2) Mobilising Hand Book

Question 1

What can limit joint range

Answer 1

degenerative changes
disease 
trauma
immobility
muscle weakness
muscle spasm 
pain

Question 2

Methods of mobilisation

Answer 2

Manual therapy
Passive movements
Active assisted
Exercise interventions

Question 3

Principles of joint mobilisation

Answer 3

Movement needs to be made easy

Mobilising through range and end range

Question 4

Principles of joint mobilisation

Answer 4

1. Continuous movement
2. Increase momentum- speed,add weight
3. Large amplitude through range
4. Gravity assisted
5. Auto assisted
6. Reduce friction
7. Mobilise end range
8. End range holds

Question 5

Continuous movement

Answer 5

Newton’s 1st law

Reduces muscle work no stopping and starting

Question 6

Increased momentum

Answer 6

Speed and weight

Newton’s 2nd law

Don’t go past end range knee + elbow = may cause injury

Question 7

Large amplitude through range movement

Answer 7

Newton’s 2nd law

Increased sweep and squeeze of synovial fluid

Question 8

Gravity assistant movement

Answer 8

Newton’s 2nd law

Acceleration assisted by gravitational force

Question 9

Auto assisted movement

Answer 9

Newton’s 2nd law

Acceleration assisted other limb

Question 10

Reduce friction

Answer 10

Newton’s 3rd law

Reduce muscle work required to start stop and sustain movement

Question 11

Mobilisation end range and end range holds

Answer 11

Effects neural stretch tolerance and viscoelastic changes in tissues

i.e time under tension and muscle length

Question 12

Therapeutic principles

Answer 12

Ensures exercises are performed optimally with the required degree of effort.

1. Use of targets (especially to achieve end range)
2. Motivation (use of voice) & correction if required
3. Competition (with self or others)
4. Variety of exercise & individual approach (consider patient age & interests)
5. Instruction & demonstration
6. Explanation of potential benefits

Question 13

Practical considerations

Answer 13

Appropriately dressed patient

Optimal starting position

Warm up i.e ankle circling 1-2 mins

Equipment engage + efficacy

2 exercises suitable for home

Question 14

Efficacy and progression

Answer 14

For mobilising to be effective it needs to be performed through range and end range with high reps

Minimum reps 10-15 of 3 sets

1-2 times daily

Static stretches held 30 seconds

Question 15

How do you progress a mobilising programme

Answer 15

Go further into range

Increase amplitude- +momentum

Actively push/pull stretching whole articular surface

Question 16

What is Proprioreceptive neuromuscular facilitation (PNF)

Answer 16

Method of stretching = increasing passive range of movement

All movement is governed by voluntary and sensory sources and utilises both voluntary and reflex movements - CONTRACT RELAX

Proprioreceptors increase and reinforce the demands of the voluntary system

Reflex reactions are stimulated to initiate and reinforce voluntary movements

Question 17

PNF - contract relax

Why would you use it

Answer 17

Reflex muscle relaxation follows maximumal voluntary muscle contraction

Used to increase passive range of movement typically used to stretch 2 joint muscles e.g. hamstrings

Following a maximal resisted contraction of the antagonist and range the muscle is relaxed and passively moved further into range

Question 18

Contract Relax method

Answer 18

Position patient with muscle to be stretched (antagonist) at end range – consider both joints for 2 jointed muscles

Therapist position themselves at a mechanical advantage and provide resistance as patient maximally contracts the muscle to be stretched for at least five seconds

Instruct the patient to relax as they do so moving the limb passively further into range sustaining the passive stretch for at least 30 seconds

Without releasing tension repeat technique until no more range is gained afinishing with a final 30s stretch

This is a therapist assisted technique always teach the patient static stretching for the same muscle group = home exercise

Question 19

Manual therapy mobilisation

Answer 19

Passive movement enables physiotherapist to:

1. Find differences between active and passive movement – indicate muscle weakness/movement inhibited by pain
2. Find a Movement which produces symptoms of pain resistance stiffness and muscle spasm = joint dysfunction

Question 20

2 groups of passive movement

Answer 20

1. Passive physiological movements – passive movements which may also be performed actively by the patient
2. Passive accessory movements – gliding or rotation of movement which can only be performed passively

Question 21

Passive accessory movements

Answer 21

If accessory movements are limited or absent the range of physiological movement will be affected

Accessory movements are applied to all joints that are suspected to produce pain or stiffness

Pain/stiffness can be treated by selecting appropriate accessory movement and using manual therapy mobilisation to improve both quality and range of accessory movement available

Question 22

Arthrokinamatics

Answer 22

Arthrokinamatics needs to be understood in order for physiotherapist to select appropriate accessory technique

Spin, roll, glide

Rolling cannot occur on its own or else it would role of the joint surface therefore glide must occur

Rolling direction is always in the same direction as the bone moving

CONCAVE CONVEX RULE

Question 23

Graded accessory movements

Answer 23

Accessory movements may be used for treatment of pain and to increase joint range of movement they are performed in a specific direction with a specific part of the joint range and are graded from I – IV

Question 24

Maitland joint mobilisation grading scale

See sheet in notes as well

Answer 24

Grade I: Small amplitude movement performed within a resistance three part of range usually beginning of French

Great II: large amplitude movement performed within a resistance free part of range

Grade III: large amplitude movement performed into resistance

Grade IV: small amplitude movement performed into resistance