Accessory Mobilisations (PAIVMs) for one spinal region / Peripheral joint Flashcards
Rationale behind PAIVMs
Reduce experience of pain
Give a sense of wellbeing
Increase movement
Reduce muscle spasm
How do PAIVMs reduce the experience of pain?
Reduced fear/threat from graded movement/touch
Changes in chemical irritants released and inflammatory mediators (PNS)
Stimulation of PAG and descending control/modulation of pain (CNS)
Autonomic response which increases circulation and flushes away chemical irritants, less nociceptor stimulation (CNS)
Improved sense of relaxation/well-being reduces pain
How do PAIVMs give a sense of well-being?
Endorphin release (CNS)
Cortisol/ stress hormone altered
Touch reducing fear/threat
Dopamine released – sleepy and relaxed feeling
How do PAIVMs increase movement?
Reduced fear of movement so more willing to move
Reduced pain so more willing/able to move
Reduced muscle spasm so more able to move
Local biomechanical effects on collagen/adhesions/synovial fluid
How do PAIVMs reduce muscle spasm?
Reduced pain leads to reduced muscle spasm
Reduced fear/threat relaxes muscle tone
Direct effect from spinal cord activity
What structures do PAIVMs affect?
Synovial joints
Nerves
Muscle fascia
How do you carry out PAIVMs?
1) Introduce
2) Explain procedure & benefits for informed consent
3) Check area visually and ask about contraindications
4) Palpate joint
5) Perform accessory movement using one of 4 grades:
Grade I - Small amplitude movement performed near
beginning of available range
Grade II - Large amplitude movement, into resistance free
part of range
Grade III - Large amplitude movement, into firm
resistance/up to limit of available range
Grade IV - Small amplitude movement, into firm resistance of
up to limit of available range
Use ½ if painful, ¾ if not
10 reps/ 30s/ 2mins
6) Visually check area and ensure patient is feeling okay
Describe grade 1
Small amplitude movement performed near
beginning of available range
Describe grade 2
Large amplitude movement, into resistance free
part of range
Describe grade 3
Large amplitude movement, into firm
resistance/up to limit of available range
Describe grade 4
Small amplitude movement, into firm resistance of
up to limit of available range
Contraindications
Osteoporosis in the target area
History of radiotherapy in area
Infection of the joint
Recent surgery of the joint or surgical protocol prohibits
Malignancy/active Ca in the area
No consent
Acute fear of movement/touch
Unstable/unhealed fracture
Unstable joint/s (especially upper cervical spine)
Artificial joint
Anti-coagulant drugs (warfarin/heparin) –risk of bleed
Precautions
Pain of unknown origin/mechanism
Symptoms over 3 months, signs of chronicity
Patient dependent on passive treatment
Inflammatory joint disease – avoid if in active
inflammation
Pregnancy (positional difficulties)
Active Ca
Systemic infection
Children/ not achieved skeletal maturity
Strong suspicion of bone density problems
Eating disorder
Previously failed response to manual therapy
What questions should you ask to check contraindications?
Are you feeling well in yourself?
Do you have any muscle or joint injuries?
Do you feel pain in the area?
Have you recently broken or fractured a bone?
If you have an injury, How long have you had it for?
How would you document this?
Date, Time, Patient name
Explanation of procedure & gaining informed consent
Joint being mobilised & how
Grade used
Adverse effects?
Sign
