To optimise the benefits from the passive movements and passive therapeutic exercises, more experimental evidence needs to be gathered in order to better understand things like specific tissue effects and physiological mechanims of action involved (Frank et al. 1987).
A clinical approach utilizing skilled, specific hands-on techniques, including but not limited to manipulation and mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function (AAOMPT, 1999).
Some recent research has demonstrated significantly better outcomes for patients who used manual therapy in conjunction with other forms of therapy, such as exercise and proprioception training, than when manual therapy was used alone (Jull et al. 2002).
Within manual therapy, the administration of passive movements is generally denoted by the term "mobilization". The APTA (American Physical Therapy Association), and the AAOMPT (American Academy of Orthopedic Manual Physical Therapy) define mobilization as
a manual therapy technique comprised of a continuum of skilled passive movements to joints and/or related soft tissues that are applied at varying speeds and amplitudes, including a small amplitude/high velocity therapeutic movement (Olson, 2004).
In this essay, we are specifically concerned with joint mobilization, which differs from soft-tissue mobilization (massage therapy) or manipulation (chiropractic). We shall be discussing the specific physiological pathways underlying the manifest effects of passive movements. We shall begin, though, by better familiarizing ourselves with the nature and scope of passive movements as they are employed in a clinical setting.
Neurophysiological Response to Joint Mobilization
Physiotherapy aims to bring about musculoskeletal rehabilitation. To this end, PT prominently involves the use of a combination of exercise and manual therapy techniques. Joint mobilization is a manual therapy procedure involving loosening up of the restricted joints and increasing their range of motion by providing slow velocity and increasing amplitude movement directly into the barrier of a joint, moving the actual bone surfaces on each other in ways which individuals with compromised musculoskeletal function cannot move by themselves. By subjecting motion-restricted joints to gentle movement through a particular segment of the full range, joint receptors can be by and by reeducated to allow a range of motion. Such release from stiffness happens with a concomitant relief from pain in most cases. Administation of passive movements to an affected joint can lead to restoration of the optimal length of muscle fibres, besides resulting in the reduction of the pain-spasm cycle (American Academy of Orthopaedic Surgeons, 1991).
A joint can primarily move in two ways: a) in physiological movements consisting of extension, flexion,