Joint Mobilization

Replies to This Discussion

Permalink Reply by Joseph E. Muscolino on December 22, 2009 at 11:45pm

I will leave your question for the group to reply to.

Regarding your question about the thoracic joint mobilization, yes, rotation is definitely a component.

Permalink Reply by Robert Downes on December 27, 2009 at 3:52pm

Here's the Lumbar Facet/Gait answer.

Here is the Lumbar Facet Biomechanics in gait (right lead leg) as it was described to me by my friend Dr. Dave Tiberio. As the right leg comes forward we have anterior pelvic tilt. The trunk doesn't tilt forward as much as the pelvis therefore we have relative lumbar extension. This gives Lumbar Extension therefore this gives Lumbar facet compression in the sagittal plane. When the right leg goes forward I get a right pelvic elevation and a left pelvic depression which gives a right lateral side bending. This compresses my right lumbar facet in the frontal plane on my right side. When my right leg comes forward I will rotate my pelvis to the left. Because my pelvis is rotating to the left faster than my lumbar spine - I get lumbar spine rotation to the right. This will unload my lumbar facet in the transverse plane

The above would be an example of Type II (same direction of the frontal and transverse planes) spinal motion.

I am going to re-read the Cervical Spine Mobilization Article to make sure I understand it. I will then give a description of Applied Functional Science (including Functional Manual Reaction - FMR). I think that Joe's Mobilizations can be used in conjuction with FMR and/or while doing FMR.

Thanks Joe!

Permalink Reply by Robert Downes on December 27, 2009 at 6:11pm

Hi Rick, you can check out www.grayinstitute.com

You can also check out the Gray Institute Functional Video Digests on FMR.

Permalink Reply by Robert Downes on December 28, 2009 at 10:19am

Here is another "quiz" question from Applied Functional Science (www.grayinstitute.com). There are 2196 ways a joint can move. How did Gary Gray come up with this number?

Hint: you have to understand Real and Relative bone movement.

Permalink Reply by Joseph E. Muscolino on December 28, 2009 at 12:05pm

Hey Bob,

First, I love the analytical reasoning involved with this. This is the exact kind of critical thinking and reasoning that I believe helps someone be an excellent clinical therapist!
My preface is that I do not have that much expertise on the gait cycle. I do not necessarily agree or necessarily disagree with what is said here. I do have some concerns/doubts though on some of the assumptions.
My first question/doubt is whether there really is anterior tilt of the pelvis when the thigh moves forward into flexion. Yes, the muscles that flex the thigh at the hip joint also pull on the pelvis toward anterior tilt at the hip joint. But that does not necessarily mean that the pelvis will be moved into anterior tilt. I do not think that it does. My take is that in a healthy functioning individual, the pelvis would be stabilized and not allowed to actually move into anterior tilt at the hip joint. In fact, pelvis posterior tilt often accompanies flexion of the thigh because it furthers the forward movement/reach of the foot.
My second question/doubt is whether we do get elevation of the right side of the pelvis when the right thigh swings forward into flexion. There are many people who, if anything, due to a weak gluteus medius (and other pelvic depressors on the other "support-stance side") actually end up with with pelvic depression on the swing side. So, do we definitely get pelvis elevation on the swing leg side???
Regarding the transverse plane pelvic rotation, I definitely see that one much more.

So, I do not in any way disagree with the effects upon the spine if these pelvic motions occur. I just question the underlying assumptions that they do in fact occur.

I invite and look forward to discussion on this topic!

Robert Downes said:

Here's the Lumbar Facet/Gait answer.

