To mobilize or manipulate?

manip or mob

As therapist I think or at least I used to think about whether I should be just mobilizing the joint instead of just manipulating the joint. As such should I just prioritize mobilization over manipulations or manipulations or mobilization? Can I do both of them at the same time? Is it even safe to do manipulations? I think these are valid questions usually asked by therapist particularly because training for both these techniques take a lot of dough out of our good friend the wallet. As such to give you an idea and to help clear up some misconceptions I have written this short article.

For those who are not familiar with these two therapeutic modalities. The mobilization is anything in which you put pressure on a joint then release them in intermittent successions. The pressure might move the joint in small or big amounts and might or might not be felt by the client. The usual goal of a mobilization is to make the joint itself able to move on or around the structures surrounding the joint. The thing is while this modality is safe it is a modality which can irritate the soft tissues of the client when done too much causing a phenomenon named muscle guarding in which the body tries to protect the area that is constantly being moved by tightening up the muscles near the joint. The manipulations however is a modality in which a thigh velocity thrust is delivered so as to make the joint more mobile. This modality would usually require a lot of skill from the therapist since for a manipulation to be successful. The skills that the therapist would need to have to be able to perform a successful manipulation are ample palpation skills, percussion testing skill and knowing the red flags. Once skills are present a manipulation can then more or less be delivered by the therapist in a safe way. A manipulation can only be dangerous once there is no assessments done since every client is different. Manipulations also tend to lose their effectiveness once done frequently as such manipulations in my opinion should only be done when needs or as frequent as once per month unless there is a good reason of doing it in succession.

Both the manipulation and mobilization are modalities which aim to increase the ability of the joint to move specially those limited by some pathology specifically muscular-skeletal pathology. These techniques when used a few times would definitely cause some soft tissue irritation as such it would be beneficial to just choose one of the two modalities at a time so as to avoid muscle guarding. The two modalities however can be used in the same session once the therapist develops enough skill as to be able to make the joints more mobile in just a few number of mobilizations or manipulations. For those who are just starting out it might be beneficial to just stick to one of the two modalities at a certain time.

For the safety issues on both the two modalities for those worried about whether it is safe to do mobilizations or manipulations. The only answer is once you evaluate a client and see that there is no cracks of fractures in the joints, anatomical anomalies and there are no physical fusions it is more or less safe to do mobilizations or manipulations.

The same thing can be said of the traffic if you cannot find the problem have someone look at it from a different perspective.

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