Enhancing the Traditional 5 Point Joint Mobilization Scale
Traditional 5-point Scale
Grade I Oscillation
Is a small amplitude movement conducted from the beginning of the available range of motion.
Grade II Oscillation
Is a large amplitude movement conducted within the range. It does not reach either end of the range.
Grade III Oscillation
Is a large amplitude movement that does reach the end of the range of motion.
Grade IV Oscillation
Is a small amplitude movement conducted at the very end of the range of motion.
Grade V Oscillation
Is a high velocity, low-amplitude thrust at the end of the available range and within its anatomical range. Think "joint popping". also called a "manipulation".
I look forward to this topic. I always felt that the 5 point (grades1-5) joint mobilization scale was limiting. for more than 25 years I practiced using an expanded scale that made much more sense to me. the 5 point scale makes a lot of sense for acute conditions, but for chronic conditions I was much more comfortable with 2 more points which I will call Grade 6, and Grade 7. I will be back soon to elaborate and to clean up earlier posts, add video to some, etc.
Key concepts: You MUST keep the slack taken up at all times! Always oscillate forward from the position of having taken up the slack, and maintained the tightned position throughout the treatment. You must mobilize a joint many times to maximize the gain, e.g. 30 reps.
I look forward to this topic. I always felt that the 5 point (grades1-5) joint mobilization scale was limiting. for more than 25 years I practiced using an expanded scale that made much more sense to me. the 5 point scale makes a lot of sense for acute conditions, but for chronic conditions I was much more comfortable with 2 more points which I will call Grade 6, and Grade 7. I will be back soon to elaborate and to clean up earlier posts, add video to some, etc.
Key concepts: You MUST keep the slack taken up at all times! Always oscillate forward from the position of having taken up the slack, and maintained the tightned position throughout the treatment. You must mobilize a joint many times to maximize the gain, e.g. 30 reps.
Grade VI Sustained Creep Without Ossilation
Take up the slack in a joint and maintain that position with constant force typically for 2 minutes, in some joints up to 5 minutes such as symphysis pubis to allow lasting elongation, lasting soft tissue deformation, AKA: viscoelastic creep into the plastic range. Creep is a fundamental property of joints, defined as deformation over time. The element of specific length of time makes this a distinct departure.
Grade VII Sustained Creep With Forward Thrusts Avoiding Recoil
This differs in that just like the lesser grades, the slack is taken up, though there is a subtle difference. In essence, there is no recoil with this technique, whenever the barrier is increased with a forward spring, recoil is avoided, by actively preventing it. In contrast, with the lesser grades, such as grade 3 recoil is allowed after each forward portion of oscillation such that the new barrier is encountered again with the next forward part of the oscillation. This seem very counter-intuitive to me, I feel much more effective when the barrier is held constant and not let go of during recoil. This may be a subtle concept for some, it may be denied that this is different than they learned from a particular discipline, though a published reference would be ideal. It is a distinct departure from the traditional grades of mobilization treatment.
Take up the slack in a joint and perform repeat mobilizations, being gentle, but applying repeated moderate velocity, low amplitude forces. Always keep the slack taken up, as motion is gained, it is followed, such that there is a new position of the slack being taken up. This assures that the energy in the next mobilization will be applied directly against the barrier. Each thrust has the potential to move the joint past the barrier into a new range of motion. Typical number of repetitions for me: 30.
I recognize that the above topic needs to expand into a full position paper. surely this is a topic worthy of debate and may generate some controversy, appropriately labeled as "iconoclastic", the mere suggestion that the traditional 5-point scale is not adequate or at worst; is not understood and therefore not properly applied. I marvel at studies on mobilizing the talus in which a few degrees are gained. I regularly obtain 10 degrees rather easily in similar population using the above techniques. I have often observed other Manual Therapists, and it appears that they perform a small number of oscillations (regardless of the Grade). I submit that 30 reps is optimal for most synovial joint restrictions (unless scar is present) or if utilizing creep; 2 to 5 minutes or more.
Take up the slack in a joint and perform repeat mobilizations, being gentle, but applying repeated moderate velocity, low amplitude forces. Always keep the slack taken up, as motion is gained, it is followed, such that there is a new position of the slack being taken up. This assures that the energy in the next mobilization will be applied directly against the barrier. Each thrust has the potential to move the joint past the barrier into a new range of motion. Typical number of repetitions for me: 30.
I recognize that the above topic needs to expand into a full position paper. surely this is a topic worthy of debate and may generate some controversy, appropriately labeled as "iconoclastic", the mere suggestion that the traditional 5-point scale is not adequate or at worst; is not understood and therefore not properly applied. I marvel at studies on mobilizing the talus in which a few degrees are gained. I regularly obtain 10 degrees rather easily in similar population using the above techniques. I have often observed other Manual Therapists, and it appears that they perform a small number of oscillations (regardless of the Grade). I submit that 30 reps is optimal for most synovial joint restrictions (unless scar is present) or if utilizing creep; 2 to 5 minutes or more.