Joint mobilization is utilized on patients in which spinal manipulative therapy is not warranted, not appropriate or contra-indicated. Joint mobilization is the careful use of skillfully applied passive graded forces to move a joint in a desired direction. It is usually used to improve motion and normalize joint function. Mobilization can also be used to help control pain. Any joint that is lacking sufficient motion may be mobilized. It can be used on all regions of the spine and pelvis as well as all of the joints of the extremities such as the shoulder, wrist, hand, hip, knee, foot and ankle.
Spinal Manipulative Therapy
Manipulation is defined as a form of manual therapy, which involves movement of a joint past its usual end range of motion. This can be applied to any joint. The patient is first positioned in a way that the involved joint or joints can be isolated from the others. Then, the doctor uses his hands to apply a gentle force to the joint. This moves the joint surfaces, and usually results in a popping sound. To better understand why the “popping” sound occurs, an understanding of the structure of joints is important. A joint is made up of the surfaces of two bones that slide over or pivot around each other. These surfaces are lined with smooth cartilage and encased in an elastic tissue called the joint capsule. This capsule is filled with a fluid which lubricates and nourishes the cartilage. The fluid is pressurized and has gasses dissolved inside, similar to carbonated soda. During a manipulation, the joint capsule is stretched and some gas bubbles are released similar to the bubbles that are released when a soda bottle is opened. This is what causes the “popping” sound.
Many times, back and neck pain is the result of joints that are not moving properly. Imagine a door that only opens halfway because of a stuck hinge. You could still use it, but it is more troublesome than a door that opens fully.
What Benefits Are Derived From Joint Mobilization and Manipulation?
- Improved joint mobility
- Decreased muscle spasms & tension
- Decreased pain
Originally developed by a New Zealand physical therapist, the McKenzie Method is a comprehensive and logical step-by-step process to evaluate a patient’s problem quickly. This mechanical examination classifies patient conditions by the level of pain or limitation that results from certain movements or positions. Research has shown the initial McKenzie assessment procedures to be as reliable as costly diagnostic imaging (i.e., x-rays, MRIs) to determine the source of the problem and quickly identify responders and non-responders. It is an excellent diagnostic and treatment approach for disc injuries and pinched nerves and works by re-positioning the disc back to its proper position thus relieving pressure on an injured nerve. website
Flexion-distraction technique is a widely used treatment approach for treating symptomatic disc injuries, lumbar spine stenosis, degenerative disc disease and conditions of the spinal joints. Flexion-distraction involves the use of a specialized table that gently distracts or stretches the spine and allows the doctor to isolate the area of complaint while slightly flexing the spine. There is no pain involved in the treatment.
Cervical and Lumbar Traction
Therapeutic spinal traction uses mechanically created forces to stretch and mobilize the spine. In doing so it separates the spinal joints, widens the intervertebral foramen to relieve nerve root impingement and decreases intradiscal pressure. Recent evidence has found that therapeutic spinal traction is an effective treatment approach for cervical and lumbar pain originating from spinal joints, injured discs and pinched nerves or sciatica. A clinical prediction rule now exists that can determine who is most likely to respond to this form of therapy.
Soft Tissue Techniques
The Graston Technique is an innovative, patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restrictions. The Technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation. website
Myofascial Release Techniques
This umbrella term encompasses all forms of soft tissue mobilization. These include stretching techniques, massage therapy, and facilitation techniques. Also included is Trigger Point Therapy which is deep manual pressure applied to and held on sensitive pressure points within muscles. The desired therapeutic benefit is to re-establish proper muscle balances and decrease pain originating from a muscle origin.
These include both Ultrasound and Electrical Muscle Stimulation. Both modalities are used to improve tissue healing and speed recovery. Ultrasound emits sound waves that warm up the tissues and increase blood flow to the area of complaint whereas EMS decreases muscle “spasm” and helps to relieve pain.
Current literature recommends that all forms of manual care should include an active component. By engaging patients in exercises they are taking an active role in their recovery and preventing their condition from becoming chronic and disabling. Rehabilitative exercises that target condition specific areas will improve strength and endurance and decrease levels of pain. The prescribed program will also decrease the likelihood of recurrence and in the event of a future episode should limit the amount of time to recovery.
All patients are given recommendations on lifestyle modifications, ergonomic corrections and postural corrections. These factors have been shown to perpetuate most patients’ complaint and in some cases be the cause of their pain. The main goal of our practice is to empower the patient to achieve independence from care thus limiting their out of pocket expense.