The treatment goal: To restore joint play & normalize roll-gliding that occurs in normal active physiological movements
1. Resting & actual resting positions: resting positions is otherwise called maximum loose pack position. In this position the capsule is lax maximally hence can accommodate maximum most fluid.
a. The term actual resting position is used for special circumstances where it is impossible, impractical or difficult to use maximum loose pack position.
b. Positional fault: Traction to decrease pain is usually performed form resting position. If it is difficult to perform traction from the resting position then the actual resting position is chosen. If traction to reduce pain performed from actual resting position produces pain then a positional fault is said to exist.
c. Once this is found first aim is to perform glide-mobilizations to correct the positional fault & it is obvious that one must find the direction of glide that is restricted & responsible for positional fault.
d. Once the positional fault is corrected traction & other mobilization techniques may then be performed.
2. Every hypo-mobile joint is initially treated with traction-mobilization for pain possibly with other electro-therapeutic adjunct. After there is improvement of pain glide-mobilization in the restricted direction can be carried out.
3. Traction-mobilization & Glide-mobilization should occur without pain.
4. In severely restricted joints usually the Glide-mobilization is painful in the restricted direction. In this case traction-mobilization &/or glide-mobilization in pain-free directions is performed until the joint is more mobile or gliding in the restricted direction is no longer painful.
Excerpts from my manual therapy class