Joint Mobility is Essential
Improving joint mobility is critical if you are going to address the body's full kinetic chain. In fact, we are greatly reducing the effectiveness of any myofascial technique if we don’t address restrictions in joint mobility.
Joint mobilization, or manipulation, is powerful! Its effects can be divided into two primary categories mechanical, and neurophysiological. Although each of these subjects could fill several textbooks, we will try and mention just a few key points in this discussion.
Mechanical Considerations Behind Joint Mobility
Our capacity to produce an unlimited variety of movements requires good joint integrity. As practitioners, it is important for us to understand the complex interrelationships between the structure and function of multiple joints. No joint ever works in isolation. For example, the stability of shoulder is often affected by the joints of the cervical and thoracic spine, and even by the upper extremity joints of the elbow and wrist. An injury in one joint often creates compensations in both adjacent and distant joints.
The same fascia that infuses our muscles, ligaments, tendons, osseous structures, neurological, and cardiovascular structures also connects directly into the joint capsules. Our fascia is the ultimate physical manifestation of a kinetic chain.
Research has shown us that when joints become immobile, as in injury or osteoarthritis, then they become subject to several physiological changes.
This includes a decrease in fluid content, which in turn can cause a decrease in the joint-fiber distance within the capsule surrounding the joint.
This in turn causes the development of increased cross-fiber linkages, which can then cause adhesion formation in the synovial folds of the joints. These adhesions cause a decrease in the strength of collagenous tissue, which can then cascade into tissue failure, even with diminished tissue loading. (1, 2)
Effects of Joint Mobilization/Manipulation
The objective of joint mobilization is to reverse these physiological changes by promoting movement between capsular fibers.
Research has shown that joint mobilization can gradually cause rearrangement of collagen tissue to increase mobility.
In addition joint manipulation can break adhesions within the joint capsule and help to increase the length of capsular fibers. (3)
Though the best evidence to support this has focused on the short-term effects of joint mobilization, clinically we have found that it is possible to retain these changes over the long-term, by combining mobility exercises with strengthening routines.
Keep in mind that the joint capsule is not the only structure that is positively affected by joint mobilization. Other peri-articular tissues, such as ligaments, tendons, muscles, and fascia, also improve in function when joint mobilization techniques are used.
Research has shown that mobilization and manipulative techniques result in a number of beneficial neurological effects. One of the most positive effects is a reduction of pain.
Research has shown that after joint manipulation, there is an increase in what is called the pain-pressure threshold (the minimum force applied which induces pain). (4) This could be due to changes in b-endorphin and serotonin levels, an alteration in alpha motor neuron activity, or to changes in the autonomic nervous system (ANS) responses. The reality is that there is no definitive consensus between researchers.
What we do know is that the pain experienced by the patient is greatly reduced after joint manipulation. (5) Seeing a reduction in the patient's pain should not be taken lightly. Pain reduction can give patients an opportunity to:
Normalize their movement patterns
Perform their prescribed exercises
Increase their level of functional activities of daily-living.
All of which promotes long-term functional and physiological changes. (6)
There is also good evidence that mobilization/manipulation of joints produces changes in muscle activity. Some of these changes include an increased ability for force generation by the muscle, and a decrease in muscle hyper-tonicity. This is seen for both for spinal musculature during spinal manipulation in the extremities during extremity manipulation. (7, 8)
Integrating Joint Manipulation into Soft Tissue Protocols
The majority of musculoskeletal problems do not just involve one type of structure; this is especially true when dealing with chronic conditions. By considering joint function to be part of a myofascial kinetic chain, you will find that your success rate with patients improves exponentially.
It is also important not to limit yourself to just those joints that are adjacent to the area of chief complaint. For example, hip, knee, ankle and even shoulder function can often be part of a single kinetic chain. Which means it is important to address joint function throughout this entire chain.
DR. BRIAN ABELSON DC.
Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.
Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publications which will be available later this year.
Make an appointment with our incredible team at Kinetic Health in NW Calgary. Just scan the QR code with your phones camera and click the link, or call Kinetic Health at 403-241-3772 to make an appointment today!
Akeson WH, Amiel D, Abel JF, et al. (1987). Effects of immobilization on joints. , 219, pp. 28-37.
Woo SL, Matthews JV, Akeson WH, et al. (1975). Connective tissue response to immobility: correlative study of biomechanical and biochemical measurements of normal and immobilized rabbit knees. , 18(3), pp. 257-264.
Snodgrass SJ, Haskins R, Rivett DA. A structured review of spinal stiffness as a kinesiological outcome of manipulation: its measurement and utility in diagnosis, prognosis and treatment decision-making. J Electromyogr Kinesiol. 2012;22: 708– 723.
Coronado RA, Gay CW, Bialosky JE, et al. (2012). Changes in pain sensitivity following spinal manipulation: a systematic review and meta-analysis. , 22(5), pp. 752-767.
Degenhardt BF, Darmani NA, Johnson JC, et al. (2007). Role of osteopathic manipulative treatment in altering pain biomarkers: a pilot study. , 107(9), pp. 387-400.
Perry J, and Green A. (2008). An investigation into the effects of a unilaterally applied lumbar mobilisation technique on peripheral sympathetic nervous system activity in the lower limbs. , 13(6), pp. 492-499.
Cleland JA, Selleck B, Stowell T, et al. (2004). Short-term effects of thoracic manipulation on lower trapezius muscle strength. , 12, pp. 82-90.
Szlezak AM, Georgilopoulos P, Bullock-Saxton JE, and Steele MC. (2011). The immediate effect of unilateral lumbar Z-joint mobilization on posterior chain neurodynamics: a randomized controlled study. , 16(6), pp. 609-613.
Linnamo V, Moritani T, Nicol C, et al: Motor unit activation patterns during isometric, concentric and eccentric actions at different force levels. J Electromyogr Kinesiol 13:93, 2003.