Spinal joint mobilization

 Stretch-traction mobilization(Grade III)

 Grade Ill traction mobilization in the (actual)
resting position
 Grade III traction mobilization at the point of
restriction
 Stretch-glide mobilization (Grade III)
 Manipulation
 Manipulation education
 If traction treatment exacerbates symptoms
 Avoiding high-risk manual treatment
 Joint compression
 A series of sustained grade III stretch-traction
…initial treatment
 At a right angle to the treatment plane.
 Treatment plane depends on the orientation
of the caudal surface of the cranial vertebra in
the disc joint.
 In stretch traction techniques where the
caudal vertebra is stabilized ,the spacial
orientation of the treatment plane changes
with the positioning of cranial vertebra.
 If cranial vertebra is stabilized the traction
force is applied to the caudal vertebra in a
segment, the spacial orientation of the
treatment plane does not change.
 Reason???
 As a trial treatment, apply about ten stretch
traction mobilizations.
 Improvement…continue and progress toward
the true resting position.
 Next Progress the stretch-traction
mobilization in non-resting positions.
 Joint pre-positioned near the limit of range in
the restricted movement direction…pre-
position in multiple directions…like?
 Often successful
 Sometimes, for the last degrees of
restriction, stretch-glide mobilization.
 Same direction as the restriction,
 Directly stretch the tissues restricting joint
movement.
 Progress to grade III stretch-glide
mobilizations when stretch-traction
mobilization no longer produces adequate
mobility gains or to re-position a positional
fault.
 Glide-mobilizations produce some intra-
articular compression, more in stiffer joints…
 Grade I traction movement.
 Advanced degenerative changes /painful on
compression…additional traction force or less
gliding force.
 Joint compression produces nerve root
symptoms…stretch glide mobilization is
contraindicated.
 Apply vertebral stretch-glide mobilizations parallel to
the treatment plane
 Orientation of the cranial vertebra
 Perform in direction of restriction.
 In class I hypomobility… produce joint compression
and be too painful.
 In this case, return to grade iii stretch-traction
mobilizations carefully applied in less restricted and
less symptomatic positions.
 Improvement to slight hypomobility (class 2),
progress again to specific grade iii stretch-glide
mobilization in the most restricted gliding direction .
 Carries risk of serious injury.
Manipulation technique
 Translatoric linear thrust techniques are safer and
technically more difficult than rotatory thrusts.
 After stretch-mobilization "screening test," the
stretch is released into the grade ii range then taking
up the slack and tightening the tissues through the
transition zone into the grade iii range
 Immediately applying the low-force thrust at the
point of the actual pathological stop.
 Not successful….Return to relaxation or stretch
mobilizations until the joint state is amenable to a low
force manipulation.
 Gentle spinal traction-thrusts ("quick
mobilizations") in the actual resting position
are safe to perform
 Useful as screening tests and to differentiate
a temporarily hypomobile "locked" joint from
a permanently hypermobile joint.
 Rare
Adjust joint positioning.
 Continuously adjusting three dimensional positioning
Alter traction force.
 Early in the healing process …only minimal forces .
correct an underlying positional fault.
 A positional fault can occur in both hypomobile and
hypermobile joints.
 Minor positional faults ….Grade ii traction
mobilization
 Strongly fixated positional faults … grade III stretch
glide-mobilization or manipulation.
Discontinue traction treatment.
 In some cases, like acute soft tissue lesions
…traction treatment plus any form of stretch
contraindicated.
 Treatment is postponed until some healing
occurs.
 Contraindicated …where symptoms are
produced in an adjacent hypermobile joint
which cannot be adequately locked during
treatment.
 Rotation mobilization
 General spinal rotation mobilization is one of the
most potentially dangerous techniques for the
patient.
 Not indicated = disc involvement, vertebral
artery involvement, or irritation of nerve
structures.
 Techniques producing a lesser vertebral rotation
can produce damaging compression forces .
 Use a grade iii stretch-traction mobilization with
specific three-dimensional positioning to
increase rotation.
 Can aggravate a joint condition.
 Techniques producing indirect compression
should be used with caution, especially when
compression tests are symptomatic.
 Although , passive manual joint compression
can stimulate cartilage nutrition and
regeneration, it is not recommended.
 Critical to the maintenance of articular
cartilage is its fluid supply of nutrients by
diffusion.
 This fluid nutrient transfer is facilitated by
changes in joint loading creating pressure
changes.
 Compression may be useful for pressure
changes.
 Same benefit by joint traction.
 Normal Rolling, gliding, and compression are
stresses necessary for the maintenance of
articular cartilage.
 imbalance of rolling, gliding and
compression… effects of wear and tear,
marking the onset of degenerative joint
disease (DJD).
 Too much or less stress also lead to
degenerative joint disease.
 If joint compression occurs during a patient's
treatment program, the amount of load-bearing
is increased gradually and monitored closely to
avoid pain.
 lower extremity joints. .. begins with toe-touch
weight bearing using two crutches and
progresses to one crutch, then a cane, and
eventually full weight-bearing.
 graduated compression therapy
 Premature load-bearing can lead to joint
swelling and additional injury
 Many daily activities produce joint
compression
 Sidelying …compression through the
shoulder girdle, in the cervical and upper
thoracic spine, and in the hip joint.
 Management …position pillows under the
thorax and neck
 Also avoid additional joint compression during
manual treatment.
 Gliding techniques have a compression
effect, especially at the end range of motion.
 If a glide-mobilization technique is painful,
increase its traction componet.
 If still painful…discontinue.