabilize P1. And that gives me a little bit more purchase on that finger. So I'm not sliding off the end of that fingers. I'm trying to do distraction. Maybe all I'm doing is distraction. It just gives me a little more purchase on that P2 to get that joint to distract a little bit better.
00:08:30
Speaker
Yeah, especially if you've been using lotion, it's sometimes hard to get enough traction on the small joints.
00:08:35
Speaker
Yeah, I'll have them go wash their hands, I'll have them come back, and some dice them, those kinds of things. Yeah, sometimes I grab paper towels, I think that works
CMC Joint Mobilization Precautions
00:08:42
Speaker
too. Yeah, yeah. And let's talk about that CMC joint, the first CMC joint for arthritis patients. I typically will avoid grade two and above. I might do some light distraction. That can be just enough to relieve some tension and help relieve some pain in that joint, but I'm not gonna do
00:09:02
Speaker
much more than a grade one on those patients, maybe even just distraction. It can kind of simulate the grind test, which in and of itself is uncomfortable. So yeah, I'm hesitant to do it if the patient has any history or indications of arthritis on that thumb joint.
00:09:16
Speaker
And usually that joint's pretty mobile because it is a saddle joint too. So you're not as likely to do it from a joint stiffness standpoint either. Yeah. Yeah. Yeah. Even if they have like a shoulder sign with some advanced CMC arthritis going on there, that's just going to encourage slippage, lack of stability. So I want to encourage the stability of that joint and doing joint modes is kind of the opposite direction we want to go on. Right.
Listener Feedback and Experiences
00:09:43
Speaker
Yeah.
00:09:44
Speaker
So do you let us know, is joint mobilization something you use in your practice a bunch? Is it something you, is a go-to for you early on with stiffness of joints? Or is it something you kind of like shy away from because you haven't maybe been to a good joint mobilization course? Those are kind of hard for us to find is efforts term specialists. So let us know what you think. Reach out to us at info at handtherapyacademy.com or on social media at hand therapy academy.