Arthrofascial Stretching (AFS) – Soft Tissue Joint Mobilization for Manual Therapists



Clinical Orthopedic Manual Therapy (COMT): Arthrofascial Stretching is a 2-day hands-on workshop that is part of the COMT Certification – Skillset Approach Program offered by Dr. Joe Muscolino. The goal of the COMT Skillset Approach Certification is to reinforce and hone essential COMT assessment and treatment skills, thereby strengthening your level of critical thinking and effectiveness of practice.

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.


LE-Medial-Rotator-Stretch-Supine-copyAfter attending this workshop, the participant will be able to:

Describe the five grades of joint mobilization.
State the indications and contraindications for Arthrofascial Stretching (AFS).
Explain the physiologic basis for motion palpation assessment and AFS treatment techniques.
Demonstrate how to perform motion palpation assessment and AFS treatment techniques for the joints of the body.
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

Jt-Mob-YAN_2489-Edit-copy-2AFS 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)

Review and paperwork: 30 min

  • Question and answer
  • Fill out evaluation forms
  • Hand out Certificates


  • 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).

COMT: Arthrofascial Stretching is part of the COMT Skillset Approach Certification.

The five courses are: