9/16 - Peripheral Joint Mobilization Flashcards
what are 2 main goals of joint mobilization
modulate pain
treat joint impairments limiting ROM
how does joint mobilization treat joint impairments limiting ROM
replicate normal joint mechanics while minimizing abnormal compressive stresses on articular cartilage
what do you need to know in order to determine if joint mobilization is indicated
knowledge of anatomy, arthrokinematics, and pathology of neuromuscular system
what is a joint mobilization/manipulation
skilled, passive manual therapy techniques applied at joint and related soft tissues at varying speeds and amplitudes
osteokinematic
“motion you see”
movements of bones in space
- flex, ext, ABD
arthrokinematic
“motion you feel”
accessory motion b/w adjacent joint surfaces
- roll
- glide
- spin
occurs w all A/PROM
how do you assess osteo vs arthrokinematics
osteo - typical AROM/PROM assessment
arthro - joint play
what is joint play
passive movement
- can’t be achieved by active ms contraction
what is a component movement
involuntary obligatory joint motion
- occurs w active motion
ex: scapular upward rotation (component) w shoulder flexion (active)
arthrokinematic motion: roll
new points on one surface come in contact w new points on another surface
what are other words for a glide
slide
translation
what arthrokinematic motion is the majority of joint play assessments
glide
arthrokinematic motion: glide
translatory motion
one point on one surface contacts new points on another surface
arthrokinematic motion: spin
rotation around a single point of contact
- CW or CCW direction
describe osteo and arthro motion when concave moves on convex
osteo and arthro move in the same direction
ex: tibia on femur, flexion means a posterior roll and posterior slide
describe osteo and arthro motion when convex moves on concave
osteo and arthro move in opposite directions
ex: humerus on glenoid, when flex or ABD arm - humerus glides inferiorly and rolls superiorly
obligate translation
restricted capsular mobility will cause translation AWAY from tightness
what are some reasons you could have limited shoulder flexion
limited inferior glide
- capsule tightness
tight muscles / ms length
pain / anticipated pain
- empty end feel or pt stops you
- more indicative of pain/guarding
where is the treatment plane
perp to axis
parallel to joint surface
traction
separation of joint surfaces perp to treatment plane
what can traction do and how does it accomplish this
help w pain and mobility
- applies load to entirety of joint capsule
gliding (in terms of treatment plane)
joint surfaces displaced parallel to treatment plane
if no gliding is occurring what does this likely indicate
issue w capsule
overall grades for traction
grade 1 - unweighting
grade 2 - taking up slack
grade 3 - capsule & ligaments stretched
describe grade 1 traction
unweighting/loosening
- not pulling hard enough to feel end point
- won’t feel anything stopping motion
when is grade 1 traction typically indicated
helpful to dec pain
good for people w high reactivity
describe grade 2 traction
taking up the slack
as you separate
- the first time you feel some tissue resistance
- feel some tension
describe grade 3 traction
capsule and ligaments stretched
- get to end of available motion
how do you assess joint mobility
it is difficult - poor intra/intertester reliability
quantity graded in mm
quality graded by “end feel”
comparison to uninvolved side
- assess that side first
why are soft hands important when doing a joint mobility assessment
if you grab to hard, can make patient guard
describe handling technique in a joint mobility assessment
soft hands
hands close to joint line (most proximal)
palpate joint line to inc sensitivity to motion
why is it important for a patient to be relaxed for a joint mobility assessment
guarding or tightening muscles can limit motion
- can feel like a false end range
how relaxed pt is correlates to PT handling techniques and how supported pt feels
what are things of note when assessing the quality of joint mobility
onset of resistance/ms guarding
end feel - normal?
pain provocation - reactivity?
joint mobility grades
0 - no movement, ankylosed
1 - mod, marked hypomobility
2 - slightly hypomobile
3 - normal
4 - slightly hypermobile
5 - mod, marked hypermobility
6 - unstable, dislocated, subluxed
what joint mobility grade do you not mobilize
grade 0**
shouldn’t be mobilizing grades 4 or 5
what joint mobility grades are mobilization indicated for
grades 1 and 2
what joint mobility grade is no treatment needed at all for
grade 3
what joint mobility grade is the treatment plan assessment for adjacent hypomobility, stabilization exercise, taping, bracing
grade 4 and 5
what are indications for mobilization
pain, ms guarding & spasm
reversible hypomobility
positional fault / subluxation
goal to achieve full unrestricted pain free ROM
grade 6 treatment plan
bracing, splinting, casting, surgical stabilization
how does joint mobilization help w pain, ms guarding and spasm
gentle techniques stimulate mechanoreceptors to inhibit transmission of nociceptive stimuli
how does join mobilization reverse hypomobility
progressively vigorous techniques
how can joint mobilization help w a positional fault / subluxation
relocate joint
- seen w patella and shoulder
what are 3 neurophysiological effects of mobilization
- stim of mechanoreceptors
- dec nociceptive stim of brainstem/SC
- proprioceptive & kinesthetic awareness
what are 3 mechanical effects of mobilization
- inc blood supply and nutrients to area
- stretch/elongate hypomobile structures such as capsular or ligamentous tissue
- break adhesions
contraindications to mobilization (8)
- most acute cases
- malignancy in area
- infectious arthritis
- metabolic bone dz
- fusion / ankylosis
- OM
- fx
- ligament rupture
precautions for mobilization (7)
- excessive pain/swelling
- arthroplasty
- pregnancy
- hypermobility
- spondylolisthesis
- RA
- vertebrobasilar insufficiency
why is excessive pain/swelling a precaution for mobilization
can indicate something more serious is happening and should look further into it
why is arthroplasty a precaution for mobilization
depending on surgery technique can change how you mobilize the joint
grades of mobilization
I - small amplitude at beginning of range
II - large amplitude w/i available range
III - large amplitude reaching end range
IV - small amplitude movement at end range
V - high velocity thrust manipulation
what are grades 1 and 2 for joint mobilization helpful for
for pain
- stimulate mechanoreceptors
not for inc motion bc not in end range
what are grades 3 and 4 for joint mobilization helpful for
ROM and joint play
- getting into end range
- putting load onto tissues
how do you pick what grade of joint mobilization to implement
what the goal is
what is the role of pain in how you determine the grade of joint mobilization to implement
just bc have pain doesn’t mean you can only do grades 1 or 2
- if have <5/10 pain, and person is hypomobile you can do grades 3 or 4
the pain is relatively low
primary problem is hypomobility
- addressing this will help relieve pain
one thing to be uncomfortable, as long as they can tolerate it
how do you stabilize for joint mobilization
stabilize one segment and be as close to joint line as possible
what is the procedure for joint mobilization (7)
explain what you are going to do
pt position and PT position
joint position
stabilization
direction of force
amt of force
pt response
what are mobilization treatment variables (6)
grade of technique
rhythmic or sustained
position of joint
direction of movement
sx guides selection of techniques
always re-exam joint for change in ROM
what position do you typically start joint mobilization in
open pack
- there is equal slack in the joint
after doing joint mobilization what is an important next step
to do something active to engage the muscle
what are treatment considerations for grades I and II
neurophysiological effect to treat pain
- neuromodulation on sensory innervation of joint mechanoreceptors & pain receptors
neutralizes joint pressures
what are treatment considerations for grades III and IV
mechanical effect to treat stiffness / hypomobility
- inc mobility
plastic deformation of capsule
