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World Manual Therapy Encyclopedia
Orthopedic reasoningAccessory joint movement assessment concept

Mennell Joint-Play Approach

Testing tiny involuntary joint movements ('joint play') that you cannot do by yourself, to find out if a joint is blocked.

Evidence position: Historical framework; modern evidence is joint-specific

Master it · Start here

What it is, in plain words

Testing tiny involuntary joint movements ('joint play') that you cannot do by yourself, to find out if a joint is blocked.

Joint play (Mennell) means the small, passive give inside a joint, such as a slight glide or spin, which allows normal movement. If it is lost, normal movement may be restricted or painful. You test each joint's play, compare sides, and treat if it is reduced.

Think of it like this: A door hinge needs a tiny bit of wiggle to swing smoothly. If the hinge has no wiggle, the door sticks even though the door itself is fine.

1. The three ideas behind it

  1. 1Joint play cannot be performed actively; you must test it passively with the joint relaxed.
  2. 2Test in a loose-packed position, compare to the other side, and look for lost or painful play.
  3. 3Reduced joint play is one finding to interpret alongside pain and function.

2. Words you need (no dictionary required)

Joint play
Small passive movements of joint surfaces.
Loose-packed position
The joint position with the most room for joint play.
Close-packed position
The joint position with the least play, most stable.
Capsular pattern
A pattern of limited movements typical for joint capsule stiffness.

3. When to use it, and when not to

Good fit

  • A joint with restricted movement and no clear tissue cause.
  • As part of an orthopedic examination.

Do not use, or get advice first

  • Fractures, infection, or instability.
  • Joint play testing that increases pain sharply.

4. How to do it, step by step

  1. Step 1 · Position in loose-pack

    Support the joint so muscles relax.

  2. Step 2 · Stabilize one bone

    Hold one side still.

  3. Step 3 · Glide the other bone

    Apply a gentle glide, traction or compression.

  4. Step 4 · Compare with the other side

    Note amount, end-feel and pain.

  5. Step 5 · Decide

    Reduced play with a link to the patient's problem supports treatment.

  6. Step 6 · Treat and retest

    Mobilize if appropriate and recheck the movement.

5. How much is enough?

Testing is brief and gentle. Treatment dose follows the mobilization technique chosen.

6. A real-life example, start to finish

Fictional teaching case. Real patients always need individual assessment.

The patient
Hannah, 36, wrist pain after a cast was removed; wrist extension is limited.
What you find
Joint play at the radiocarpal joint is reduced compared with the other wrist.
What you do
A gentle glide mobilization is applied, followed by active movement.
What changed
Wrist extension improves. She continues home exercises.

7. Mistakes that spoil it

  • Testing in a tense position.
  • Forgetting to compare sides.
  • Treating a finding that does not match the patient's complaint.

8. Check yourself

Can the patient do joint play on their own?

No, it must be tested passively.

Which position is best?

Loose-packed.

Remember this one line

Test the hinge's wiggle, compare sides, and link to function.

What the research does and does not support

Joint-play testing is a classic examination concept. Reliability varies, so findings should be linked to symptoms and function rather than used alone.

Educational content. Hands-on skills require supervised practice, screening and informed consent.

Optional · Short patient story to help rememberThe door hinge that wasn't actually the door

Inside the clinic

The door hinge that wasn't actually the door

Fictional teaching scenario. Real patients always require individual assessment.

The arrival

A patient bends the wrist and says, 'It moves, so the joint must be perfect.' The clinician explains that visible movement and tiny accessory movements are related—but not identical. The wrist declines to comment.

The conversation

Patient: 'Can my wrist do an invisible dance?' Therapist: 'More like tiny joint movements. No choreography certificate needed.'

Detective work

Accessory joint play helps clinicians reason about motion, but perceived end-feel and translation cannot diagnose a tissue lesion by themselves.

Plot twist: What is the hidden catch?

A joint-play finding is one part of an assessment, not an X-ray built into the therapist's thumbs.

Aha Moment

Visible motion is only part of the mechanics; useful treatment still depends on measurable functional change.

