09-01 Manipulation/Mobilization Flashcards
1
Q
Definition of Manual Physical Therapy
A
- Skilled hand movements intended to improve tissue extensibility; increase ROM; induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; reduce soft tissue swelling, inflammation, or restriction
- Hands-on; doing something with hands
2
Q
Manual Physical Therapy - Procedures/Modalities
A
- Manual lymphatic drainage
- Manual traction
- Massage
- Mobilization/manipulation
- Passive ROM
3
Q
Definition of Mobilization
A
- “A skilled passive movement of a joint” [Stanley Paris, Pres/Founder of USA]
- Continuum of skilled passive movements to the joints and/or related soft tissues that are applied at varying speeds and amplitudes, including a small amplitude/high velocity therapeutic movement
- Amplitude = Size/motion
- Velocity = Speed
4
Q
Somatic Dysfunction
A
- Impairment or altered function of the related components of the somatic system
- Skeletal
- Arthrodial
- Myofacial structures
- Related vascular, lymphatic, and neural elements
5
Q
Classical [Physiological] Movements
A
- Active and passive
- Osteokinematics: Cardinal plane movements
- ROM and muscle function/end range
6
Q
Accessory movements
A
- Component motions [Accompany active motion but not under voluntary control]
- Joint play [Motions occur between joint capsules; the “give” that causes bones to move]
- Arthrokinematics: Necessary to complete Roll, Glide, Spin, Distraction, Sliding, Compression
- Facilitates movement
- Cannot be actively performed by the patient
- Relieves and absorbs extrinsic forces
7
Q
Joint play
A
- Extra bit of motion outside of volutional control
- Protects joint at end range
- Mobilization restores joint play
8
Q
Manipulation movements
A
- Non-thrust [Distraction and glides]
- Thrust
- Muscle energy
9
Q
Non-thrust manipulation
A
- Distraction and glides
- Elongates connective tissue including adhesions, neurophysiologically to fire cutaneous muscular and joint receptor mechanisms [adhesions occur after 10 days]
10
Q
Distraction vs Traction
A
- Distraction: Application of a force with joint separation
- Traction: Application of a force with NO joint separation
11
Q
Thrust
A
- Sudden high velocity, short amplitude motion
- Delivered at the pathological limit [end of available ROM when there is restriction] of an accessory motion
- Grade 5, can cavitate [POP!] joint
12
Q
Muscle Energy
A
- Active isometric muscle contraction alters positional relationships or mobilizes joints
- Different approach to contract/relax
- Muscle contraction moves joint using reversed origin/insertion
13
Q
Self-mobilization
A
- Teach patient to enhance what is done in-clinic and maintain goals
- Self-stretching techniques specifically use joint traction or glides to direct the stretch force to the capsule
14
Q
Mobilization with Movement (MWM)
A
- Developed by Brian Mulligan
- Combination of active physiological movement by the patient and passive accessory movement by the therapist
- Passive stretching delivered without pain as a barrier
15
Q
Mobilization Under Anasthesia (MUA)
A
- Medical procedure
- Patient is manipulated while anesthetized
- Restores full ROM by breaking adhesions around a joint
- Uses rapid thrust or passive stretch using physiological or accessory movements
16
Q
Goals of manipulation
A
- Restore normal, pain-free movement of the musculoskeletal system in postural balance
- Restore joint play and ROM
- Even distribution of loads
17
Q
Biomechanical effects of manipulation
A
- Improves the plasticity and elasticity of shortened or thickened soft tissue by:
- Stretching tight capsules
- Snapping adhesions
- Alter positional relationships
- Improve fluid dynamics [blood, lymph synovial fluid]
- Release sensitive structures [nerves, facet capsules]
18
Q
Neurophysiological effects of manipulation
A
- Reduce muscle tone/pain by firing mechanoreceptors
- Types I-II [gate pain]
- Type III [stretch, thrust]
- Type IV [injury, inflammation]
19
Q
Type I manipulation
A
- Postural
- Capsule
- Oscillations [small movement of joints]
- Releases endorphins and enkephalins; gates pain
20
Q
Type II manipulation
A
- Dynamic
- Capsule
- Oscillations [small movement of joints]
- Releases endorphins and enkephalins; gates pain
21
Q
Type III manipulation
A
- Inhibits muscle contraction & sense of direction
- Capsule, ligaments
- Stretch, sustained pressure, thrust
- Releases chemical holds
22
Q
Type IV manipulation
A
- Nociception
- Most tissue
- Injury, inflammation
23
Q
Chemcial effects of manipulation
A
- Release of endorphins and lipoproteins
24
Q
Psychological effects of manipulation
