2) Mobilising Reduced ROM theory Flashcards
What does normal movement depend on
What does reduced movement impact on
*Ligaments
*Capsule
*Cartilage *connective tissues
*Tendons
*Fascia
Synovium
Muscles
Skin
Bone
Subcutaneous tissue
Neurological control
Intra-articular
Capsule
Synovium
Periarticular
Surrounds joint
Extra articular
Outside joint
Muscle skin
Abnormal joint movement
X3 categories
1) Reduced range of movement
• ROM passive movement
- stiffness/hypomobility contracture
- reduced ROM
2)Hypermobility
• Increased range of passive/active movement
- Desirable pathological or incidental
- Without sufficient muscle control= joint instability
3)Insufficient neurological control
- Muscle tone and/or controller on joints or abnormal
- Pathological
Contracture
Irreversible lack of range of passive movement
Connective tissue
See core skills 1
What determines joint range of movement
a) Arthrology have a joint
b) Resistance within the joint – low co-efficient friction
c)Properties of each joint structure
•Interarticular – Cartlidge
•Periarticular – joint capsule
•Extra-articular – muscle tendon units
d)By external forces are transmitted by articular soft tissue
•Function of passive viscoelasticity
Viscoelasticity
Elastic and water content
Ability to stretch is stress dependent and time dependent
Viscoelasticity depends on numbers of
- elastin
- Collagen
- Proteoglycans- lubracin chemical lubricator
- Water
Mechanical properties of articular connective tissue
- Dense connective tissues very strong
- Organise structure
- Resistance to tensile stress
- Strongly resistant rope like along lines of stress -one direction but not the other
- Collagen fibre crimping
What is stiffness
What’s is the stiffest structure
Ability to resist tensile stress
Tendon > ligament > joint capsule strength
Collagen crimping
Small force initiate large elongation
When the barbers straight no elongation is directly proportional to the force applied due to elastic properties
Up until a point then Microfailure occurs - small tissue tares can result in permanent damage
What is a small tissue tare that results in permanent change in length
Plasticdeformation
If force continues to increase rupture will occur of structure
Rapid high force applied
What is tissue elongation subject to
Time and stress
Causes of reduced ROM
Trauma
Chronic diseases
Immobility
See diagram
Effects of reduced range of movement
1) Function
- UL– reduced independent e.g. getting dressed
- LL- poor gait and functional mobility falls
- Time off work
- Quality of life
2) pain
3) muscle weakness
4) vicious cycle of inactivity
Physiological changes of mobility
connective tissue
Immobility = stress deprivation = remodelling
See diagram
Physiological changes of mobility
Intra articular
Cartilage
Reduced water content
Reduced GAGS
Reduced nutrients from synovial fluid
Thinning of extracellular matrix
Fibrofatty connective-tissue proliferation
Adherence of synoviocytes and protein deposits
Physiological changes of mobility
Intra articular
Synovium
Reduced number of synoivosytes
Reduced synovial fluid volume
Reduced synovial fluid movement - loss of
( sweep & squeeze)
Reduced lubricin
Adhesions between microfilms in synovial membrane
Physiological changes of mobility
Bone
Increased reabsorption of cancellous and compact bone (eight weeks)
Decreased bone mineral density
Decreased ability to withstand stress
Increased risk of fracture
Physiological changes of mobility
Muscle
Atrophy
Sarcomeres lost from end of myofibrils = shortening
connective tissue proliferation
= increase collagen within endomysium perimysuim and epimysium
= adaptive shortening
