Assessment & Treatment Principles

Question 1

What are the effects of joint mobilizations?

Answer 1

Pain control, Joint Lubrication and Improves health of the tissues.

Question 2

What are the indications for Joint Mobilizations?

Answer 2

Pain and muscle guarding
Reversible joint hypomobility
Positional Faults/Subluxations
Progressive Limitations
Functional Immobility
Poor proprioception

Question 3

What are the ABSOLUTE Contraindications to Mobilizations and Assessment of Joint play?

Answer 3

• Hypermobility and instability
• Acute inflammation
• Bone Lesions (ie. neoplasm, bone disease, inhealed fracture, osteophytes, dislocation, total joint replacement)
• Connective tissue lesions (muscle spasm, recent ligament/capsular tear and rupture, local in jection of coriticosteriods (no mobs for 3 weeks), systemic diseases such as RA where connective tissue has weakened, elderly individuals where connective tissue has weakened and circulation has diminished.)
• bacteria infection/sepsis
• excessive pain
• spinal chord lesion, dizziness

Question 4

What are some Precautions to Joint Mobilizations? (May assess and mobilize, but proceed with caution)

Answer 4

Joint Effusion
Prolonged used of corticosteroids can wekaen cartilage and capsule/ligaments
History of neoplasm, radiations (can lead to osteoporosis)
Osteoporosis
Neurological signs
Pregnancy

Question 5

The __________ must be comfortable and relaxed so that there is no muscle guarding across the joints to be mobilized, otherwise the treatment will be very difficult and probably ineffective. You must have the _________ total trust. Watch for non-verbal signs, expressing discomfort or pain.

Answer 5

patient

Question 6

The ________________ must be RELAXED and COMFORTABLE so that full attention can be paid to the mobilization, and that the mobilization can be sustained for as long as needed.

Answer 6

massage therapist

Question 7

For pain relief, the best position to mobilize is in _____1______ or ______2_____.

Answer 7

1- resting position

2 - loose-packed position

Question 8

The two systems of grading dosages for mobilizations that are used are: ________1______ and _______2_____. ________1_____ is the one used mostly in class.

Answer 8

1- Graded Oscillation Techniques (Maitland)

2 - Sustained Translatory Techniques (Kaltenborn)

Question 9

_______________ is small amplitude rhythmic oscillation performed at the beginning of the range, before tissue resistance. Performed at approximately 3-5 cycles per second.

Answer 9

Grade I Oscillation Technique

Question 10

______________ is large amplitude oscillations performed within tissue resistance (in and out), but before the joint limit. Performed at 2 cycles per second.

Answer 10

Grade III Oscillation Technique

Question 11

______________ is large amplitude oscillations performed within the range, before tissue resistance. Performed at 2 cycles per second.

Answer 11

Grade II Oscillation Technique

Question 12

______________ is small amplitude oscillations performed just beyond tissue resistance but before the joint limit. Performed at approximately 3-5 cycles per second.

Answer 12

Grade IV Oscillation Technique

Question 13

____________ is small amplitude, high velocity movement (not oscillatory) that begins at the tissue resistance and ends up at the anatomical limit of the joint (manipulation). THIS IS NOT IN OUR SCOPE OF PRACTICE.

Answer 13

Grade V Oscillation Technique

Question 14

Grades ___ & ____ are used to reduce pain

Answer 14

Grades I and II Oscillations

Question 15

Grades _____ & _____ are used to improve range of motion.

Answer 15

Grades III and IV Oscillations

Question 16

Grades ____ & _____ can create more irritation because of their higher frequency.

Answer 16

Grades I and IV Oscillations

Question 17

_______________ is small-amplitude distraction or glide applied where no stress is placed on capsule. This is a pain relief, non-corrective grade mobilization.

Answer 17

Grade I Sustained Translatory Technique

Question 18

______________ enough distraction or glide is applied to tighten the tissue around the joint to tissue resistance. This is also a non-corrective grade and can be used to decrease pain and maintain ROM. Also ALWAYS used in assessment to find the starting point.

Answer 18

Grade II Sustained Translatory Technique

Question 19

_____________ distraction or glide is enough to put a stretch on the joint capsule and on periarticular structures. Movement is through the tissue resistance. This is corrective grade used to stretch the joint structures and increase ROM and joint play.

Answer 19

Grade III Sustained Translatory Technique