Basics of Mobilization

Question 1

Order of Test for Objective Examination

Answer 1

1. Active range of motion
2. Passive range of motion
3. Accessory motions/ tests/end feel
4. Special tests

Question 2

Effects of Joint Mobilization - Neurophysiological Effects

Answer 2

• Pain relief: neuromodulation at CNS level. Stimulate mechanoreceptors 1 and 2, reduces pain.
• Small-amplitude joint mobilization oscillations.

Question 2

Effects of Joint Mobilization - Nutritional Effects

Answer 2

• Synovial fluid movement
• Distraction or small gliding movements

Question 3

Effects of Joint Mobilization - Mechanical Effects

Answer 3

• By stretching collagen structures
• Inhibitory effects on joint afferent receptors

Question 4

Descending Nociceptive Inhibition

Answer 4

Suppresses pain perception.
From the midbrain.
Suppresses release of excitatory transmitters in dorsal horn, and postsynaptic responses.
Activated by mobilization → Reduces pain.

Question 5

What prevents effective descending nociceptive inhibition?

Answer 5

Catastrophizing, avoidance, somatization.

Question 6

Resting/Open Packed Position

Answer 6

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.

Question 7

Closed Packed Position

Answer 7

Blocked position.
Surrounding tissue under maximal tension. Intracapsular space minimal. Locked, efficient load bearing, dynamically dangerous.

Question 8

Open/Closed Packed Position - Vertebral

Answer 8

Open: Midway between flex and ext.
Closed: Maximal extension

Question 9

Open/Closed Packed Position - Glenohumeral

Answer 9

Open: 55-70 abd; 30 horiz add, neutral rotation.
Closed: maximal abd and external rotation

Question 10

Open/Closed Packed Position - Humeroulnar/radial

Answer 10

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.

Question 11

Open/Closed Packed Position - Radio/ulnocarpal

Answer 11

Open: neutral, slight ulnar deviation.
Closed: full ext. and radial deviation.

Question 12

Open/Closed Packed Position - Hip

Answer 12

Open: 30 flex; 30 abd.; slight external rotation.
Closed:
- Ligamentous: full ext., abd., internal rotation
- Bony: 90 flex; slight abd.; slight external rotation

Question 13

Open/Closed Packed Position - Knee

Answer 13

Open: 25 flex
Closed: full ext. and external rotation

Question 14

Open/Closed Packed Position - Talocrural

Answer 14

Open: mid inversion/eversion; 10 plantar flex.
Closed: Full dorsiflexion.

Question 15

Types of end feel

Answer 15

• 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.

Question 16

Grades of Movement: Normal Joint - Grade I

Answer 16

Small amplitude movement at the beginning of available ROM, no resistance.

Question 17

Grades of Movement: Normal Joint - Grade II

Answer 17

Large amplitude movement through the middle of the ROM, no resistance.

Question 18

Grades of Movement: Normal Joint - Grade III

Answer 18

Large amplitude movement from the middle to the limit of the ROM.

Question 19

Grades of Movement: Normal Joint - Grade IV

Answer 19

small amplitude movement at the very end ROM.

Question 20

Grades of Movement: Normal Joint - Grade V

Answer 20

Manipulation.
High velocity thrust of small amplitude beyond the ROM.

Question 21

Grades I and II - Grades of Movement

Answer 21

Pain relief!
Stimulate mechanoreceptors to inhibit nociceptive feedback.
Neutralizes joint pressure, prevents grinding.

Question 22

Grades III-V - Grades of movement

Answer 22

Restore function! treat stiffness or hypomobility.
Mechanical distension and/or stretching of shortened tissue.

Question 23

Mobilization Treatment Principles - Oscillations

Answer 23

• 60-120/min
• 1-5 sets of 5-60s
• Generally used to treat pain

Question 24

Mobilization Treatment Principles - Prolonged hold/sustained techniques

Answer 24

• 5-30s
• 1-5 reps
• Typically applied at end range to treat stiffness

Question 25

Classification of Joint Mobility - Grade 0

Answer 25

No movement.
Treatment possibilities: no mobilization.

Question 26

Classification of Joint Mobility - Grade 1

Answer 26

Extremely hypomobile.
Treatment possibilities: mobilization.

Question 27

Classification of Joint Mobility - Grade 2

Answer 27

Slightly hypomobile.
Treatment possibilities: mobilization-manipulation.

Question 28

Classification of Joint Mobility - Grade 3

Answer 28

Normal
No treatment needed.

Question 29

Classification of Joint Mobility - Grade 4

Answer 29

Slightly hypermobile.
Treatment possibilities: stabilization.

Question 30

Classification of Joint Mobility - Grade 5

Answer 30

Extremely hypermobile.
Treatment possibilities: stabilization.

Question 31

Classification of Joint Mobility - Grade 6

Answer 31

Unstable. Repeated injury.
Treatment possibilities: bracing, splinting, casting, surgical stabilization.

Question 32

Joint Mobilization - Definition

Answer 32

Continuum of skilled passive movements to joint complex, applied at varying speed and amplitude.
Intent to restore optimal motion, function and/or reduce pain.

Question 33

Joint Mobilization vs Manipulation

Answer 33

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.