Joint Mobilisation

Joint mobilization is a skilled manual therapy treatment consisting of a continuum of skilled passive movement that is applied at varying speeds and amplitudes, that may include a small amplitude/ high velocity to joints, muscles, or nerves with the intent to improve or normalize joint function.

This treatment is usually pain-free and enhances movements like gliding, rolling, spinning, etc that take place between the bones after injury. As this technique is usually graded and is varied based on two factors: the pain tolerance of the patient and the severity of the patient’s condition. Joint mobilization is the application of graded forces to move a joint in the desired direction.

It takes place with the individual in a comfortable and relaxed position. As this allows the clinical physiotherapist to move the joint within the desired range.

Then, the therapist stabilizes one segment of a joint that is to be mobilized, and mobilization is applied at a slow speed, with or without oscillations or a stretch, by using the hands in the appropriate direction. Thus, the grades of joint mobilization range from Grades 1 – 5. While grades 1 – 4 are used to apply partial movement glides to the end range and Grade 5 is the same as manipulation.

Hence, the treatment progressed with the application of high-speed mobilizations to help in restoring joint play.

Thus, the amount and type of force applied to the joint vary, depending on the injury or musculoskeletal pain that is being treated. The joint mobilization technique can benefit many problems such as knee osteoarthritis, Low back and neck pain, tendonitis, joint stiffness, etc. This technique helps to improve range of motion and joint mobility and reduce pain, joint tightness, muscle spa, and muscle tension.

Hence, if you are feeling joint pain or stiffness your physiotherapist may decide that manipulation or mobilization are the best courses of treatment.

Myofascial Release

Myofascial release is a manual therapy technique that is a combination of gentle stretching and massage designed to release restrictions such as trigger points, muscle tightness, and dysfunctions in soft tissue that may cause pain and limit motion in all parts of the body.

The fascia is a structure of connective tissue have tough membranes that wrap, connect and support your muscles. This fascial tissue is relaxed and wavy and provides cushioning support so that movement is easy.

Injury, surgery, poor posture, or inflammation of tissues can create myofascial restrictions. Thus, the myofascial release technique helps to detect restrictions and can facilitate the release of the fascia. The palpation is a gold standard in identifying the presence of taut bands in muscle; it needs a precise knowledge of muscle anatomy, the direction of specific muscle fibers, and muscle function.

Thus, this involves the training and accurate skills of clinical physiotherapists to identify these taut bands. The physiotherapist will apply moderate traction and twisting techniques in combination with gentle stretching to achieve this. Each stretch and massage technique can last for several minutes and be performed several times until the muscle is completely relaxed. Myofascial release can benefit several conditions including muscle spasms, contractures, carpal tunnel syndrome, arthritis, whiplash, fibromyalgia, migraines, headaches, etc.

Trigger Point Release

A Trigger Point is a hyperirritable sensitive palpable nodule in the fascia, the connective tissue attached to your muscles that becomes painful when compressed.

It feels like knots or a taut band that is located just under the skin, and when pressing many people feel pain or discomfort. So, the direct compression or muscle contraction can elicit jump signs, local tenderness, local twitch response, and referred pain.

Two types of Trigger Points are Active and Passive Trigger Points. Active Trigger Point refers to spontaneous pain or pain in response to a movement mainly seen in another part of the body. Passive Trigger Point refers to a sensitive spot with pain or discomfort simply seen at its exact location.

The Trigger Point Therapy performed by your clinical physiotherapists will press and hold on top of these points this will temporarily cut off circulation to the tissue which increases a chemical called nitric oxide in the tissue.

As, nitric oxide signals your body to open up microcapillaries, thus bringing in more blood flow and breaking the pain-spasm-pain cycle. This process is repeated multiple times on the same trigger point and other trigger points until the therapist feels the tension is fully released.

Hence, this treatment uses pressure applied either manually or through dry-needling, physiotherapy, massage, heat, or a combination. It can even reduce headaches and other tension-related conditions.

Movement with Mobilization

Movement with Mobilization (MWM) is a joint mobilization technique developed by Brian Mulligan. This technique is also referred to as Mulligan Concept used for restricted limb movements that could be restricted due to spinal problems.

This technique is mostly used to treat: lateral elbow pain (tennis elbow), shoulder disorders, hip restrictions, as well as injuries that result in loss of range of motion of ankles, wrists, and knees.

The benefits of MWMs include: Reducing pain in the movement of limbs and Increased function and range of movement of limbs. Mulligan Concept techniques are referred to as NAGS (Natural Apophyseal Glide) and SNAGS (Sustained Natural Apophyseal Glide).

NAGS utilizes an oscillatory force in an attempt to increase the accessory motion of a joint. SNAGS is applied to take the joint through a full range of motion in a mechanically improved way such that mobility is maximized without producing pain.

Thus, the basic technique used by a clinical physiotherapist is to apply the corrective mobilization force to one of the joint partners while the joint is taken through the full range of motion and sustained with overpressure at the limit of the movement.

The technique is never performed in the presence of pain. Thus, it is considered appropriate only if there is an immediate pain-free increase in range of motion.