Joint Mobilisations: How They Work, Benefits, and Indications

How do joint mobilisations work?

Joint mobilisations are manual therapy techniques that apply specific, controlled movements to a joint to improve its range of motion, reduce pain, and restore optimal joint mechanics by influencing both mechanical and neurophysiological processes.

Understanding Joint Mobilisation

Joint mobilisation is a skilled, passive movement technique applied to a joint by a trained practitioner, typically a physical therapist, chiropractor, or osteopath. Unlike joint manipulation (often characterized by a high-velocity, low-amplitude thrust accompanied by a "pop"), mobilisations involve slower, oscillatory, or sustained movements performed within or at the physiological end-range of a joint's motion. The primary goal is to restore normal joint play, reduce pain, and improve the overall function of the musculoskeletal system.

The Anatomy and Physiology of a Joint

To understand how mobilisations work, it's crucial to grasp the basic anatomy and physiology of a synovial joint. A typical synovial joint, such as the knee or shoulder, consists of:

• Articular Cartilage: Smooth, resilient tissue covering the ends of bones, reducing friction and absorbing shock.
• Synovial Membrane: Lines the joint capsule, producing synovial fluid.
• Synovial Fluid: A viscous fluid that lubricates the joint, nourishes the cartilage, and distributes load.
• Joint Capsule: A fibrous sac enclosing the joint, providing stability and containing the synovial fluid.
• Ligaments: Strong, fibrous bands that connect bones, providing passive stability and guiding joint motion.
• Muscles and Tendons: Provide active movement and dynamic stability around the joint.
• Nerve Endings: Receptors within the joint capsule, ligaments, and surrounding tissues detect movement, position, and pain.

When a joint becomes dysfunctional due to injury, inflammation, or prolonged immobility, these components can be negatively affected, leading to stiffness, pain, and restricted movement. The joint capsule can tighten, adhesions may form, and the normal gliding and rolling motions between joint surfaces (arthrokinematics) can be impaired.

Mechanisms of Action: How Mobilisations Exert Their Effects

Joint mobilisations work through a combination of mechanical, neurophysiological, and even psychological effects:

Mechanical Effects

These effects directly influence the physical structures of the joint:

• Restoring Arthrokinematics: Joints move not just by bones rotating (osteokinematics), but also by subtle accessory movements like gliding, rolling, and spinning between articular surfaces. Dysfunction often impairs these accessory movements. Mobilisations specifically target these restricted glides and rolls, helping to restore normal mechanics and improve the overall range of motion.
• Stretching Joint Capsule and Ligaments: When a joint is stiff, the surrounding capsule and ligaments can become tight or shortened. Mobilisations apply sustained or oscillatory stretch to these periarticular tissues, elongating them and increasing their extensibility, thereby improving the joint's available range of motion.
• Breaking Adhesions: Prolonged immobility or injury can lead to the formation of fibrous adhesions within the joint capsule or between fascial layers. The controlled forces of mobilisation can help to gently break down these adhesions, allowing for smoother, unrestricted movement.
• Improving Synovial Fluid Dynamics: Movement is essential for the distribution of synovial fluid, which nourishes the articular cartilage and lubricates the joint. Mobilisations encourage fluid movement within the joint, enhancing nutrient exchange and waste removal, which is vital for cartilage health.

Neurophysiological Effects

These effects relate to the influence of mobilisations on the nervous system, particularly in pain modulation and muscle tone:

• Pain Modulation (Gate Control Theory): The mechanical stimulation of joint mobilisations activates mechanoreceptors (nerve endings sensitive to pressure and stretch) located within the joint capsule and surrounding tissues. The signals from these mechanoreceptors travel faster than pain signals (nociceptive input) and can effectively "close the gate" on pain transmission at the spinal cord level, thereby reducing the perception of pain.
• Muscle Relaxation/Spasm Reduction: By stimulating mechanoreceptors, mobilisations can reflexively inhibit muscle spasm and hyperactivity around the joint. This reduces guarding and allows for greater movement and less pain.
• Altering Central Nervous System Processing: Through repeated, positive movement experiences, mobilisations can help to "re-educate" the nervous system, reducing central sensitization (where the nervous system becomes over-reactive to pain) and improving motor control and body awareness.

Psychological Effects

While not directly related to the physical or neurological mechanisms, the psychological impact of manual therapy can be significant:

• Placebo Effect: Patient expectation and belief in the treatment's effectiveness can contribute to positive outcomes.
• Therapeutic Alliance: The hands-on nature of the treatment and the positive interaction with a skilled practitioner can build trust and confidence, which can reduce anxiety and improve pain tolerance.

When Are Joint Mobilisations Indicated?

Joint mobilisations are typically indicated for conditions characterized by:

• Hypomobility: Restricted range of motion in a specific joint.
• Pain with Movement: Especially when the pain is associated with joint stiffness or dysfunction.
• Post-Immobilization Stiffness: After a period of casting or bracing.
• Certain Musculoskeletal Conditions: Such as adhesive capsulitis (frozen shoulder), specific spinal dysfunctions, or osteoarthritis where joint motion is limited.

Who Performs Joint Mobilisations?

Joint mobilisations are advanced techniques that require extensive training in anatomy, biomechanics, and clinical reasoning. They are primarily performed by:

• Licensed Physical Therapists (Physiotherapists): A core component of their manual therapy skill set.
• Chiropractors: Often utilize mobilisations alongside manipulations.
• Osteopaths: Integral to their holistic approach to musculoskeletal care.
• Certified Manual Therapists: Professionals with specialized postgraduate training in manual therapy techniques.

It is crucial to seek a qualified and licensed professional for joint mobilisations to ensure proper assessment, technique, and safety.

Important Considerations and Limitations

While highly effective, joint mobilisations are rarely a standalone treatment. They are typically integrated into a comprehensive rehabilitation program that includes:

• Therapeutic Exercise: To strengthen surrounding muscles, improve stability, and maintain the newly gained range of motion.
• Patient Education: Understanding the condition and self-management strategies.
• Postural Correction: Addressing contributing factors to joint dysfunction.

Contraindications: Joint mobilisations are not appropriate for everyone. Absolute contraindications include acute fractures, joint instability, active inflammation or infection in the joint, malignancy, and certain neurological conditions. A thorough assessment by a qualified practitioner is always necessary to determine appropriateness and safety.