Open your exercise therapy syllabus and you'll find what looks like one topic: manipulation of joints, soft tissue work, mobilization of all joints, traction. Then class begins, and that single line splits into 4 different treatments, 2 grading systems and a long list of precautions. Most students lose the thread right there.
Here's the good news. Once you understand how joint surfaces move, the rest shrinks to a few rules you can reuse on any joint. That's all joint mobilization techniques really are: the same logic, applied again and again.
Table of Contents
What Counts as Passive Movement in Exercise Therapy?
Passive movement techniques are treatments where the therapist moves the tissue and the patient stays relaxed. They include soft tissue manipulation (massage strokes), joint mobilization (graded oscillations or glides), manipulation (a single fast thrust at end range), and traction (pulling joint surfaces apart). Each one targets a different structure and goal.
Think of the body as a stack of layers. Soft tissue work reaches skin, muscle, fascia and scar. Joint mobilization goes a layer deeper, to the capsule and ligaments. Manipulation, in its strict sense, is a quick thrust at the end of the range. Traction pulls the surfaces apart, so it works on the capsule and the surfaces together. Figure 1 shows how the four groups fit together.
Here's the idea in plain words. Joint mobilization is a skilled, passive movement of a joint, applied slowly enough that the patient can stop it. The therapist glides or oscillates one joint surface on the other, which stretches a tight capsule and stimulates the joint's sensory receptors. Why should you care? A stiff joint with a shortened capsule won't loosen with muscle stretching alone, and "define joint mobilization" is a standard theory question.
Soft tissue sits on top of every joint, so it's the first layer your hands meet. That's where we start.
Soft Tissue Manipulation: What Do Your Hands Actually Do?
Soft tissue manipulation means moving, squeezing or stretching skin, muscle, fascia and scar with your hands. Classic massage texts group the strokes into stroking (effleurage), kneading (pétrissage), friction, percussion (tapotement) and vibration.
Think of a tight muscle like a wet towel twisted into a rope. Wringing and untwisting it squeezes fluid out and lets fresh fluid in. Kneading does a version of that to the muscle belly, which is why it's linked with better circulation and lower muscle tone.
Three kinds of effect get taught. The mechanical effects come first: strokes toward the heart push venous blood and lymph along (veins have valves, so direction matters), while deeper strokes stretch shortened tissue and loosen adhesions. Then come reflex effects, where touch input quiets pain and muscle guarding. Last, relaxation helps the patient's state of mind. Evidence for some of the deeper mechanical claims is still limited, so your exam answer follows the classic list while current research stays more cautious.
| Technique | What your hands do | Main aim |
|---|---|---|
| Stroking (effleurage) | Hands glide over the skin, light to firm, usually toward the heart | Relaxation, venous and lymphatic return; opens and closes a session |
| Kneading (pétrissage) | Lift, squeeze and roll the muscle belly (wringing, picking up) | Free muscle from deeper layers, improve circulation, reduce tone |
| Friction | Small circular or transverse movements; fingertip moves the skin and tissue beneath it | Loosen adhesions, mobilise scar, tendon and ligament |
| Percussion (tapotement) | Brisk rhythmic strikes: clapping, hacking, cupping, pounding | Stimulate muscle; loosen secretions in chest physiotherapy |
| Vibration | Fine, rapid trembling transmitted through the hand | Relaxation; help clear chest secretions |
| Myofascial release | Sustained gentle load along the fascia until the tissue eases | Lengthen restricted fascia |
Here's where students blur 2 techniques. Kneading moves the muscle belly as a whole, lifting and rolling it. Friction barely moves your fingertip across the skin. It shifts the skin and the tissue under it across a tiny range, usually across the fibres, which is why it suits a scar or a tendon sheath.
Know the red flags as well, because examiners love them. Soft tissue work is avoided over acute local inflammation or infection, over a suspected deep vein thrombosis (a clot could move), over open wounds or skin disease, over a tumour, and over an unhealed fracture.
Soft tissue work frees the muscles and fascia around a joint. If the joint itself is stiff, though, hands on muscle won't solve it. For that, you need to know how joint surfaces actually move.
Why Do Joint Surfaces Roll, Glide and Spin?
Because no joint is a perfect match. Two bone ends with different curves can travel through a big range only if they roll, glide and spin on each other. That idea sits underneath every technique that follows.
Start with 2 words your textbook uses constantly. Osteokinematics is the movement you can see: the bone swings, as in flexion or abduction, and a goniometer measures it. Arthrokinematics is what the joint surfaces do inside the joint while the bone swings. Then there's joint play (also called accessory movement): the tiny give inside a joint that your own muscles can't produce, only an outside force can. Relax your hand and let a friend slide 1 knuckle a few millimetres. That small give is joint play, and without it the big visible movement gets stuck.
Surfaces move on each other in 3 ways. A roll is when new points on one surface meet new points on the other, like a tyre rolling along a road. A glide (or slide) happens when a single point on one surface meets new points on the other, the way a tyre skids on ice. Spin is the simplest: 1 surface rotates on a fixed point, like a top. Most joints mix all 3.
A joint needs the glide because a rolling head would run off its socket. Picture the humeral head as the arm goes up. If it only rolled upward, it would crash into the acromion above it. The glide slides it downward at the same moment, which keeps it centred. The arm rises while the joint surface sinks.
But which way should the glide go? The convex-concave rule answers that. When a convex surface moves on a fixed concave one, roll and glide run in opposite directions. When a concave surface moves on a fixed convex one, roll and glide run the same way. Measured against the bone you're moving: convex glides opposite, concave glides along with it.
Take the shoulder first. The humeral head is convex and the glenoid is concave, so the head is convex on concave. Raise the arm and the head rolls up while gliding down. Now take the knee in open chain, with the foot free to swing. The tibial plateau is concave and the femoral condyles are convex, so as the lower leg swings forward into extension, the tibia glides forward too. Figure 2 puts both side by side.
The shape of the moving surface decides the glide direction.
Here's where most students slip. They apply the rule to whichever surface they happen to be holding. The rule follows the surface that is moving, and which one moves depends on which bone you stabilise. Steady the scapula and move the humerus, and you have convex on concave. Steady the femur and swing the tibia, and you have concave on convex.
Kaltenborn added 1 more idea that simplifies the hands-on work: the treatment plane. It's an imaginary flat surface that lies across the concave partner at the joint. A glide runs parallel to that plane, and a traction pull runs at right angles to it. Learn to picture the plane and you can place your hands on a joint you've never treated.
Your exam expects the rule exactly as stated. Current research adds a caution: studies in living joints suggest real surface movement can differ from the rule, especially in joints with unusual shapes. Treat it as a dependable starting plan, then let your assessment confirm it.
Next, where should the joint sit while you work? In the close-packed position, the surfaces fit most tightly, the capsule and ligaments are taut, and the joint is at its most stable. That also leaves almost no joint play. In the loose-packed position, the surfaces fit least and the capsule is slack, so joint play is greatest. The resting position is the loose-packed position with the most slack, and it's where you begin. Kisner and Colby's 2018 text lists the standard positions, and these are the ones students are asked most.
| Joint | Resting (loose-packed) position | Close-packed position |
|---|---|---|
| Glenohumeral | 55° abduction, 30° horizontal adduction | Full abduction and lateral rotation |
| Humeroulnar (elbow) | 70° flexion, 10° supination | Full extension and supination |
| Radiocarpal (wrist) | Neutral, slight ulnar deviation | Extension with radial deviation |
| Hip | 30° flexion, 30° abduction, slight lateral rotation | Full extension, abduction and medial rotation |
| Tibiofemoral (knee) | 25° flexion | Full extension with lateral rotation of the tibia |
| Talocrural (ankle) | 10° plantar flexion, midway between inversion and eversion | Maximum dorsiflexion |
| Lumbar facet joints | Midway between flexion and extension | Full extension |
What happens if you try to glide a joint in its close-packed position? The capsule is already pulled tight, so almost nothing moves, and you load the cartilage for no gain. That's why initial treatment starts in the resting position. "Close-packed" means maximally stable, with surfaces tightly fitted, so it's the position for testing stability and never the place to begin stretching.
Quick pause. Hold on to 3 points: a joint needs play, glide direction comes from the shape of the moving surface, and you begin in the loose-packed position. Everything from here uses those 3.
Those ideas tell you where to place the joint and which way to slide. They don't tell you how hard, how far or how fast. Grades handle that.
How Do Maitland and Kaltenborn Grade Mobilization?
Maitland grades oscillating movements by their size and their position in the range. Kaltenborn grades sustained movements by how much tissue slack you take up. Both systems aim at the same goal, and you'll need both for exams.
