The word articulation originates from the latin meaning ‘jointed’ or ‘divided into joints’. Articulation is the cornerstone of most manual therapies, including osteopathy, physiotherapy, chiropractic, sports therapy and massage therapy.
Articulation uses a low amplitude (short distance) and low to moderate velocity (speed) of movement within the patients pain free range of motion while in dysfunction. This aids the bodies natural lubricating system (synovial fluid) to embalm the joint which increased range of motion, decreased pain or both (ideally).
Articulation techniques have been shown to help relieve pain and increase range of motion in joints.
Human joints bear considerable forces resulting from the day-to-day activities of daily living. Our joint tissues help the body to protect against and withstand these forces. When these tissues are stretched due to movement and stress, they undergo an elastic phase of deformation. However, if the tissues are stressed beyond the greatest capacity of the elastic phase, this leads to the plastic phase of deformation 13.
The plastic deformation of tissues in the joint often causes a number of problems, these include Tissue thickening, a tear of the tissue, loss of tissue elasticity, shortening of the tissue, joint stiffness and a loss of range of motion in joints.
Healthy movement through the joint tissues can assist in tissue repair and recovery. This healing mechanism of tissues is thought to promote by a process known as mechanotransduction, any of various mechanical and structural cues that encourage cell behaviour 8. Joint articulation techniques can influence the mechanotransduction process, enabling the patient to return to normal physical activity 6.
Encouraging faster tissue repair and recovery
Promoting healthy cellular homeostasis
Reducing musculoskeletal pain and discomfort
Increasing joint movement by stretching fibrous tissue and affecting the stretch reflex excitability
Increasing the vascular circulation in and out of the joint
Improving structural stability and integrity of the intervertebral disc
Preventing degenerative changes to the articular surfaces
Inhibiting the build-up of fluid and distension forces upon the tissues and joint
Aiding the removal of metabolic waste products
Influencing the sympathetic nervous system activity, thus affecting blood flow, blood pressure, heart rate or respiratory rate
Exceed the natural motion barrier
Stress the tissues excessively
Force the tissues to undergo the plastic deformation
Synovial joints allow friction-free, smooth movement to the articulating bones at their point of contact. This gives the bones of a joint the freedom to move freely in various planes. The articular cartilage plays a significant role in the increased joint mobility. It serves as the load-bearing material for synovial joints, allowing distribution of contact forces and reducing friction and wear.
However, articular cartilage is an avascular structure, thus depends predominately on the synovial fluid for the nutritional supply. The continuous supply of nutrition to the cartilage ensures faster recovery from an injury. It is also important for the smooth lubrication of the articular surfaces. A lack of lubrication at the articular cartilage causes reduced nutritional input during joint immobility 17.
Therefore, movement through the joint, whether active or passive, is essential for the optimal functioning of articular cartilage 1, 14. The application of articulation techniques through injury and recovery can aid the lubrication of the joint, encouraging the trans-synovial pump 2.
Fluctuation of the intra-articular pressure
Regulation of blood flow to the joint
Facilitation of fluid drainage in and out of the joint.
Potentially enhance the healing mechanism within the joint
Aid the fluid circulation to and from the joint
Stability to the bones of the joint
Ensure rigidity when needed, and
Assist in the guiding of movement through the joint.
When tendons and ligaments are placed under stress, they change their shape to absorb the pressures applied on them within their physical limits 6. They toughen and become stiffer with increased strain but weaken with less strain 15.
Therefore, the application of either passive or active movement through connective tissues is important following a trauma. The movement is essential not only for the nutritional and vascular health of tissues but also for the tissue repair and recovery 5, 12.
Help ligaments to develop greater tensile strength
Inhibit adhesion of the tendon with its sheath
Prolong the strength and resistance of the tissues
Reduce the formation of fibrous tissue
Articulation of the joints can result in stimulation of mechanoreceptors in joint tissues, ligaments and the joint capsule 2. When a joint is articulated within its anatomical limits, the large myelinated A-beta fibres are activated, which are responsible for the ‘closing’ of the gating system 11. This, in turn, generates the pain threshold lowering effects, neutralising the transmission of pain signals by the small neurofibres, A-δ and C fibres.
Increase extensibility of targeted joint tissues
Produce hypoalgesic effects, both locally and distally
Decrease pain and muscle spasm in the chronically inflamed joint and muscle areas
Enhance pain-free mobility of joints and better joint alignment
There are no absolute values for the duration, amplitude, and frequency of articulation. They should be personalised depending on the individual patient, joint and practitioner 10. The amplitude of articulation should be less enough to cause pain but ample to generate movement. Research has shown that three cycles of 60-second articulations can achieve both local and widespread analgesia 4, 9, 16. The amplitude can be slowly increased with the subsiding of symptoms.
In conclusion, it can be said that early articulation of joints can significantly contribute to the treatment of pain and immobility. If the articulation techniques are applied skilfully and accurately, they can profoundly lower the pain threshold, increase the range of motion of joints, and promote faster recovery of tissues.