Joint mobilization

Joint mobilization is a type of passive movement of a skeletal joint. It is usually aimed at a 'target' synovial joint with the aim of achieving a therapeutic effect.


Mobilization is a manual therapy intervention and is classified by five 'grades' of motion, each of which describes the range of motion of the target joint during the procedure. [1]

Roman numerals are generally used in labelling the grades of motion (i.e. Grades I to V). Grade V is the same as manipulation.

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Mechanisms of action

The different grades of mobilization are believed to produce selective activation of different mechanoreceptors in the joint:

  • Grade I - Activates Type I mechanoreceptors with a low threshold and which respond to very small increments of tension. Activates cutaneous mechanoreceptors. Oscillatory motion will selectively activate the dynamic, rapidly adapting receptors, i.e. Meissner's and Pacinian Corpuscles. The former responds to the rate of skin indentation and the latter respond to the acceleration and retraction of that indentation.

  • Grade II - Similar effect as Grade I. By virtue of the large amplitude movement it will affect Type II mechanoreceptors to a greater extent.

  • Grade III - Similar to Grade II. Selectively activates more of the muscle and joint mechanoreceptors as it goes into resistance, and less of the cutaneous ones as the slack of the subcutaneous tissues is taken up.

  • Grade IV - Similar to Grade III. With its more sustained movement at the end of range will activate the static, slow adapting, Type I mechanoreceptors, whose resting discharge rises in proportion to the degree of change in joint capsule tension.

  • Grade V - This is the same as joint manipulation. Use of the term 'Grade V' is only valid if the joint is positioned near to its end range of motion during joint manipulation. Evans and Breen [2] recently contested this assumption, in fact arguing that an individual synovial joint should be positioned near to its resting, neutral position.


Recognizing and Preventing Childhood Injuries

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The benefits of regular exercise are vast, especially among young athletes. Athletic programs provide opportunities to improve self-esteem, acquire leadership skills and self-discipline, and develop general fitness and motor skills. Peer socialization is another important, though sometimes overlooked, benefit. Participation, however, is not without injury risk. Any parent that has had their child participate in regular physical activity knows that their child may sustain some sort of injury. Parents have also witnessed the resilience of children and how fast they heal, however, kids are not immune to developing compensations in their musculoskeletal system that can change how they will use their bodies in sport and regular day to day activities in the future. All parents understand that the choices they make today have a strong impact on their child’s future. This is why it is especially important to properly manage childhood injury. This information session is intended to improve your understanding of the following:

  • Determining if your child has an injury

  • What to do when your child is injured

  • How to prevent injuries in and out of the pool


Injuries can be either traumatic, such as a sprain or a fracture, or due to repetitive strains that overloads the tissues and lead to disruption and even failure, a great example of this is when your back has been perfectly fine and then one day you attempt to pick up a pencil and it just locks, or you hear a pop and pain sets in.

Tissue, such as skin, muscles, tendons, ligaments, bones and other forms of connective tissue can be placed under strain, and often this strain is not painful. However, this continuous strain creates some sort of compensatory movement. When a body experiences localized pain, it will attempt to adapt in a manner that decreases that local pain but changes the way a particular movement occurs, very often in an “unnatural” manner. Repetitive strains can exhaust the body’s ability to adapt and over time can lead to painful injury. This is how pain can be experienced even when there has not been a single traumatic event, remember the pencil and back example. These programmed adaptations lead to muscle weakness, uncoordinated movements, soft tissue shrinkage or atrophy, and loss of flexibility in a region of the body. These changes are termed deconditioning, and deconditioning syndromes can cause changes to surrounding joints. When joints are not moving properly, the bones surrounding the joint can weaken and breakdown, scar tissue can develop around the joint capsule and weakening of surrounding ligaments can occur.

These changes occur in children but are much subtler. Unfortunately, pain is not always the best way of determining something is wrong. Actually, pain does not serve as a good early- warning system of something wrong; it often arises only after damage is done. Once damage occurs, such as a traumatic injury or repetitive strain, several biochemical processes ensue, and inflammation begins. This inflammation is often painful but is too late to prevent and your child is not only in pain but is often removed from the activities that did not create the problem but give them very much joy. This is why it is important to have a professional that is well versed in childhood injuries and the tissue mechanics within children to appropriately assess a possible injured state.


The more often a particular movement is repeated, the greater the likelihood of sustaining an injury. However, there are certain factors that contribute to injuries among children. The following are examples that increase the risk of injury and are not exclusive to swimming:

  • Body Alignment, i.e., poor posture, such as forward slouched shoulders

  • Prior injury

  • Inappropriate rehabilitation with previous injury

  • Inadequate conditioning

  • Returning to play too soon after injury

  • Inappropriate equipment/footwear

  • Incorrect sport technique


There is not a single way to determine if your child is injured. There are often warning signs, but children often conceal an injury for fear of being punished or removed from a particular activity. Parents may notice their child supporting or rubbing a particular body part too frequently; not moving with the same grace they once did; or actually telling you that they are hurt. Decreased performance, which is often noticed by a coach or by keen parents, can be the first warning sign. However, this is not always the case, recall the whole issue of compensatory movements.

It is very important that parents realize one thing. One particular sport does not result in more injuries than another. Any form of physical activity is accompanied with risk of injury, even something as simple as walking, or even playing video games, repetitive strain injury to the thumb is highly prevalent among children that spent too much time playing video games. Therefore, it is important to communicate with your child that they should not be afraid to tell you or their coach when they are not feeling their body is working the way it used to.