Start with Maitland. The Australian physiotherapist Geoffrey Maitland described 5 grades in his work on peripheral manipulation. According to a Western States Chiropractic College clinic protocol based on his work, grades I to IV are rhythmic oscillations, and grade V is a separate thrust technique. Here's the full set in one place.
| Grade | Amplitude | Position in the range | Main aim |
|---|---|---|---|
| I | Small | Start of the range | Pain relief |
| II | Large | Within the free range, before resistance | Pain relief, relaxation |
| III | Large | Into resistance, up to the limit | Stretch stiff tissue |
| IV | Small | At the limit, into resistance | Stretch stiff tissue |
| V | Small, high velocity | End of the available range | Thrust manipulation |
See the pattern? Grades I and II stay in the free part of the range, and grades III and IV push into resistance. So why do I and II suit pain while III and IV suit stiffness? Because I and II sit where tissue isn't being stretched, so they work mainly through the nervous system, as the joint's sensory receptors calm pain input. Grades III and IV load the stiff tissue, so they work mechanically on the capsule. Figure 3 lays the 4 grades along 1 line of movement. R1 marks the first resistance you feel, and R2 marks the limit.
Pace matters too. Most texts describe a slow, smooth rhythm of roughly 2 to 3 oscillations per second, though the exact rate varies by author. Many texts also advise beginning and ending a session with grade I or II, so the joint settles before and after the stretch.
Kaltenborn's Nordic system, described in his book Manual Mobilization of the Joints, works differently. The Norwegian physiotherapist describes translatoric movements, where 1 surface moves along or away from the other. A traction pulls at right angles to the treatment plane. A glide slides parallel to it. Compression pushes the surfaces together, and it's used only as a provocation test. His grades describe slack. Grade I loosens the joint by cancelling compression, grade II takes up the slack, and grade III stretches tissue beyond the slack. Grade I applies only to traction.
Kaltenborn also scores joint play from 0 to 6. A score of 0 means no movement (ankylosed), 3 is normal, 1 and 2 are hypomobile, 4 and 5 are hypermobile, and 6 is completely unstable. Mobilization targets the hypomobile joints, scores 1 and 2. Hypermobile and unstable joints need a different approach.
| Feature | Maitland | Kaltenborn |
|---|---|---|
| Movement type | Rhythmic oscillation | Sustained hold |
| Grades | I to IV, plus V thrust | I to III |
| Grading basis | Amplitude and position in the range | How much slack is taken up |
| Pain relief | Grades I and II | Grade I and II traction |
| Stiffness | Grades III and IV | Grade III |
| Origin | Australia | Norway (Nordic system) |
Now the pair that confuses everyone: mobilization and manipulation. Both are passive. The single difference that separates them is control. In mobilization, the patient can usually stop the movement. In manipulation, the thrust is too fast to stop once it starts.
Going deeper: the 4 joint receptor types
Joint receptors fall into 4 types. Type I (postural, slow adapting) and Type II (dynamic, fast adapting) sit in the capsule and fire with gentle movement. Stimulating them is how grades I and II are thought to damp pain signals. Type III (inhibitive) sits mainly in ligaments and fires at the extremes of range, and its firing inhibits nearby muscle guarding. Type IV receptors are free nerve endings that carry pain.
Older teaching says mobilization "frees" stuck surfaces or corrects a positional fault. Current thinking gives more weight to neurophysiological effects, such as immediate pain relief through receptor input. Most exams still expect the classic explanation, so learn both and label each.
That covers the language. Now put it to work on real joints.
Joint Mobilization Techniques, Joint by Joint
You now hold the full toolkit: where to place the joint, which way to glide, and how hard. Here's the sequence a textbook technique follows, in the order you should be able to recite it.
- Position the patient comfortably, with the joint in its resting (loose-packed) position.
- Stabilise the fixed bone as close to the joint line as you can.
- Grasp the moving bone as close to the joint line as possible.
- Take up the slack and test the joint's reactivity with grade I or II.
- Apply the glide parallel to the treatment plane (or traction at right angles to it), in the direction the convex-concave rule predicts for the restricted movement.
- Reassess range and symptoms, and finish the session with a gentle grade I or II.