Here is the Lumbar Facet Biomechanics in gait (right lead leg) as it was described to me by my friend Dr. Dave Tiberio. As the right leg comes forward we have anterior pelvic tilt. The trunk doesn't tilt forward as much as the pelvis therefore we have relative lumbar extension. This gives Lumbar Extension therefore this gives Lumbar facet compression in the sagittal plane. When the right leg goes forward I get a right pelvic elevation and a left pelvic depression which gives a right lateral side bending. This compresses my right lumbar facet in the frontal plane on my right side. When my right leg comes forward I will rotate my pelvis to the left. Because my pelvis is rotating to the left faster than my lumbar spine - I get lumbar spine rotation to the right. This will unload my lumbar facet in the transverse plane

The above would be an example of Type II (same direction of the frontal and transverse planes) spinal motion.

I am going to re-read the Cervical Spine Mobilization Article to make sure I understand it. I will then give a description of Applied Functional Science (including Functional Manual Reaction - FMR). I think that Joe's Mobilizations can be used in conjuction with FMR and/or while doing FMR.

Thanks Joe!

Permalink Reply by Robert Downes on December 29, 2009 at 1:34pm

Hi Joe, We were both correct about the Sagittal plane Anterior/Posterior Tilt. I checked with Dr. Donald Neumann and he said that you get posterior pelvic tilt first then you get anterior pelvic tilt next. So to state it correctly it would be that in the front leg load in gait when the pelvis tilts anteriorly the lumbar spine is going through relative lumbar extension. This lumbar extension will compress the lumbar facets in the Sagittal plane.

Neumann does have pelvic elevation on the right side in the right lead leg in gait.

I think the confusion came up when Dr. Dave said "As the right leg comes forward." I am used to Dr. Dave's way of speaking so I understood him to mean that the right leg was the lead leg that had already contacted the ground (not the swing leg).

To reiterate, during the right lead leg load in gait, you get compression of the lumbar facet in the Sagittal plane, compression of the right side lumbar facet in the Frontal plane and distraction of the right side lumbar facet in the Transverse plane.

Thanks, Bob D

Permalink Reply by Joseph E. Muscolino on December 29, 2009 at 2:57pm

Hi Bob,

As we say, terminology, terminology, terminology! Perhaps it would be best to stick with the standard terms for the landmarks of gait: swing and support limb, and then heel strike, midstance, toe-off, etc.

Thanks for clearing this up. I have the highest respect for Don Neumann. I have taken his workshops at Marquette three times.



Robert Downes said:

Hi Joe, We were both correct about the Sagittal plane Anterior/Posterior Tilt. I checked with Dr. Donald Neumann and he said that you get posterior pelvic tilt first then you get anterior pelvic tilt next. So to state it correctly it would be that in the front leg load in gait when the pelvis tilts anteriorly the lumbar spine is going through relative lumbar extension. This lumbar extension will compress the lumbar facets in the Sagittal plane.

Neumann does have pelvic elevation on the right side in the right lead leg in gait.

I think the confusion came up when Dr. Dave said "As the right leg comes forward." I am used to Dr. Dave's way of speaking so I understood him to mean that the right leg was the lead leg that had already contacted the ground (not the swing leg).

To reiterate, during the right lead leg load in gait, you get compression of the lumbar facet in the Sagittal plane, compression of the right side lumbar facet in the Frontal plane and distraction of the right side lumbar facet in the Transverse plane.

Thanks, Bob D

Permalink Reply by Robert Downes on December 29, 2009 at 5:09pm

In Applied Functional Science (AFS) we use the words "Load," "Loading," "Loading Phase" to mean the eccenctric part of a movement that "turns on" or "activates" the proprioceptors. AFS uses the term "Point of Transformation" to mean the amortization or transition part of a movement. AFS uses the terms "unloading," or "exploding" to mean the concentric part. I define these words here because if you speak with AFS people that is how they are going to talk. I am not beholden to any terminology as long as we get to an understanding of how it is defined or if a consensus can be reached as to why one term is "better" - I am for eliminating the words Abduction and Adduction. In fact until we get to a consensus we will necessarily have to go through this exercise of defining terms. This is the cost of having not only accurate communication but also precise communication.

In the Personal Training Realm there is a push to adopt a univeral nomenclature to define position and movement. This is being undertaken by the PTAGlobal folks. It may come to pass!

