Issue link: https://www.massageandbodyworkdigital.com/i/790815
56 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 7 At the outset of this conversation, I posited that there are three fundamental skill sets in the world of clinical orthopedic manual therapy: soft-tissue manipulation, stretching, and joint mobilization. However, I believe this list can be narrowed to just two fundamental skill sets: soft-tissue manipulation and stretching. I say this because joint mobilization is actually a type of stretching. If we name the two bones at a joint Bone A and Bone B, then the technique of joint mobilization is performed by pinning Bone A and then moving Bone B away from Bone A. Therefore, joint mobilization is actually a form of the pin and stretch technique. But, instead of placing the pin in a muscle belly to focus the stretch toward one end of the muscle or the other, the pin is placed on a bone to focus the stretch on the intrinsic fascial tissue (the joint capsule/ ligamentous complex) between that bone and the other bone of the joint. For this reason, I like to refer to joint mobilization as arthrofascial stretching (arthro means "joint"). Given the tremendous emphasis in recent years placed on treating fascia, it is surprising that more massage therapists do not perform joint mobilization or arthrofascial stretching as part of their treatment. After all, if we recognize that it is important to treat myofascial tissue (as recognized with Thomas Myers's work), and it is important to treat visceral fascial tissue (as recognized with Jean-Pierre Barral's work), and it is important to treat subcutaneous fascial tissue (as done with skin rolling and cupping), then why would we want to leave intrinsic fascial tissue untreated? The type of joint mobilization that can be legally and ethically practiced by most massage therapists is Grade IV joint mobilization.* Grade IV joint mobilization is performed with slow oscillations. (It's important to note that a fast thrust is beyond the scope of practice for massage therapists. Fast-thrust joint mobilization is typically performed only by chiropractic and osteopathic physicians.) As with any technique, it is extremely important that the skill be learned properly and that the therapist has a proficiency in performing the technique before using it on clients. Even though the technique of joint mobilization/arthrofascial stretching can be learned from an article or video content, given the precision required for this technique, small in-person continuing education classes with one-on-one guidance is recommended. * Before employing any new technique, including joint mobilization/arthrofascial stretching, please check with your state licensure/certification body to ensure it is legal (within scope of practice) and ethical for you to use. JOINT MOBILIZATION Various contacts used for the pin when performing the pin and stretch technique. A: Thumb pad B: Finger pads C: Knuckles D: Heel of palm E: Elbow F: Forearm 6A 6D 6B 6E 6C 6F