Most commonly used manual therapy technique.
Manipulation and mobilisation are on a continuum.
Passive movement of a joint can be:
1) Physiological – the joint is moved by an outside force though its range of motion; a movement that people can perform and control voluntarily.
2) Accessory – movement between articular surfaces that can not be produced actively – such as ‘glide’, ‘roll’ and ‘spin’; cannot be voluntarily controlled or performed. Two types that are necessary for normal motion:
a) Joint play
Aim is to restore full movement to a stiff and/or painful joint if the range of motion is restricted due to non-contractile structures. May be aiming to restore a restriction in physiological (movements performed by patient; eg first MPJ dorsiflexion/plantarflexion) or accessory movements (can not be performed voluntarily by patient; eg first MPJ glide).
Capsular patterns of motions:
All joints have expected, normal ranges of motion.
When loss of motion is due to tightness in joint capsule, specific characteristic changes are seen called capsular pattern.
Ankle joint – plantarflexion is more limited than dorsiflexion
Subtalar joint – inversion is more limited than eversion and foot becomes fixed in a pronated position
Midtarsal joints- limitation of adduction and inversion with forefoot becoming fixed in an abducted and everted position
First metatarsophalangeal joint – extension is more limited than flexion
2nd to 5th metatarsophalangeal joints – variable
Interphalangeal joints – joints in flexed position.
Capsular pattern indicates that mobilisation should be part of treatment program. A non-capsular pattern suggests that structures other than the joint capsule is involved mobilisation may not increase range of motion.
Grades of mobilisation:
Grade 1: Small amplitude movement performed at the beginning of the range
Grade 2: Large amplitude movement performed within the free range but not moving into any resistance or stiffness
Grade 3: Large amplitude movement performed up to the limit of the range
Grade 4: Small amplitude movement performed at the limit of the range
Grade 5: High velocity thrust of small amplitude at end of range of motion (manipulation)
Local infections or malignancy; fractures