Joined: December 22, 2007
out there have about using grade III traction mobs/distraction versus the use of grade III and IV osc. mobs.
You know, I'm not sure you'll see tons of evidence showing one to be vastly superior to the other. Empirically I can tell you traction (mobilization perpendicular to the joint surface) mobs tend to be less painful, but I see very little carryover to increased motion.
I think a translatory mobilization tends to be more productive in terms of improving pure motion, but are not always well tolerated depending on the irritability of the tissue in question.
With adhesive capsulitis patients, I tend to utilize both to varying degrees. Again, depending upon the irritibility of the joint. If pain levels are higher, I will probe around with traction mobs and move on toward translation in a slackened position, followed by mid range, followed by end range. I think the slackened and mid range mobs are primarily for afferent input vs actually "mobilizing" the joint. The money shot comes during the end-range mobilizations.
Interesting tangent. I have a frozen shoulder patient who presented very "hot". High and irritible pain levels and very tight in all planes. I have spent the last two weeks really pushing the need for joint protection and oral antiinflammatories per the MD orders. Interestingly, I have performed only grades I-II mobs with her at mid and end range (mostly pain free). She has experienced significant improvements in ROM and pain and is now tolerating much more aggressive mobilization. The results seem to have come better with gentler initial strategy. For what it's worth...