If in doubt whether your child is injured or not, you should have your child see a health care provider that understands childhood sport injuries and their appropriate management, what the proper body mechanics are for their athletic event, the correct strength of opposing muscle groups necessary for their sport, the proper nutrition required to maximize their performance and aid in healing the injured athlete and the prescription of a progressive rehabilitation program for their sport. This health care provider can be like me, Dr. Nick Tsaggarelis, BKin, DC, MEd, a sports focused chiropractor, or a sports medicine physician. If you are unaware of who to send your child to, speak to the child’s coach, their paediatrician or contact my office and I can direct you to the appropriate person depending on what the condition requires.

It is important to understand that not all conditions are treated the same. There is a specific treatment for a specific condition, occurring in a specific child. This is why it is very important that the proper assessment and diagnosis be made, and the correct treatment plan be implemented. To develop the proper diagnosis a detailed assessment is necessary. Each health professional has a different approach to evaluate a patient and I can only explain the approach I take to develop a diagnosis and subsequently implement a treatment plan. I first begin with a detailed history of the child, some of the questions I may ask the athletes I take care of, especially children are as follows:

  • Has there been a similar injury in the past, and does the patient have a history of other overuse injuries?

  • How were past injuries treated?

  • Was there a change in training intensity, frequency, or duration?

  • Was a new technique or piece of equipment introduced?

  • Is the athlete involved in other activities such as resistance training or physical education classes that could have contributed to the injury?

  • When was the last athletic shoe purchase?

These questions along with a thorough exam using orthopaedic and neurological tests allows me to evaluate the movement of joints, the muscles surrounding these joints and the nervous system. This evaluation provides me with the information needed to develop an understanding of the individual needs each patient requires in order to restore optimal health and proper function of the body.


Every parent wants the best for their child. In order to receive the best possible health care parents, need to find a health care provider they can trust. One who knows how to appropriately manage their child and has a good team of other health care providers they can rely on when they need to send your child too if further investigation is necessary. In addition, it is imperative that the health care provider has the ability to communicate the diagnosis to you and your child in easy to understand terms. This is necessary because when you and your child both understand what is going on there is increased awareness and motivation to get better and stay that way for a long time.

Once the proper diagnosis is made, the key factors resulting in the injury identified, the appropriate treatment plan is implemented in order to restore proper motion to joints and surrounding muscles and rehabilitative exercises are given in order to maintain the changes that have been made. I have had great success treating both recreational and professional athletes by using a functional approach to the management of a variety of conditions. By integrating and implementing various therapies, such as Active Release Technique® (ART®), Joint Manipulation, Medical Acupuncture, and Functional Rehabilitation Exercises, I am able to quickly re-establish proper mechanics of muscles and joints. This not only reduces the pain my patients have been experiencing from their injury, but it also restores proper function and even improves performance. However, the most important point to remember in any treatment plan is a re-evaluation of your child’s condition/injury within two weeks of treatment onset in order to determine whether it has been helping or not. My experience treating various sports and recreational injuries has been that there should be an improvement within three (3) to four (4) treatments, especially among children and adolescence. An improvement is measured as either an increased range of motion, decreased intensity or duration of pain, and/or improved performance. Therefore, not only should your health professional be providing you with an accurate diagnosis, the treatment they implement should result in noticeable improvements relatively quickly. Of course, there are some exceptions, but these too should be explained and understood by all parties involved.

The following is a brief explanation of how some of the therapies can benefit your child:

JOINT MANIPULATION/CHIROPRACTIC CARE –Joint manipulation is performed by chiropractors that also diagnose pain and dysfunction of muscles and joints. With the aid of a specific, high velocity, and short amplitude thrust applied to a joint, there is an audible release of gas, which is referred to as a joint cavitation. The audible sound is caused by the release of oxygen, nitrogen, and carbon dioxide, which releases joint pressure (cavitation). These manipulations are safe and rarely cause any discomfort. The result is not only increased range of motion, and reduced nerve irritability, but also improved function of the joint manipulated and its surrounding tissue.

ACTIVE RELEASE TECHNIQUE® (ART®) – This is a specific soft tissue therapy used to break up fibrous adhesions (scar tissue between muscles, nerves and other connective tissue) that develop during a sudden injury, a repetitive or chronic injury, or poor posture. ART® re- establishes the proper motion between muscles, tendons, ligaments, blood vessels, fascia and nerves. In many situations your condition will significantly improve within five to six treatments, with the average treatment session lasting 10-15 minutes per area treated.

MEDICAL ACUPUNCTURE – This approach used by physicians and chiropractors in North America, Europe, and parts of Asia involves the insertion of very fine needles into specific points on the body to relieve pain and improve the function of the nervous system. This enhances the energy and hormonal balance within the body, stimulating your natural healing abilities.

REHABILITATIVE EXERCISE PROGRAMS – The condition being treating will dictate the type of exercise program given. By completing a progressive and easy-to-follow program, patients experience increased strength and flexibility. This not only helps decrease pain but prevents the condition from returning in the future.


It is believed that the majority of injuries are preventable. Having your child evaluated by a qualified health professional as discussed above, prior to beginning a training program and informing you and your child if any areas need to be addressed to prevent injuries can be of great benefit.


To have your child receive faster recovery from their injury or general muscle and joint pain call one80Health on (647) 560-4495.

 Our friendly and knowledgeable staff will put you at ease and answer any of your questions.

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