A
- Effects of touch
- Ability to find and reproduce a patient’s pain
- Thorough evaluations
- Drama of the “pop” - something has happened
25
Indications for manipulation
- Reduce pain
- Improve ROM
- Improve function
- Improve circulation
- Neurophysiological benefits
- Break fixations/adhesions
- Release entrapments
- Psychological effects
- If thrusting - quicker, requires less work, less painful than repeated mobilization
26
Contraindications for manipulation
- Hypermobility: Stabilization is intervention of choice
- Joint effusion: Capsule already stretched, limitations due to extra fluid, not shortened muscle
- Inflammation: Stretching increases pain and muscle guarding; 10 days = adhesion formation
27
Precautions for manipulation
- Malignancy
- Bone disease
- Unhealed fx
- Excessive pain
- Hypermobility in associated joints
- Total joint replacements - self limiting [TKR = 2 wks to restore full extension]
- Newly formed connective tissue
- Systemic connective tissue disease [RA - tissue weak already]
28
Types of arthrokinematic motion
- Roll, glide, spin
| - Most joint movements involve combination of all three motions
29
Convex-Concave Rule
- Concave [Cave on Vex]: Moves in same direction as body segment's motion
- Convex [Vex on Cave]: Moves in opposite direction of body segment's motion
30
Grades of Mobility
- Mobilize above and below joint
- 6 = Unstable [specific joint/stabilize]
- 5 = Considerable hypermobility [specific joint/stabilize]
- 4 = Slight hypermobility [specific joint/stabilize]
- 3 = Normal
- 2 = Slight hypomobility
- 1 = Considerable hypomobility
- 0 = Ankylosed [zero motion]
31
Joint congruency
- Joint surfaces have maximum contact with each other
- Tightly compressed; difficult to separate
- Ligaments are taut
- Close-packed or closed-pack postion
- Usually occurs at one extreme or the other
- Mobilization: Put joint in loose-packed position
32
Joint incongruency
- Joint surfaces do not have maximum contact with each other
- Easily separated
- Ligaments are lax
- Open-packed or loose-packed position
- Best position for joint mobilization techniques
- Accessory motion/joint play demonstrated
33
Passive- Angular Stretching
- May cause increased pain and joint trauma [tears and rips]
- Lever magnifies force at the joint
- Excessive compression in the direction of the rolling bone
- Roll without glide does not replicate normal joint mechanics
34
Joint-glide Stretching
- Safer and more selective
- Forces applied close to the joint surface; controlled at an intensity compatible with the pathology
- Forces replicate gliding component; does not compress cartilage
- Forces selectively applied to desired tissue
35
Mobilization grades
- Range of joint glide inside joint
- Grades I & II: gate pain
- Grade III & IV: stretching maneuvers
- Grade I: Small-amplitude rhythmic oscillations; Performed at beginning of the range
- Grade II: Large-amplitude rhythmic oscillations; Performed within the range, not reaching limit
- Grade III: Large amplitude rhythmic oscillations; Performed up to limit of available motion and stressed into tissue resistance
- Grade IV: Small-amplitude rhythmic oscillations; Performed at limit of available motion and stressed into tissue resistance
36
Capsular lengthening
- 20-40 newtons to make significant change in capsular lengthening
- 1N = .2 lbs
- 5N = 1 lb
- 20N = 4 lbs
- Geoffrey Maitland
37
Joint distraction grades
- Grade I [loosen] = "Bunching skin" unweights the joint
- Grade II [tighten] = "Taking up the slack" enough distraction/glide to tighten tissues around the joint
- Grade III [stretch] = Amplitude large enough to place stretch on joint and surrounding structures; increase joint play
- Kaltenborn: Arthrokinematic glide with capsular pattern and distraction grades
38
Definition of Capsular pattern
- Order in which a joint moves
- Motion restriction is due to capsule tightness
- Motion lost in certain pattern when loss is due to restriction in a capsule
39
Capsular patterns - UE
- Glenohumeral: ER [LR] - ABD - IR [MR]
- Humeroulnar: FLEX - EXT
- Radiohumeral: FLEX - EXT - SUP - PRO
- Proximal Radiohumeral: SUP - PRO
- Distal Radioulnar: Pain at extremes of rotation
- Wrist: FLEX - EXT [equally limited]
- MCP/IP: FLEX - EXT
40
Capsular patterns - LE
- Thoracic Spine: Side FLEX/ROT [equally limited] - EXT
- Lumbar Spine: Side FLEX/ROT [equally limited] - EXT
- Hip: IR [MR] - EXT- ABD - FLEX - ER [LR]
- Knee: FLEX - EXT
- Talocrural: PF - DF
- Midtarsal: DF - PF - ADD - IR [MR]
- First MTP: EXT - FLEX
- Second to fifth MTP: Variable
- IP: FLEX - EXT
