Basic concept: Joint release technique is a highly targeted manipulation technique done by the therapist within the movable range of joint activities, and belongs to the category of passive motion. 1.Physiological movement of the joint: 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 for maintaining 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, lateral movement of the patella, etc. 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. Basic methods: 1. Oscillation: The lever-like movement of the bone is called oscillation, i.e., physiologic motion, and the oscillation should be fixed at the proximal end of the joint, and the joint should do round-trip motion remotely. Oscillation must be applied only when the ROM is >60% (normal). For example, the oscillation maneuver for shoulder pronation should be applied only when the shoulder pronation reaches at least 100°, if it does not reach this range it should be improved first with accessory motion maneuvers. 2.Rolling: When a bone rolls on the surface of another bone, the surface shapes of the two bones must not coincide and the contact points change at the same time. The movement that occurs is an angular movement, and the direction of the roll is always in the direction of the angular bone movement, often accompanied by sliding and rotation of the joint. 3.Sliding: When a bone slides on another 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 contacts a different point on the opposite bone surface. The direction of sliding depends on the concave and convex shape of the articular surface of the moving bone (convex – the direction of sliding is opposite to the direction of osteogenic angular movement; concave – the direction of bone movement is the same as the direction of osteogenic angular movement) The closer the shape of the articular surface – the more sliding, the more inconsistent the shape of the articular surface – the more rolling. 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 movement of the surface of the bone at rest around the axis of rotation, when rotation, the same point of the mobile surface for circular 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 an external force acts on the long axis of the bone to make the joint remotely displaced, it is called long-axis traction. Difference: 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 may not be separated. Manual grading: 1. Matland grading criteria: Grade I – The therapist loosens the joint at the beginning of the patient’s joint movement, in a small, rhythmic back and forth manner. 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 loosens 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 at the end of the patient’s joint, in a small range, rhythmically back and forth, each time contacting the end of the joint activity, and can feel the tension of the soft tissues around the joint. 2.Manipulation application options: Ⅰ, Ⅱ grade – pain , Ⅲ – pain + joint stiffness, Ⅳ – adhesions, contractures. Manual grading can be used for accessory motion and physiological motion of the joint. Accessory motion – I-IV can be used. Physiological motion – ROM > 60% of normal can be used, mostly grade III-IV, rarely grade I. Grading range of joint range of motion changes in size. Therapeutic effects and clinical applications: 1. Therapeutic effects: (1) Physiological effects: mechanics + neurological effects. Mechanical effect: 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 nociceptive, improve pain threshold. (2) Maintain tissue extensibility: joint loosening, especially grade III and IV – directly stretches the soft tissues around the joint → can maintain or increase extensibility and improve ROM. (3) Increase proprioceptive feedback: joint loosening to provide the following sensory information: resting position and speed and change of joint movement, direction of joint movement, muscle tension and change. 2. Clinical applications: (1) Indications: Joint dysfunction caused by any mechanical factor (non-neurological). These include: a. pain, muscle tension and spasm, b. reversible ROM↓, c. progressive joint motion limitation, and 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. Operating procedures: 1. Patient position: comfortable, relaxed and pain-free position. 2. Position of the therapist: 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 of 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 where the joint movement is restricted. Pain-Reaching the painful point and not exceeding it. Stiffness – should exceed the point of stiffness. The manipulation is balanced, rhythmic and lasts 30 seconds to 1 minute. (3) Treatment response: slight pain – normal response. 24 hours and still no reduction, or even increase indicates that the intensity of treatment is too high or the duration is too long.