I. Basic concept Joint loosening technique is a highly targeted manipulation technique completed by the therapist within the movable range of joint activities, which belongs to the passive movement category. 1.Physiological movement of the joint refers to the movement of the joint within the physiological range, which can be done actively or passively. 2.Auxiliary motion of the joint The motion that is completed within the range allowed by the joint and its surrounding tissues is called auxiliary motion, which is indispensable to maintain the normal activities of the joint. Generally, it cannot be done actively and requires the help of other people or the opposite limb to complete, such as joint separation and lateral movement of the patella. When a joint is restricted due to pain or stiffness, its physiological and accessory movements are limited. If the joint is still painful or stiff after physiologic motion has been restored, the accessory motion may not be fully restored. Usually, before improving the physiological movement, the accessory movement is improved first, and the improvement of the accessory movement can promote the improvement of the physiological movement. Second, the basic method 1, swing The lever-like movement of the bone is called ~, that is, physiological motion, swing to fix the proximal end of the joint, the joint remote to do round-trip movement. Oscillation must be applied only when the ROM is > 60% (normal). For example, the swing maneuver for shoulder anteversion should be applied only when the shoulder anteversion reaches at least 100°, if it does not reach this range it should be improved with accessory motion maneuvers first. 2.Rolling When a bone rolls on the surface of another bone, the surface shape of the two bones must be inconsistent and the contact points change at the same time. The movement that occurs is angular, and the direction of its rolling is always in the direction of the angular bone movement, often accompanied by sliding and rotation of the joint. 3.Sliding When a piece of bone slides on another piece of bone, such as simple sliding, the shape of the two bone surfaces must be the same, either flat or curved (the degree of concavity and convexity of the two bone surfaces must be equal). When sliding, the same point on one bone surface touches a different point on the opposite bone surface. The closer the shape of the joint surfaces – the more sliding, the more inconsistent the shape of the joint surfaces – the more rolling. In clinical application, sliding can relieve pain, and combined with pulling can loosen the joint capsule, relax the joint and improve the range of motion of the joint, so it is used more often. 4.Rotation Rotation refers to the rotation of the stationary bone surface around the axis of rotation, when the rotation, the same point of the mobile surface for garden circumferential motion. Rotation often occurs simultaneously with sliding and rolling, and rarely acts alone. 5.Separation and pulling Separation and pulling is called traction. Separation: When the external force causes the two bone surfaces of the joint to be separated from each other at right angles, it is called separation or intra-articular traction. Traction: When the external force acts on the long axis of the bone to make the joint remotely displaced, it is called long axis traction. Distinguish between separation – the external force is perpendicular to the articular surface and the two joints must be separated. Pulling – the external force is parallel to the long axis of the bone, and the joint surfaces can be separated. Grade I – The therapist loosens the joint back and forth in a small, rhythmic manner at the beginning of the patient’s joint movement. Grade II – The therapist loosens the joint in a wide range of rhythmic back and forth within the patient’s permissible range of joint movement, but does not touch the beginning and end of the joint movement. Level III – The therapist releases the joint in a wide range of motion, rhythmically back and forth, within the patient’s range of joint motion, contacting the end of joint motion each time and feeling tension in the soft tissues around the joint. Ⅳ-The therapist loosens the joint back and forth in a small, rhythmic manner at the end of the patient’s joint, touching the end of the joint activity each time and feeling the tension in the soft tissues around the joint. 2.Manipulation application selection Ⅰ Ⅱ – pain Ⅲ – pain + joint stiffness Ⅳ – adhesions, contractures, manipulation grading can be used for accessory motion and physiological motion of the joint. Accessory motion-Ⅰ-Ⅳ are available. Physiological motion – ROM > 60% of normal can be applied, mostly grade III-IV, rarely grade I. Grading range of joint range of motion changes in size. IV. Therapeutic effects and clinical applications. 1, therapeutic effect (1) physiological effect: mechanics + neurological effect Mechanics: promote the flow of joint fluid, increase the nutrition of articular cartilage and cartilage disc without blood vessels, relieve pain and prevent joint degeneration. Neurological effect: inhibit the corresponding release of spinal cord and brainstem pain-causing and increase the pain threshold. (2) Maintain tissue extension Joint loosening, especially grade III and IV-directly stretches the soft tissues around the joint → can maintain or increase extension and improve ROM. (3) Increase proprioceptive feedback Joint loosening to provide the following sensory information: resting position and speed of joint movement and changes, direction of joint movement, muscle tension and changes. 2. Clinical application (1) Indications: Joint dysfunction caused by any mechanical factor (non-neurological). Including: a, pain, muscle tension and spasm, b, reversible ROM↓, c, progressive joint movement limitation, d, functional joint braking. For the latter two it is mainly to maintain the existing ROM. (2) Contraindications: excessive ROM, joint swelling, inflammation, tumors and unhealed fractures. V. Operating procedures 1. Patient position: comfortable, relaxed and pain-free position. 2. Position of the therapist: The treatment should be performed close to the treated joint, with one hand fixing one end of the joint and the other hand loosening the other end. 3.Pre-treatment assessment: Identify the existing problems (pain, stiffness and its degree). 4.Application of manipulation (1) Direction of movement of manipulation: can be perpendicular or parallel to the treatment plane. The treatment plane is the plane perpendicular to the axis of rotation at the midpoint of the joint surface. Separation – perpendicular to the treatment plane; sliding and long-axis traction – parallel to the treatment plane. (2) The degree of manipulation: should reach the joint movement limitation. Pain – up to the pain point, not beyond the pain point. Stiffness – should exceed the point of stiffness. The manipulation is balanced, rhythmic and lasts 30 seconds to 1 minute. (3) Treatment response: Mild pain – normal response. 24 hours still no reduction, or even increase indicates that the treatment intensity is too high or duration is too long.