Basics of Mobilization Flashcards
Order of Test for Objective Examination
- Active range of motion
- Passive range of motion
- Accessory motions/ tests/end feel
- Special tests
Effects of Joint Mobilization - Neurophysiological Effects
• Pain relief: neuromodulation at CNS level. Stimulate mechanoreceptors 1 and 2, reduces pain.
• Small-amplitude joint mobilization oscillations.
Effects of Joint Mobilization - Nutritional Effects
• Synovial fluid movement
• Distraction or small gliding movements
Effects of Joint Mobilization - Mechanical Effects
• By stretching collagen structures
• Inhibitory effects on joint afferent receptors
Descending Nociceptive Inhibition
Suppresses pain perception.
From the midbrain.
Suppresses release of excitatory transmitters in dorsal horn, and postsynaptic responses.
Activated by mobilization → Reduces pain.
What prevents effective descending nociceptive inhibition?
Catastrophizing, avoidance, somatization.
Resting/Open Packed Position
When patient is resting, after acute trauma or start of treatment.
Surrounding tissue as lax as possible. Intracapsular space is maximal. Unlocked, inefficient load bearing, dynamically safe.
Accommodates maximal fluid accumulation.
Closed Packed Position
Blocked position.
Surrounding tissue under maximal tension. Intracapsular space minimal. Locked, efficient load bearing, dynamically dangerous.
Open/Closed Packed Position - Vertebral
Open: Midway between flex and ext.
Closed: Maximal extension
Open/Closed Packed Position - Glenohumeral
Open: 55-70 abd; 30 horiz add, neutral rotation.
Closed: maximal abd and external rotation
Open/Closed Packed Position - Humeroulnar/radial
Humeroulnar open: 70 flex; 10 sup.
Humeroulnar closed: full ext and sup.
Humeroradial open: full ext and sup.
Humeroradial closed: 90 flex and 5 sup.
Open/Closed Packed Position - Radio/ulnocarpal
Open: neutral, slight ulnar deviation.
Closed: full ext. and radial deviation.
Open/Closed Packed Position - Hip
Open: 30 flex; 30 abd.; slight external rotation.
Closed:
- Ligamentous: full ext., abd., internal rotation
- Bony: 90 flex; slight abd.; slight external rotation
Open/Closed Packed Position - Knee
Open: 25 flex
Closed: full ext. and external rotation
Open/Closed Packed Position - Talocrural
Open: mid inversion/eversion; 10 plantar flex.
Closed: Full dorsiflexion.
Types of end feel
- Hard: bone to bone - elbow ext.
- Soft: soft tissue compressed - biceps.
- Firm or springy: soft tissue reaching limit of stretch - knee.
- Empty: nothing to stabilize. Abnormal.
- Spasm: muscle contraction or pain at end ROM. Abnormal.
Grades of Movement: Normal Joint - Grade I
Small amplitude movement at the beginning of available ROM, no resistance.
Grades of Movement: Normal Joint - Grade II
Large amplitude movement through the middle of the ROM, no resistance.
Grades of Movement: Normal Joint - Grade III
Large amplitude movement from the middle to the limit of the ROM.
Grades of Movement: Normal Joint - Grade IV
small amplitude movement at the very end ROM.
Grades of Movement: Normal Joint - Grade V
Manipulation.
High velocity thrust of small amplitude beyond the ROM.
Grades I and II - Grades of Movement
Pain relief!
Stimulate mechanoreceptors to inhibit nociceptive feedback.
Neutralizes joint pressure, prevents grinding.
Grades III-V - Grades of movement
Restore function! treat stiffness or hypomobility.
Mechanical distension and/or stretching of shortened tissue.
Mobilization Treatment Principles - Oscillations
• 60-120/min
• 1-5 sets of 5-60s
• Generally used to treat pain
Mobilization Treatment Principles - Prolonged hold/sustained techniques
• 5-30s
• 1-5 reps
• Typically applied at end range to treat stiffness
Classification of Joint Mobility - Grade 0
No movement.
Treatment possibilities: no mobilization.
Classification of Joint Mobility - Grade 1
Extremely hypomobile.
Treatment possibilities: mobilization.
Classification of Joint Mobility - Grade 2
Slightly hypomobile.
Treatment possibilities: mobilization-manipulation.
Classification of Joint Mobility - Grade 3
Normal
No treatment needed.
Classification of Joint Mobility - Grade 4
Slightly hypermobile.
Treatment possibilities: stabilization.
Classification of Joint Mobility - Grade 5
Extremely hypermobile.
Treatment possibilities: stabilization.
Classification of Joint Mobility - Grade 6
Unstable. Repeated injury.
Treatment possibilities: bracing, splinting, casting, surgical stabilization.
Joint Mobilization - Definition
Continuum of skilled passive movements to joint complex, applied at varying speed and amplitude.
Intent to restore optimal motion, function and/or reduce pain.
Joint Mobilization vs Manipulation
Mobilization is on a continuum with manipulation. Both involve passive movements.
Mobilization: under patients control.
Manipulation: done at a speed which patient cannot stop the motion.