Which bone do you stabilise? The bone you don't want to move. For a stiff shoulder, steady the scapula and glide the humerus. The table below shows what the rule predicts once you've made that choice.
| Joint | Restricted movement | Glide to use | Rule applied |
|---|---|---|---|
| Glenohumeral | Abduction | Inferior glide of the humeral head | Convex on concave |
| Flexion, medial rotation | Posterior glide | ||
| Extension, lateral rotation | Anterior glide | ||
| Elbow (forearm bones on humerus) | Flexion | Anterior glide of the forearm bones | Concave on convex |
| Extension | Posterior glide | ||
| Radiocarpal (wrist) | Flexion | Dorsal glide of the carpals | Convex on concave |
| Extension | Volar (palmar) glide | ||
| MCP and IP joints | Flexion | Palmar glide of the proximal bone's base on the head | Concave on convex |
| Hip | Flexion, medial rotation | Posterior glide of the femoral head | Convex on concave |
| Extension, lateral rotation | Anterior glide | ||
| Knee (tibiofemoral, open chain) | Extension | Anterior glide of the tibia | Concave on convex |
| Flexion | Posterior glide of the tibia | ||
| Knee (patellofemoral) | Knee flexion | Inferior glide of the patella | Patellar glide |
| Knee extension | Superior glide | ||
| Ankle (talocrural) | Dorsiflexion | Posterior glide of the talus | Convex on concave |
| Plantar flexion | Anterior glide |
Textbooks differ on hand placement and a few glide names, so treat the table as the rule applied, and confirm against your own syllabus text before an exam.
Spinal techniques follow a different naming habit. They're usually named by the direction of the applied force. Maitland's classic set includes central posteroanterior (PA) pressure on the spinous process, unilateral PA pressure over the facet region, and transverse pressure on the side of the spinous process.
The table skips joints like the sternoclavicular, acromioclavicular, subtalar and temporomandibular. For those, repeat the same 3 moves: name the convex and concave partners, decide which surface moves given your stabilisation, and apply the rule.
Know when to hold back, too. Joint mobilization is avoided or modified in a hypermobile or unstable joint, in acute inflammation or infection, over a tumour, with an unhealed fracture, and with signs of nerve compression. A joint with considerable effusion tolerates only gentle grade I or II work, according to many sources.
All of those techniques press or slide the surfaces together. The next one does the opposite: it pulls them apart.
Traction: When Do You Pull a Joint Apart?
Traction is a pulling force that separates joint surfaces and stretches the soft tissue around them. You can apply it by hand (manual traction) or with a motor or weights (mechanical traction), and you can apply it to a limb joint or to the spine.
For limb joints, traction follows Kaltenborn's grades from Figure 4 and is usually given in the resting position, where the capsule is slackest. For the spine, the vocabulary changes. Now you talk about force, hold time, rest time and duration.
Traction does 3 classic jobs. It separates surfaces by a few millimetres, it stretches capsule, ligament and muscle, and it eases muscle guarding through the receptors we met earlier. In a central posterior disc protrusion, the tightened posterior longitudinal ligament is said to push the bulge inward, a centripetal effect. Studies have measured small separations, but they fade once the pull ends. Evidence for lasting benefit remains limited and mixed, so you'll meet 2 views: the classic mechanical story, and a more cautious modern one.
Manual and mechanical traction differ mainly in who sets the force. In manual traction your hands do. You can aim at 1 segment, change the pull instantly and feel the tissue respond, but the force is hard to measure, hard to repeat, and impossible to hold for long. In mechanical traction a dial does. Force and time are controlled and repeatable, though it's harder to target a single segment. That's why a brief manual trial often comes first, to check the patient tolerates the pull.
How much force is enough? Texts quote different cut-offs, so treat these as typical ranges. A widely taught figure is about 25% of body weight as a lower end for the lumbar spine, with up to about 50% of body weight quoted for separating the vertebrae. The neck needs far less, and about 7% of body weight is a commonly quoted starting point. Why the gap? The neck carries a small mass, while lumbar traction first has to beat friction between the body and the table.
| Parameter | Cervical traction | Lumbar traction |
|---|---|---|
| Position | Supine or sitting, neck about 20 to 30° flexion | Supine with hips and knees flexed, or prone |
| Force (typical teaching) | About 7% of body weight to start; about 10 to 25 lb (roughly 4.5 to 11 kg) in many notes | About 25% up to 50% of body weight |
| Mode | Intermittent is common | Sustained often chosen for disc protrusion; intermittent for joint stiffness or muscle spasm |
| Example hold:rest | About 6 s : 2 s (3:1) | About 60 s : 20 s for a disc; 15 s : 15 s for joint distraction |
| Duration | About 10 to 20 minutes | About 10 to 30 minutes, built up across sessions |
What if the lumbar force is too low? Friction swallows most of it, so the vertebrae may not separate at all. What if it's too high, too fast? The muscles guard against the pull, and the treatment tightens when you wanted it to relax. Cervical harnesses add 1 more detail: most of the pull should go through the occiput, because a strong chin pull loads the temporomandibular joint.
