1. Joint Mobility Assessment
PT 142: Assessment in Physical Therapy
Joint Mobility Assessment
Kristofferson G. Mendoza, PTRP
Department of Physical Therapy
College of Allied Medical Professions
University of the Philippines Manila
All Rights Reserved 2009

2. Learning Objectives
Identify indications and precautions as to the use of joint mobility assessment
Given a simulated patient care situation, interpret the results of the joint mobility assessment
Record in an acceptable format the findings gathered from the joint mobility assessment
Given a simulated patient care situation, demonstrate joint mobility assessment techniques with correct procedure and patient care skills
Given a simulated patient care situation, communicate the assessment rationale, procedure, and results clearly and concisely
By the end of the learning session, the student should be able to:
Explain relevant concepts in joint mobility assessment
State principles and guidelines related to the proper use of joint mobility assessment techniques

3. Review of Relevant Concepts
Joint Mobility Assessment
Review of Relevant Concepts

4. Amount of Available ROM
joint motion
integrity of
joint surfaces
amount of scarring
present
Amount of Available ROM
age and gender
mobility and pliability
of the soft tissues
around the joint
degree of soft tissue
approximation that
occurs

5. Amount of Joint Motion shape of articulating surfaces health of the
surrounding tissues
load-deformation
history of the joint

6. physiologic motion is limited by a physiologic barrier
tension develops within the surrounding tissues
(joint capsule, ligaments and connective tissue)

7. additional amount of passive range of motion can be performed
the anatomic barrier cannot be exceeded without disrupting the joints integrity
accessory motion can be observed
when resistance to active motion is applied
when the patient’s muscles are completely relaxed

8. = Normal Range of Motion
Physiologic Motion (Osteokinematic) controlled by contractile tissues +
Accessory Motion (Arthrokinematic) controlled by inert tissues
= Normal Range of Motion

9. Physiologic Motion (Osteokinematic) controlled by contractile tissues+
Accessory Motion (Arthrokinematic) controlled by inert tissues
Limitation of Motion

10. Joint Mobility Assessment
Assessment Procedure

11. Assessment Procedures
Pain Assessment
Active Motion Test
Passive Motion Test (Endfeel)
Passive Accessory Mobility Test (PAM Test)
Passive Accessory Intervertebral Mobility Test (PAIVM Test)

12. Passive Accessory Mobility Test
tests the accessory joint motion
determines if joint accessory motion is hypomobile, normal or hypermobile

13. Passive Accessory Mobility Test
gives information about the integrity of the inert structures
accessory motion are involuntary
muscles cannot restrict the glides of a joint (with just a few exceptions)

14. Positioning avoid closed-packed positions
use open-packed positions (resting position)
or place the joint at the end of available motion (especially the spine)

15. Use of Glides Base direction of glide on
the direction of the limited physiologic motion and
the convex-concave rule

16. Use of Glides Perform 2 to 3 glides (ideally 1 only)
Test the unaffected extremity (or spinal segments) first
to provide baseline information
to avoid traumatizing the patient

17. Use of Distraction and Compression
Provides additional information as to the structure causing the problem
Perform 2 to 3 distractions / compressions (ideally 1 only)

18. Use of Distraction and Compression
Test the unaffected extremity (or spinal segments) first
to provide baseline information
to avoid traumatizing the patient

19. Precautions
same as the precautions and contraindications of PJM and spinal mobilization

20. Interpretation of Results
Joint Mobility Assessment
Interpretation of Results

21. Hypomobility vs. Hypermobility
hypomobile joint
lesser movement compared to what is normal or compared to the same joint on the opposite extremity
hypermobile joint
more movement compared to what is normal or compared to the same joint on the opposite extremity

22. Hypomobility vs. Hypermobility
hypomobile joint
has insufficient motion for it to be functional
hypermobile joint
has insufficient stability to prevent damage from occurring

23. Hypermobility generalized hypermobility
multiple joint laxity; greater mobility in all joints
e.g. acrobats, gymnasts, genetic diseases
localized hypermobility
single joint involvement
reaction/compensation to neighboring joint stiffness or injury

24. Hypermobility generalized hypermobility no intervention warranted
localized hypermobility
need to address the neighboring hypomobility

25. Joint Instability vs. Hypermobility
an unstable joint is
different from a hypermobile joint
a hypermobile joint
has insufficient stability to prevent damage from occurring
but its stability is preserved under normal conditions
and remains functional in weight bearing and within certain limits of motion

26. Joint Instability vs. Hypermobility
an unstable joint is
different from a hypermobile joint
an unstable joint
involves disruption of the osseous and ligamentous structures of that joint
resulting to loss of function

27. Interpreting Glides If the joint glide is unrestricted
integrity of both the joint surface and the periarticular tissue is good
the patient’s loss of motion must be the result of contractile tissue
intervention: soft-tissue mobilization

28. Interpreting Glides If the joint glide is unrestricted and excessive
excessive motion may indicate:
pathological hypermobility
instability
may be normal for the individual
intervention:
stabilizing techniques to support the joint through muscle action and
mobilization of hypomobile neighboring joint

29. Interpreting Glides If joint glide is restricted
LOM is caused by the joint surface and periarticular tissues (but contractile tissue may still be affected)
intervention: joint mobilization
once intervention is done, osteokinematic motions are assessed again. if movement is still limited then the muscles are at fault

30. Interpreting Distraction
if distraction is limited, it may indicate a contracture of connective tissue
if distraction increases pain, it may indicate a tear of connective tissue and may be associated with increased range
if the distraction decreases pain, it may indicate an involvement of the joint surface

31. Interpreting Compression
if the compression increases pain, a loose body or internal derangement of the joint is present
if compression decreases pain, the joint capsule may be affected

32. Documentation

33. Sources
Kisner C, & Colby LA (2002). Therapeutic exercise: Foundations and techniques (4th ed.). PA: FA Davis.
Dutton (2004). Orthopaedic examination, evaluation, & intervention. NY: McGraw-Hilll
Magee (2002). Orthopedic physical Assessment (4th ed.). Phil: Saunders.
Uy, J. (2002). Cervical Mobilization Seminar Handout.

34. Kristofferson G. Mendoza, PTRP kmendoza.ptrp@yahoo.com
PT 142: Assessment in Physical Therapy Joint Mobility Assessment
Thank You
Kristofferson G. Mendoza, PTRP
All Rights Reserved 2009