Already familiar? Open the four-step clinical recapOptional

Mennell emphasized normal mechanical play and its role in joint movement. Present it alongside modern understanding of measurement reliability, symptom response and clinical uncertainty.

Based on joint-play work described by John M. Mennell.

1 · Screen first

Document the problematic functional movement and screen fracture, instability, inflammation and neurologic concerns.

2 · Assess the real task

Examine relevant active and passive motion, then gently compare selected accessory movements if clinically appropriate.

3 · Choose a safe clinical trial

Choose a low-risk mobility trial only when restrictions, patient goals and safety findings justify it.

4 · Retest and integrate

Retest the same meaningful movement; move toward active strengthening and self-management.

Explain it to the patient

Your wrist can look mobile in one direction while some supporting motions feel limited. We check whether that matters to the action you want back.

Go deeper · Full chapter with extra cases and clinical reasoning (optional)

Beyond the introduction · Your complete deep dive

Learn the thinking. Picture the hands. Remember the lesson.

A patient says, 'My wrist bends, so the joint play must be fine.' The clinician replies, 'A door can swing yet still have a hinge that tells a different story.' Mennell's historical joint-play concept reminds learners that visible movement and small accessory motion are related without being identical. But a metaphor is a reason to examine, not permission to invent a microscopic diagnosis with the thumb.

Chapter I · The ideas that make the method different

Understand the why before the how

Concept 1

Physiological versus accessory movement

People voluntarily flex, extend and rotate joints; some associated gliding, rolling, spinning or small distraction is not consciously performed in isolation. Joint-play assessment conceptually explores those accessory components while the person remains relaxed and supported.

Concept 2

The historical contribution

Mennell emphasized accessory movement as a potentially relevant component of joint examination. His work helped shape later manual therapy traditions, but historical influence and modern proof of the same mechanism are different things.

Concept 3

Every joint has its own geometry

A wrist, hip and facet joint do not share a universal glide direction or loading tolerance. Joint orientation, stability, ligament restraint, adjacent nerve structures and individual irritability must inform examination. Simplistic 'every stiff joint needs one glide' rules are unreliable.

Concept 4

The examiner's hands have measurement limits

Perceived resistance, end-feel and segmental movement interpretation can vary between examiners. A joint that feels stiff under one person's fingers does not automatically reveal the exact tissue at fault. Reproducible patient findings are essential.

Concept 5

Use an accessory finding as one part of a hypothesis

Ask whether the palpation finding aligns with pain behavior, range, function and risk screening. If it does, a gentle trial within training may be reasonable; if it conflicts with the rest of the examination, treat the inconsistency as useful information.

Chapter II · The clinical detective's notebook

What to notice before touching the patient

The first clue is rarely hiding under the therapist's thumb.

Observation 1

Start with a comparable functional sign

Use a task such as wrist extension during a chair rise or reaching to fasten a seat belt. Record range, symptoms and compensations. This gives the later manual trial a reason to exist.

Observation 2

Clear safety screening

Review trauma, inflammatory conditions, recent surgery, joint instability, bone fragility, altered sensation and relevant neurovascular findings. Suspected fracture or dislocation is not a moment for experimental glides.

Observation 3

Differentiate restrictions and drivers

Compare active and passive motion, joint tolerance and task-specific symptoms. Contractile weakness, neural symptoms and pain-related guarding may resemble joint stiffness; do not assume accessory restriction from one touch test.

Observation 4

Document what was felt—without overcalling it

Use observational wording such as 'reduced perceived accessory excursion under light comparison' rather than 'bone is out of alignment'. Reliability is more honest when language reflects uncertainty.

Chapter III · Inside the method

Follow the clinical sequence, not a memorized ritual

These are conceptual stages for professional learning. Region-specific manual contacts, clinical indications and supervised training remain essential; especially uncertain or higher-risk methods are not instructions for self-treatment.

1

1. Establish a meaningful target

Define one movement or task with a recognizable limitation. A patient might report pain while supporting weight through the wrist, not simply 'lack of joint play'.

2

2. Screen tissue tolerance and stability

Check history and signs that may make passive accessory stress unsafe; consider which structures lie near the planned contact, including nerves and vessels.