You'll also meet 2 words that overlap. Some authors use traction for the machine-applied pull and distraction for the manual technique, while others use them interchangeably. Expect both words in your textbook, and read the context.
Line up the 4 groups and a pattern appears. Each acts on a different layer, and each has a direction, a force and a reason. Keep that pattern, and revision fits on 1 page.
- Passive techniques: soft tissue manipulation, joint mobilization, manipulation (the Grade V thrust) and traction.
- Joint play is the small accessory movement that only an outside force can produce.
- Convex on concave: glide opposite to the bone's movement. Concave on convex: glide in the same direction.
- Begin in the loose-packed (resting) position. Close-packed means stable with very little play.
- Maitland: grades I and II for pain, III and IV for stiffness, V is a thrust.
- Kaltenborn: I loosen, II take up slack, III stretch. Grade I applies only to traction.
- Treatment plane: glides run parallel to it, and traction runs at right angles to it.
- Manual traction is graded by the therapist's hands. Mechanical traction offers controlled, repeatable force.
- Typical teaching forces: lumbar about 25% to 50% of body weight, cervical about 7% to start. Ranges vary by author.
- Know the contraindications for each technique. Joint mobilization techniques are for hypomobile joints only.
Quick Answers on Mobilization and Traction
What is the difference between joint mobilization and manipulation?
Both are passive techniques, but control separates them. In joint mobilization (Maitland grades I to IV), the therapist uses slow, graded oscillations or sustained glides, and the patient can usually stop the movement. Manipulation (Grade V) is a small, fast thrust at the end of the available range, and the patient can't stop it once it starts. That difference in control is why manipulation carries stricter precautions.
What is the convex-concave rule in simple words?
The shape of the moving joint surface decides the glide direction. When a convex surface moves on a fixed concave one, such as the humeral head in the shoulder socket, it glides opposite to the bone's movement. When a concave surface moves on a fixed convex one, such as the tibia on the femur, it glides in the same direction as the bone.
Which Maitland grades are used for pain and which for stiffness?
Grades I and II use small to large oscillations in the free part of the range, so they're taught for pain relief and relaxation. Grades III and IV push into tissue resistance, so they're taught for stiffness and loss of range. Many texts also advise starting and ending a session with grade I or II, so the joint settles before and after the stretch.
Why do we mobilize a joint in its loose-packed position?
In the loose-packed (resting) position, the joint surfaces are least congruent and the capsule and ligaments are most slack, so joint play is greatest. That makes it the easiest place to test and mobilize. In the close-packed position, the capsule is tight and the joint is at its most stable, so there's very little play to work with.
How is manual traction different from mechanical traction?
Manual traction uses the therapist's hands, so the force is adjusted by feel, can be aimed at 1 segment and is hard to record exactly. Mechanical traction uses a motor or weights, so force, hold time and duration are controlled and repeatable, though it's harder to target a single segment. Therapists often use a brief manual trial first to check that the patient tolerates the pull.
What are the main contraindications of spinal traction?
Textbooks usually list acute injury or inflammation, spinal infection, tumour, severe osteoporosis, fracture, spinal instability and signs of cord compression. For the neck, rheumatoid arthritis with upper cervical instability and vertebrobasilar insufficiency are added. For the low back, pregnancy and aortic aneurysm commonly appear. Lists differ by author, so match your syllabus text.
This article is written for educational purposes for health-science students. It is not medical advice and never replaces clinical training, professional judgment, or your institution's curriculum. Real clinical decisions always require proper patient assessment under qualified supervision.
References
- Kisner C, Colby LA, Borstad J. Therapeutic Exercise: Foundations and Techniques. 7th ed. F.A. Davis; 2018.
- Maitland GD. Peripheral Manipulation. Butterworth-Heinemann.
- Kaltenborn FM. Manual Mobilization of the Joints, Volume I: The Extremities. Olaf Norlis Bokhandel.
- Western States Chiropractic College Clinics. "Grades of Mobilization (Maitland's)." Clinic protocol. (1998).
