Joint Mobilization

Peripheral joint mobilizations are manual techniques which use physiological motions or accessory joint motions to increase ROM, decrease pain, and facilitate neuromuscular re-education.

High velocity thrust manipulations (Grade V) are outside of the PTA scope of practice.

PTAs instruct patients in self-mobilization techniques to increase accessory joint motion, particularly in the shoulder region. PTAs also apply knowledge of postural factors on arthokinematics in order to progress toward return to function. PTAs may observe subluxations or other positional faults which may be impacting progress and, therefore, require further assessment from the PT.

Contraindications and precautions for joint mobilization are closely aligned with those for stretching.

The PT will select a joint mobilization technique based on the tissue healing stage and patient pain levels. Lower grades of joint mobilization are indicated for acute pain modulation and fluid mechanics in a joint and are performed in the available range without resistance. Higher grades of joint mobilization are indicated when it is safe to mobilize into and through tissue resistance.

PTAs should be able to describe and understand the grades of joint mobilization in order to safely progress mobility with therapeutic exercise and functional activities. PTAs should document response to the previous treatment(s), so the PT may use the data for clinical decision making regarding modifications or progressions to joint mobilization techniques.

Peripheral joint mobilization is described in detail in Chapter 6, Dutton. Key points are summarized in the Joint Mobilization Take Home Points handout (see sidebar on this page).