3

3. Choose joint-appropriate positioning

The region should be supported and relaxed, with the neighboring segment stabilized only enough to isolate a safe test. Exact hand placement varies and requires supervised joint-specific training.

4

4. Explore a gentle accessory movement

A low-force distraction or glide may be tested in an appropriate direction while monitoring patient comfort and symptom quality. Do not force end range or invent a displacement diagnosis based on resistance.

5

5. Retest the baseline task

Return to the exact chair rise, reach or step under similar conditions. If the movement improves, link the response to graded active use. If not, reconsider other impairments.

6

6. Understand the limits of the result

Improvement after a manual input can arise through more than a structural change. Record symptom and function changes; avoid claiming the joint was repositioned.

Chapter IV · A day inside the treatment room

One patient's story, five moments that matter

Fictional educational case, not a real patient record or proof that the method works.

Scene 1 · The arrival

A designer struggles to push up from a chair because the wrist feels blocked. A colleague insists the joint must have a microscopic 'jam'. The wrist has apparently been accused without a trial.

Scene 2 · The clues

The clinician compares active wrist motion with supported passive testing and checks whether pain is related to load, tendon irritation or neural symptoms. The accessory finding is modest and not completely consistent with the patient's task.

Scene 3 · The decision

A gentle, joint-appropriate manual trial is considered only after screening. A task-specific strengthening or graded weight-bearing option is also discussed.

Scene 4 · The plot twist

The wrist feels 'more mobile' to the clinician afterward, but the chair rise remains uncomfortable. The patient has supplied the plot twist the thumb missed.

Scene 5 · The next chapter

The plan focuses on tolerance to progressive loading and further assessment if symptoms persist. The joint-play observation remains a clue, not a single definitive cause.

The unforgettable line

A joint can have an interesting hinge; your hand is not a microscope.

Chapter V · Claims under the microscope

What is known, what is uncertain, and what we should say

What can reasonably be said

Accessory movement forms part of normal joint mechanics, and historic joint-play reasoning influenced manual therapy examination. Some condition-specific joint mobilizations may help selected patients as part of multimodal care.

Where certainty ends

There is insufficient basis to treat perceived joint-play asymmetry as a reliable microscopic lesion or to claim that the historical Mennell method outperforms modern evidence-based exercise and assessment.

Explain it to the patient without jargon

'I will check how the joint moves with gentle support, but the test is only one clue. We still judge progress by your pain, motion and ability to do the task you came for.'

The final two plot twists · Test yourself

Would you make the same decision?

Challenge 1

Why shouldn't a 'stiff' accessory glide be called a specific joint subluxation?

Think first · Reveal the clinical reasoning

Palpated accessory findings alone lack the diagnostic specificity to establish such pathology. Integrate history, activity, symptoms and objective movement.

Challenge 2

A manual input alters perceived joint feel but not the patient's task. What should change?

Think first · Reveal the clinical reasoning

Reconsider whether the accessory finding is clinically relevant and emphasize function, graded loading or other assessed contributors.

Practical education is not a substitute for supervised skill training, differential diagnosis or professional guidelines.

Further reading for the curious clinician

Some sources describe a historical model or wider clinical guidelines. Neither should be mistaken for proof that the named method works for every patient.

Your turn · The clinical plot twist

You are the clinician. What would you do?

Which statement is sound clinical reasoning?

Pick one. Think like a clinician, not a technique collector.

See what the research actually says
Evidence context, myths and source links · Optional appendix

Evidence reality check

What research supports — and what it does not

This is an influential historical manual therapy concept. Do not infer that a palpated restriction identifies exact pathology or that a Mennell-branded manipulation is superior.

Myth vs fact

'My thumbs can tell you exactly which microscopic joint surface is wrong.' No reliable magic microscope exists.

Stop, screen or refer

Avoid accessory stress where acute fracture, dislocation, significant instability or active inflammatory joint pathology is suspected.

Reading and source material

Where a source addresses broader manual therapy rather than this exact named approach, it is contextual reading—not proof of the named method. Clinical teaching does not replace certified technique training, consent or personalized care.