Closed Chain Manipulation
Joint Mobilization is a common treatment approach by physical therapists to restore movement at an affected joint, be it either spinal or peripheral. In a typical joint mobilization procedure, the physical therapist will fixate the joints proximal end (that which is closer to the center of the body). The distal end (that is which farther away from the center of the body) is then moved on the proximal component in a manner which is consistent with the joint architecture. The term for these types of movements is Open Chain, meaning that the distal end of the articulation is free to move in space with the proximal end more fixated. Imagine sitting on a bench with your foot free from contact with the floor. If you are to straighten your knee you would be performing an open chain knee extension movement.
With a precise understanding of anatomy and biomechanics of the kinetic chain restoration of movement of joints in pain and dysfunction is enhanced by reversing the normal mobilization pattern, by closing the distal end and enlisting the patient’s assistance in normalizing the arthrokinematic and osteokinematic rolling and gliding movement at the affected articulation.
To perform a “Closed Chain Manipulation”© of a finger that has lost flexion, the physical therapist would start with holding the distal end and flexing it to a barrier of movement in that plane. Next the PT would fixate the distal end firmly and next enlist the patients help in moving the proximal end in the proper roll as well as translatory motion of the proximal component on the fixated distal end thereby stretching the associated connective tissues which are limiting the patients ability to move the joint through its normal arc of motion. Normalization of both the roll and gliding movement at a joint is required for pain-free function.
Robert Grossman, PT, OCS began developing these proprietary “Closed Chain Manipulation”© techniques in the 1990s. He has mapped out the entire body including all peripheral articulations as well as the spine. He has taught courses on the evaluation and treatment techniques using “Closed Chain Manipulation”© for years. These techniques allow the physical therapist to provide the patient with a powerfully effective manipulation of any articulation with greater ease for the physical therapist to perform than typical open chain mobilizations. “Closed Chain Manipulations”© are safe to employ in either acute or chronic conditions.
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