Top 5 Fridays! 5 Ways to Make Joint Mobilizations Pain Free | Modern Manual Therapy Blog

Top 5 Fridays! 5 Ways to Make Joint Mobilizations Pain Free


Regular blog followers have often heard stories of me being very aggressive with IASTM, soft tissue technique, and joint mobilizations. 15 years ago, I would tell students if they hadn't bruised someone within the first week, they weren't being aggressive enough. If only I could reach those students now!

Any technique you can do and have success with that is uncomfortable can be made either pain free or in the least, much less uncomfortable. Here are 5 Ways to Make Joint Mobilizations Pain Free

1) Breathing
  • many manual therapists use breathing for spinal techniques, particularly exhalation during thrust manipulation
  • a good, slow diaphragmatic exhalation can decrease tone, and thus tenderness to touch
  • why limit this powerful and simple technique to just thrust manips or spinal mobilizations?
  • if your patient can breathe diaphragmatically, have them do a good long exhale during any painful or uncomfortable joint technique and see if it helps with perception of stretch or tenderness to touch/pressure
  • here's our recent video on using breathing with a mobility ball to make it pain free!
2) Isometrics
  • There is nothing special about MET or PNF, it's just fancy isometrics
  • like most techniques, after the minutiae is stripped away, the effectiveness remains
  • isometrics have been shown to have an analgesic effect with tendon loading, but why not use resistance into the new range any time a joint mobilization is painful?
  • try resistance toward the limited range or away, and try the mobilization again, often just 2-3 reps of 3-4 second holds makes the mobilization much more comfortable
3) IASTM
  • Reducing tone and providing novel stimulus to the skin may reduce cortical smudging from pain/immobility
  • soft tissue techniques have the ability to target a much larger area of the cortical representation rather than mere "joint techniques"
  • checking end feel and joint play often changes with just 1-2 minutes of light IASTM all around the involved joint
  • IASTM integrates well with most other manual techniques, want to see how we integrate it? Check out IASTM Technique 2.0!
4) Oscillate the Entire Capsule
5) Use Positive Language to Explain the Technique
  • It's well documented that fear avoidance/anxiety affects outcomes
  • you don't have to go "all neuro" on someone who may not comprehend or believe the modern explanation for manual therapy
  • however, using positive language and maximizing placebo can turn a previously perceived painful technique into a good experience
  • i.e. a patient telling you they "hate cervical adjustments"
    • you can take 5 minutes to tell them about joints not going in and out of place
    • the cracks/pops or quick stretches provide novel input to the brain
    • the brain either gives the input a green light or red light
    • green lights equal decreased output of pain, restoration of movement after the "neuro lockdown" is temporarily improved
  • Watch Keeping the Window of Improvement Open - a video I show to my patients via auto responder when they sign up for their initial evaluation
Hope this post got you thinking about modernizing your old school joint techniques. Remember, just because you're successful with techniques that are uncomfortable/painful, does NOT mean they have to be. Any technique can be made pain free. Don't be a victim of your own success and punish your patients for it like I did for well over a decade.



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