Joint Mobilizations to Improve Joint Contractures

As we continue to discuss joint contractures in the limb loss population, it is imperative to examine the importance of joint mobilizations. Each joint in the body is protected by a capsule that may resemble a plastic bag wrapping the bone and can tighten around the joint with prolonged sedentary positioning. Sometimes the joint mobility is limited by the muscles and tendons wrapping around the bone, but other times the mobility is decreased secondary to the tightening of this joint capsule. Most often, joint mobility is limited because of both the muscle and capsule involvement.

Individuals with limb loss can learn to independently stretch the muscles and the skin of the limb, but will usually require assistance with mobilizing the capsule surrounding the joint. Physical and occupational therapists are well trained to assist individuals with concerns about joint mobility and are able to safely provide joint mobilizations as an option to improve the capsule movement. Typically, this technique is not painful and oftentimes individuals with tight capsules report that the mobilizations are similar to a deep tissue massage, aka the "hurts so good" feeling. To begin, an individual will be positioned comfortably on a treatment table while the therapist uses their hands or a piece of thick material to move the joint in particular direction, as necessary to improve the mobility of that specific capsule. A typical treatment session of joint mobilizations lasts from five to thirty minutes depending on the joint or joints involved and the level of involvement.

This technique, in conjunction with the aforementioned stretching and positioning methods, can be utilized to improve the functional movements of the joint and promote proper gait patterns with prosthetics.