Chapter 5 Flashcards
Mobilization/Manipulation
passive, skilled manual therapy techniques applied to joints and related soft tissues at varying speeds and amplitudes using physiologic or accessory motions for therapeutic purposes
What causes altered joint mechanics?
- pain
- muscle guarding
- joint effusion
- contractures
- adhesions in joint capsule or ligaments
- aberrant joint motion
Interventions unique to PT (according to APTA):
- spinal and peripheral mobilization/manipulation, which are components of the manual therapy techniques
- selected sharp debridement, which is a component of wound management
Thrust manipulation/high-velocity thrust (HVT)
high-velocity, short amplitude techniques; performed at the end of the pathological limit of the joint and is intended to alter positional relationships, snap adhesions, or stimulate joint receptors
Self-mobilization
self-stretching techniques that specifically use joint traction or glides that direct the stretch force to the capsule
Mobilization with movement (MWM)
concurrent application of sustained accessory mobilization applied by a therapist and an active physiological movement to end-range applied by the patient
Physiological movement
movements the patient can do voluntarily
Accessory movements
movements in the joint and surrounding tissues that are necessary for normal ROM but that cannot be actively performed by the patient (AKA component motions)
Examples of accessory or component motions.
upward rotation of scapula and rotation of clavicle during shoulder flexion; rotation of the fibula during ankle motion
Joint play
motions that occur between the joint surfaces and also the distensibility or give of the joint capsule, which allows the bone to move (distraction, sliding, compression, rolling, and spinning of joint surfaces - arthrokinematics)
Muscle energy techniques
use active contraction of deep muscles that attach near the joint and whose line of pull can cause the desired accessory motion
Ovoid joints
one surface is convex, the other is concave
Sellar joint
AKA saddle joint, concave/convex in one direction and convex/concave in the opposing direction
Manipulation under anesthesia
therapist can assist the surgeon in the operating room and continue with follow-up care
The movement of a bony lever is called _____ accessory motions that occur allowing greater angulation of the bone as it swings are _____ & ________, or _________.
swing; rolling/sliding, spinning
The more congruent the joint surfaces are, the more ________ there is of one bony partner on the other with movement.
sliding
The more incongruent the surfaces are, the more _______ there is of one bony partner on the other with movement.
rolling
Examples of spin occurring in joints of the body:
shoulder with flexion/extension, hip with flexion/extension, radiohumeral joint with pronation/supination
What are some benefits of compression in the joint space?
- provides stability to joints
- move synovial fluid, maintain cartilage health
Traction
longitudinal pull (long-axis traction)
Distraction
separation, or pulling apart (joint traction, joint separation)
Potential side effects of immobilization:
- atrophy of articular cartilage
- fibrofatty proliferation causing intra-articular adhesions
- potential decrease in proprioceptive feedback that may decrease balance response
Effects of joint motion:
- motion of synovial fluid
- maintenance of articular extensibility
- afferent nerve input
- sense of speed of motion
- sense change of speed of motion
- sense of direction
- regulation of muscle tone
- nociceptive stimuli
Neurophysiological effects of joint-play techniques:
stimulate mechanoreceptors that may inhibit the transmission of nociceptive stimuli at the spinal cord or brain stem levels
Mechanical effects of joint-play techniques:
cause synovial fluid motion, which is the vehicle for bringing nutrients to the avascular portions of the articular cartilage (and intra-articular fibrocartilage when present)
Indications for the use of joint manipulation:
- pain, muscle guarding, and spasm
- reversible joint hypomobility
- positional faults/subluxations
- progressive limitations
- functional immobility
Limitations of joint manipulation:
- hypermobility
- joint effusion (swelling)
- inflammation
Precautions for joint manipulation:
- malignancy
- bone disease
- unhealed fracture
- excessive pain
- total joint replacements
- new or weakened connective tissue
- systemic connective tissue diseases
- elderly patients
Quality of pain:
- before tissue limitation
- concurrently with tissue limitation
- after tissue limitation
Capsular restriction:
- PROM limited
- firm end-feel with overpressure
- decreased joint-play with mobility tests
- adhered or contracted ligament is limiting motion if there is decreased joint-play
Maitland Grading Dosages
Grade I - small-amplitude oscillations at beginning of range
Grade II - large-amplitude oscillations performed within range (not to limit)
Grade III - large-amplitude oscillations performed up to limit of available motion, stressed into tissue resistance
Grade IV - small-amplitude oscillations at the limit of available motion and stressed into tissue resistance