References

- Tokey Hill
- Spinal Manipulation Techniques
- Myofascial Release
- Massage Therapy
- Spinal, visceral and extremity mobilizations
- Postural training
- Muscle energy
- Strain/Counterstrain
- Traditional modalities
- Ultra-sound
- Ionto-phoresis
- Phonophoresis
- Manual stretching and conditioning
- PNF patterns
- Isotonics
- Isometrics
- Isokinetic exercise
- Plyometrics
- Systemic conditions
- Lyme disease
- Myofascial Syndrome
- Sympathetic Dystrophy Syndrome
- TMJ dysfunction
- CABG
- Dementia
- Alzheimerís disease
- Diabetes
- Celebrities

Spinal, Visceral and extremity mobilizations

Treatment goals of mobilization:
∑ Reduce Pain- Stimulates joint receptors
∑ Improve mobility/arthrokinematics
∑ Decrease muscle guarding
∑ Stretching and lengthening contractile and non-contractile tissues around joint
∑ Inhibit muscle tone or stretch reflex
∑ Improve joint proprioception and postural kinesthetic awareness

Maitlandís 5 Grades
Grade I
∑ Small amplitude movement at the beginning range of joint play
∑ Used when pain and spasm limit movements early in ROM
Grade II
∑ Large amplitude movement at the midrange of joint play
∑ Used for pain control, spasm reduction which inhibit movement
Grade III
∑ Large amplitude movement at the end-range of joint play
∑ Reduce pain, increase periarticular extensibility, correct positional faults, and release meniscoid tissue in the spine
Grade IV
∑ Small amplitude movement at the end-range of joint play
∑ Reduce pain, increase periarticular extensibility, correct positional faults, and release meniscoid tissue in the spine
Grade V
∑ Manipulation of high velocity and low amplitude to the anatomical end point of a joint

Oscillations - Joint Mobilization
∑ Performed at a rate of 2-3/sec for 1 min (Edmond)
∑ Stone suggested to perform 20-100 mobs in 2-5 sets
∑ Quillen and Gieck recommended mobs for 20-60 sec and repeated up to 4-5 times
∑ Prentice advocated a series of 3-6 sets lasting 20-60 sec each at a rate of 1-3/sec
∑ Gould suggested mobilization for 20-60 sec and repeated 4-5 times
∑ General- 3 sets of 30 sec to 1 min (2-3 oscillations /sec)
∑ Traction techniques are held for 10 seconds
∑ Treat with oscillations/traction for several minutes and re-assess

Joint mobilization/manipulation corrects arthrokinematic restrictions

PROM/stretching corrects osteokinematic restrictions

Items to Remember:
∑ Apply traction/distraction with joint mobilizations
∑ Treatment determined by end feel, Overpressure is a gentle passive motion at the end of active range of motion, and is used to assess end feel
∑ Muscle tendinous unit limitation is addressed with flexibility
∑ Establish a comparable sign / asterisk sign
∑ Most apply joint mobilizations with too much force
∑ Mobilization increases pain, apply the technique the opposite direction or decrease grade
∑ Joint mobilization is a passive movement with no active muscle tone
∑ Mobilization can confirm diagnosis

Visceral Mobilization
Restore the mobility to internal movement of organs with breathing there is a dropping down and a forward movement to abdominal organs decreases show a impairment to organ functionality.