So this is what I mean when I say the front lead leg load in gait.

Please don't let the various ways to define position and motion get in the way of my main point which is we have ways to position people (in each plane) that will facilitate compression or distraction of the facet joints. And this can be beneficial to get good spinal mobilization.

Permalink Reply by Joseph E. Muscolino on December 29, 2009 at 9:11pm

Hey Bob,

I definitely like the ideas here. Compression and distraction of joints is extremely important! Thanks for sharing this!

Regarding terminology, perhaps I have had my head in academia for too long, AND I realize that there are many competing terminologies even in academia, but there are certain fairly standard terminology usages that are out there and taught in the basic kinesiology textbooks (Neumann, Norkin and Levangie, mine :), etc). I try to stay with these because they are more universal than using the terminology of a certain technique, etc. In the end, a common language facilitates communication and saves some misunderstanding in the meantime. But, of course, as you point out, the most important thing is the idea, not the language of communicating it.
Thanks for introducing this idea!

Robert Downes said:

In Applied Functional Science (AFS) we use the words "Load," "Loading," "Loading Phase" to mean the eccenctric part of a movement that "turns on" or "activates" the proprioceptors. AFS uses the term "Point of Transformation" to mean the amortization or transition part of a movement. AFS uses the terms "unloading," or "exploding" to mean the concentric part. I define these words here because if you speak with AFS people that is how they are going to talk. I am not beholden to any terminology as long as we get to an understanding of how it is defined or if a consensus can be reached as to why one term is "better" - I am for eliminating the words Abduction and Adduction. In fact until we get to a consensus we will necessarily have to go through this exercise of defining terms. This is the cost of having not only accurate communication but also precise communication.

In the Personal Training Realm there is a push to adopt a univeral nomenclature to define position and movement. This is being undertaken by the PTAGlobal folks. It may come to pass!

So this is what I mean when I say the front lead leg load in gait.

Please don't let the various ways to define position and motion get in the way of my main point which is we have ways to position people (in each plane) that will facilitate compression or distraction of the facet joints. And this can be beneficial to get good spinal mobilization.

Permalink Reply by Robert Downes on December 30, 2009 at 7:29am

Hi Joe, What is Roll and Glide (of a joint) and how do you use them in joint mobilization work?

Permalink Reply by Joseph E. Muscolino on December 30, 2009 at 9:47pm

Roll and glide? Hmmm... We usually think of most axial movements as being a roll-like motion, similar to a tire rolling on a road. But in reality, if a bone, let's look at the head of the humerus for example, only rolls, it would roll off the glenoid fossa of the scapula. So, there must also be a glide that is associated with the roll (a glide is like a tire skidding along a road). So, when the humerus flexes (or extends, abducts, or adducts), it rolls some in one direction, but there is an associated glide in the opposite direction to keep the head centered in the glenoid fossa. This is much easier to appreciate with a figure. Section 5.8 (page 168) of my kinesiology book shows this. And certainly Neumann's book covers it too.
Regarding its application to joint mobilization, understanding this helps one to realize that mobilization should not only be directed at the axial roll aspect of a joint's motion, but some of the attention of joint mobilization technique should also be focused toward restoring nonaxial glide motions, if they are limited.

Robert Downes said:

Hi Joe, What is Roll and Glide (of a joint) and how do you use them in joint mobilization work?

Permalink Reply by Robert Downes on December 31, 2009 at 8:42am

Hi Joe,

What direction is the Roll of the articular surface in relationship to the direction that the bone is moving (taking the case of one bone moving on a stationary bone)?

Does the direction of the Glide depend upon whether the bone end is convex or concave?

When you have a loss restraint (laxity or tear to the ligamentous, capsular and/or muscular structures) do you tend to get more Roll or more Glide versus the normal Roll/Glide ratio? What about if you have excessive restraint (e.g. a tight muscle and/or tight casule)?

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