Chapter 3

MOBILIZATION

MOBILIZATION GRADES: The amplitude or grade of mobilization is defined as the distance a joint is passively moved into its total range {19}


Grade I:

I. small amplitude oscillations at the beginning of the range {19}
ADMINISTERED WHEN: {19}

1. pain exists at rest or increases early in the ROM
2. movement produces spasm early in the ROM (pain is less dominant)
3. early ROM is limited by both pain and spasm
SUGGESTION: Reduce the speed or amplitude if muscle spasm occurs in response to the technique. {19}


Grade II:

II. large amplitude oscillations within the ROM, but short of resistance {19}
ADMINISTERED WHEN: {19}

1. spasms occur with quick oscillations sooner than they occur with slow oscillations (spasms will limit ROM)
2. ROM is limited halfway into the range by pain which intensifies slowly

Grade III:

III. large amplitude oscillations from mid-to end of restricted ROM {19}

ADMINISTERED WHEN: {19}

motion is limited near end range by pain and resistance

Grade IV:
IV. large amplitude oscillations at end range

ADMINISTERED WHEN: {19}

ROM is limited by resistance in the absence of pain and spasm

Grade V:

V. quick thrust at the pathological limitation {19}
ADMINISTERED WHEN: {19}

minimal resistance limits the end ROM

** CAUTION: must be skilled in technique to administer {19}
SUGGESTION: Most therapists can achieve the same results with lesser grades of mobilization with longer duration. {19}

General information regarding mobilization:

1. non—contractile tissue stretching {17}
2. should be light load, long duration (light, repetitive force) {17, 19}
3. don’t have good data on time, but should be at least 10 minutes to achieve adequate stretch {17}
4. if symptoms increase with technique, try a lesser grade {19}
5. will need to reevaluate if pain persists when appropriate adjustments have been made to the technique {19}

Contraindications:

1. disease of the spinal cord or cauda equina {19, 22}
2. vertebral artery occlusion {17, 19}
3. spondylolisthesis (at that level) {19}
4. osteoporosis {19, 22}
5. ankylosing spondylitis and rheumatoid arthritis {19}
6. pain arising from nerve root compression unless accompanied by an unrelated mechanical derangement {19}
7. continuous pain unrelated to posture or activity and not relieved by rest. This is uncharacteristic of musculoskeletal disorders. {19, 22}
8. history of malignancy (rule out skeletal metastasis) {19, 22}
9. intense pain which requires morphine {19}
10. fever, weight loss, malaise, general weakness caused by disease or inflammatory process {19}
11. suspect of malingering or conversion reaction {22}
12. pregnancy {22} (SI may be acceptable with proper precautions)
13. ligament laxity {19} (lower grades may be acceptable)

  Next: Chapter 4