Accessory Mobilisations Flashcards
Define joint mobilisation
A manual therapy technic, comprising a continuum of skilled passive movements to the joint complex that are applied at varying speed and amplitudes, that may include small amplitude/high velocity therapeutic movements (manipulations) with the intent to restore optimal motion, function and/or reduce pain.
What is the difference between mobilization and manipulation ?
-Joint mobilization is on continuum with joint manipulation
-mobilization is under patient’s control
- manipulation is done at speed where the patient cannot stop the motion
Wh at are the two types of joint motion ?
- physiological joint motion
- accessory joint motion
Define physiological joint motion
A movement that the patient can perform voluntarily and can be analyzed for quality and symptom response.
Define accessory joint movement
Is necessary for normal joint motion but cannot be performed voluntarily nor controlled. These movements include, the spin, roll and glide which accompany physiological movements of the joint. The accessory movements are examined passively to assess range and symptoms response in the open pack position of a joint.
What order follows objective examination ?
-AROM
-PROM
-Accessory motions/tests/end feel
-special tests
List the effects of joint mobilization
- neurophysiological
- nutritional
- mechanical
Explain the neurophysiological effect of joint mobilization
Takes place with small amplitude joint mobilization oscillations
Causes pain relief due to neuromodulation at central nervous system
Explain the nutritional effect of joint mobilization
Takes place with distraction or small gliding movements
Is caused by synovial fluid movement
Explain the mechanical effect of joint mobilization
Takes place by stretching collagen structures ans loosening/breaking adhesion
Causes inhibitory effects on joint afferent receptors
Explain why and how mobilization affects pain ?
A descending nociceptive inhibition is sent off from the midbrain and suppresses the release of excitatory transmitters to the dorsal horn and therefore suppresses the post synaptic response.
Which factors can affect descending inhibition ?
Catastrophizing
Avoidance
Somatisation
All activate descending facilitation
Define open pack position
- treatment position
- resting position
- surrounding tissue is as lax as possible
- maximal incongruency
- intracapsular space is as large as possible
- joint is unlocked, statically inefficient for load bearing but dynamically safe
- position adopted at rest or following acute trauma to accommodate maximal fluid accumulation
Define closed pack position
- blocked position
- testing position
- joint positions are most congruent
- capsule and ligament are under maximal tension
- intracapsular space is minimal
- joint is locked, statically efficient for load bearing, dynamically dangerous
What are the different end feel ?
- hard=bony=bone to bone. A do normal if there is a loose fragments in the joint that stops the motion
- soft=soft tissue being compressed. Abnormal if there is a boggy feel to the motion which indicate an œdema.
- firm/springy=soft tissues that have reached their limit of stretch. If it limits the motion, it’s a signe of tissue shortening.
- Empty=motion is stoped upon patient’s request (due to considerable pain). Always abnormal.
- Spasm= always abnormal
