Clinical Orthopedic Manual Therapy (COMT) Arthrofascial Stretching (AFS) – Soft Tissue Joint Mobilization for Manual Therapists


This workshop covers in depth both motion palpation assessment technique and Arthrofascial Stretching (AFS, soft tissue joint mobilization [Grade IV] for Manual Therapists) treatment technique, applied to all joints of the body, including the cervical, thoracic and lumbar spine, rib cage, and sacroiliac joint, as well as the joints of the upper and lower extremities. This course is a 2-day hands-on workshop.

Motion palpation technique provides the therapist with a simple and direct means of assessing the motion of a specific joint. AFS is a very specific form of pin-and-stretch technique that is the only effective means of stretching intrinsic fascial and muscular tissues of hypomobile joints.

This two-day Clinical Orthopedic Manual Therapy (COMT) workshop begins with motion palpation and AFS of the cervical spine, offering multiple approaches to each range of motion, including traction techniques for the neck. We then learn how to assess and mobilize the thoracic spine and rib cage, and then assess and mobilize the lumbar spine and sacroiliac joint. On day two, we then cover motion palpation and AFS stretching of the joints of the upper and lower extremities. AFS is likely the most powerful and specific orthopedic treatment tool available to manual therapists.

Clinical Orthopedic Manual Therapy for Arthrofascial Stretching is part of larger Clinical Orthopedic Manual Therapy (COMT) Certification. The other hands-on workshops in this series cover the neck, low back/pelvis, upper extremity, and lower extremity.


After attending this workshop, the participant will be able to:

  1. Describe the five grades of joint mobilization.
  2. State the indications and contraindications for Arthrofascial Stretching (AFS).
  3. Explain the physiologic basis for motion palpation assessment and AFS treatment techniques.
  4. Demonstrate how to perform motion palpation assessment and AFS treatment techniques for the joints of the body.
  5. Explain and demonstrate the principles of using core body weight and larger muscle groups for efficient body mechanics.


Following is the usual time line for this workshop. Note: This time line is often adjusted as needed based on the needs of the particular group.

Introductions: 15 min

  • Introduction to the content of the class
  • Introduction of instructor and workshop participants to each other
  • Discussion of concepts of arthrofascial stretching (AFS) and motion palpation and demonstration of these techniques: 15 min
  • Discuss concept of space-occupying conditions of the spine – contraindications and indications for spinal AFS (demonstration and workshop): 30 min
  • Foraminal compression test
  • Maximal foraminal compression test
  • Cervical distraction test
  • Cough test
  • Valsalva maneuver
  • Slump test
  • Vertebral artery competency test
  • Straight leg raise

AFS of the sacroiliac joint (demonstration and workshop): 90 min

  • Prone compression PSIS anterior / anterosuperior / anterolateral / anterosuperolateral
  • Prone compression PSIS with thigh in extension
  • Prone compression midline sacral base anterior / anterosuperior
  • Prone compression lateral sacral base anterior / anterosuperior / anterolateral / anterosuperolateral
  • Prone compression sacral apex
  • Side-lying compression pelvic bone
  • Anterior compression ASISs
  • Standing sacroiliac joint motion palpation

Break: 15 min

AFS of the lumbar spine (demonstration and workshop): 75 min

  • Prone compression anterior (SP contact)
  • Prone compression anterior (mammillary process contact)
  • Prone compression anterolateral (SP/lamina contact)
  • Seated lateral flexion / rotation / rotation
  • Supine towel traction

Lunch: 60 min

AFS of the thoracic spine / rib cage (demonstration and workshop): 60 min

  • Prone compression anterior (SP contact)
  • Prone compression anterior (TP contact)
  • Prone compression anterosuperior (rib contact)
  • Supine rib cage mobilization
  • Supine thoracic extension
  • Supine thoracic flexion
  • Seated rib cage
  • Seated thoracic spine

AFS of the cervical spine (demonstration and workshop): 60 min

  • Supine flowing maneuver
  • Supine lateral flexion
  • Supine lateral flexion with extension
  • Supine rotation
  • Seated
  • Supine towel traction

Break: 15 min

Side-lying AFS of the sacroiliac spine and lumbar spine: (demonstration and workshop): 60 min

  • Sacroiliac joint PSIS contact (anterior and posterior tilt)
  • Sacroiliac joint sacral contact (anterior and posterior tilt)
  • Lumbar spine mammillary process contact
  • Lumbar spine SP contact

Seated mat mobilizations (demonstration and workshop): 30 min

  • The saw (thoracic)
  • Thai lumbar mobilization (feet contact)

Review: 15 min

  • Question and answer
  • Discuss treatment strategy


Introductions: 30 min

  • Question and answer over material from Day 1

Workshop AFS for Joints of the Upper Extremity: 105 min

  • Fingers (MCP and IP joints)
  • Glenohumeral joint (glides anterior, posterior, superior inferior, and axial distraction/traction)

Break: 15 min

Continue workshop AFS for Joints of the Upper Extremity: 90 min

  • Shoulder girdle (seated or side-lying)
  • Radioulnar joints
  • Elbow joint
  • Wrist

Lunch: 60 min

Workshop AFS for Joints of the Lower Extremity: 105 min

  • Toe joints (MCP and IP joints)
  • Intermetatarsal joints
  • Dorsal ankle region
  • Therapist contact: middle fingers braced
  • Talus traction
  • Dorsal to plantar tarsals
  • Plantar ankle region
  • Therapist contact: pisiform, reinforced thumb
  • Dropped navicular
  • Dropped cuboid
  • Other tarsals

Break: 15 min

Continue workshop AFS for Joints of the Lower Extremity: 90 min

  • Fibula (superior glide with dorsiflexion and inferior glide with plantarflexion; anterior/posterior glide)
  • Patella
  • Knee joint (around forearm)
  • Hip joint (all directions with thigh flexed to 90 degrees)
  • Traction (towel traction and Thai move for thigh contact for hip joint)


  • King-sized pillow case (preferably flannel)
    Note: Participants should wear comfortable loose-fitting clothing: short sleeve shirt and short pants.
    Females should bring a button down shirt that can be worn backwards (or a patient gown).

About the Lecturer

  • Dr. Muscolino is a licensed chiropractic physician and teaches anatomy, physiology, and nutrition at Purchase College, State University of New York (SUNY). Dr. Joe Muscolino also taught kinesiology and musculoskeletal and visceral anatomy, physiology, and pathology courses at the Connecticut Center for Massage Therapy (CCMT) from 1986 – 2010.
  • Dr. Muscolino is also an approved provider by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) for continuing education (CE) credit for massage therapists and bodyworkers and runs numerous advanced study workshops, including deep tissue, advanced stretching, joint mobilization, and palpation workshops, as well as cadaver labs.
  • He also runs in-services for instructors of massage therapy, covering topics such as how to teach muscles, muscle palpation, kinesiology, and more; as well as in-services for Pilates and yoga instructors and fitness trainers on all subjects of musculoskeletal anatomy and physiology, and kinesiology.
  • Dr. Muscolino has a private Chiropractic practice in Fairfield, CT.



Course Date and Venue

Course title:Clinical Orthopedic Manual Therapy (COMT) - Joint Mobilization (Arthrofascial Stretching)
Date: 11-12 July 2016 (Mon-Tue)
Time: 9:00am-6:00pm
Venue: TBA
Fees: S$900 per person
Closing date for registration: 11 July 2016
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