Issue link: https://www.massageandbodyworkdigital.com/i/68178
adduction, internal or medial rotation, external or lateral rotation, or other joint-specific, gross movements. There are three universally accepted forms of range of motion: active, passive, and resisted. Active range of motion occurs when clients perform the movement themselves. Passive range of motion is executed when the practitioner performs the movement as the client remains relaxed. Resisted range of motion occurs when the client attempts to move against the practitioner's resistance. Within the massage community, range of motion may be referred to as Swedish gymnastics. Controversy typically arises when describing the use of range of motion as an assessment or diagnostic tool rather than a treatment technique. It is not often disputed that massage therapists are within their qualifications to move the body or have their clients move their own bodies during a massage session. The most heated debate is over the ability to measure the amount of movement using a tool such as a goniometer or inclinometer, thus entering the realm of physical therapists, athletic trainers, and physicians. It is often these groups who claim that the use of range of motion is outside of the scope of practice of massage therapists. JOINT MOBILIZATION Joint mobilization can be confused with range of motion. According to the American Medical Association (AMA), joint mobilization is a "manual technique used to increase joint range of motion by enhancing accessory motion, joint play, or manipulating the alignment of the articulating surfaces."5 The American Physical Therapy Association (APTA) describes it as "the attempt at restoration of full, painless joint function by rhythmic, repetitive, passive movements within the patient's tolerance and within the voluntary and accessory range, and graded according to examination findings."6 Massage and bodywork education programs typically do not cover accessory motion, which is the foundational principle behind joint mobilization. Accessory motion is the change in spatial relationship between the articular surfaces of one bone relative to another, characterized as roll, spin, and glide. These movements describe how the articular surfaces shift as the joint moves through physiological or gross movements and is considered essential to normal range of motion. Additionally, joint mobilization techniques are considered both an assessment technique and a treatment method. Traditionally, joint mobilization falls under the scope of practice of physical therapists, osteopaths, and chiropractors. There is tremendous controversy about this particular technique among those professions. There are five grades of joint mobilization ranging from grade I (small oscillations at midrange of accessory motion) to grade V (rapid, thrusting forces at end range of accessory motion to realign articulating surfaces). Grade V is the most commonly challenged. This technique is also called manipulation and most often falls to chiropractors and osteopaths, but sometimes falls under the scope of practice of physical therapists or naturopathic physicians. Range of motion works with physiological motion and is not joint mobilization. Craniosacral therapy targets the dura and flow of cerebrospinal fluid and is also not joint mobilization. Swedish gymnastics are not joint mobilization. Muscle energy techniques, proprioceptive techniques, and strain-counterstrain methods affect joints, but are not considered joint mobilization. Joint mobilization is a specific technique that utilizes various grades of oscillating ABMP Code of Ethics The following section on scope of practice and appropriate techniques comes from ABMP's Code of Ethics: • I will provide services within the scope of the ABMP definition of massage, bodywork, and somatic therapies and the limits of my training. I will not employ those massage, bodywork, or somatic techniques for which I have not had adequate training and shall represent my education, training, qualifications, and abilities honestly. • I will be conscious of the intent of the services I am providing and shall be aware of and practice good judgment regarding the application of massage, bodywork, or somatic techniques utilized. • I will not perform manipulations or adjustments of the human skeletal structure, diagnose, prescribe, or provide any other service, procedure, or therapy that requires a license to practice chiropractic, osteopathy, physical therapy, podiatry, orthopedics, psychotherapy, acupuncture, dermatology, cosmetology, or any other profession or branch of medicine unless specifically licensed to do so. • I will be thoroughly educated and understand the physiological effects of the specific massage, bodywork, or somatic techniques utilized in order to determine whether such application is contraindicated and/or to determine the most beneficial techniques to apply to a given individual. I shall not apply massage, bodywork, or somatic techniques in those cases where they may be contraindicated without a written referral from the client's primary care provider. connect with your colleagues on massageprofessionals.com 59