end feel and joint mobilisations Flashcards
what is end feel?
- type of sensation or feeling that the examiner experiences when the joint is at the end of its available passive range of motioning assessment
how do you reach the end feel?
- go as far as possible where the patient feels no pain, then when the end is reached perform an isolation movement at end of range to see what end feels like
why do the joints stop?
- different joints stop for different reasons e.g., ligaments get tight in one joint so can see if its normal or strange
what are the three normal end feel?
- soft tissue apposition
- hard end feel
- elastic end feel
what is soft tissue apposition? - example
- point where two surfaces touch
e.g., elbow flexion: forearm muscles hit biceps
what is hard end feel? - example
- bony block
elbow extension> bone hits bone
what is elastic end feel? - example
- stretching of capsule and ligaments
wrist extension> wrist will spring back due to elasticity
what are joint mobilisations?
- physiological movements that a person can consciously perform
what are examples of physiological movements?
- major movements like flexion, abduction, extension, etc
what are active physiological movements?
- person performs the movement themselves
what are passive physiological movements?
- another person/ device performs the movement
how can passive physiological movement be used as an assessment tool?
- symptoms
- range of movement
- end feel
what can passive physiological mobilisation help with?
- increases ROM
- relieves pain
what are the different Maitland grades used for?
- ROM = grades III and IV
- Pain= grades I and II
what differs on a graph showing the end feel?
- width differs depending on type of end feel experienced
when would the width of end feel be narrow?
- no earning that end feel is comping then sudden bone contact
e.g., elbow extension
when would end feel width be wide?
- when you can push through elasticity until you reach end
e.g., wrist extension
what happens before we hit the end feel in elastic end feel?
- it comes on a bit earlier and lasts longer
how do grade 3 and 4 help in the treatment of stiffness?
- enters the resistance zone
what is Maitland grade I?
- small amplitude movement performed at beginning of range
- arrow point both ways
- isolation movement
what is Maitland grade II?
- large amplitude movement performed within resistance- free range
how is grade 2 split and why?
- space is too large
II- > near the start of the range
II > middle of range
II+ > near resistance
what is Maitland grade III?
- large amplitude movement performed into resistance or up to limit of range
how can you block movement from going further than limit?
- practical positions like laying on front while medially rotating hips; side of thigh blocks movement
what is Maitland grade IV?
- small amplitude movement performed into resistance or up to limit of range
what happens in restricted movement to the grades?
- everything gets smaller but grade 2 and 3 are still longer
- L to B is the new limit of range
what rhythm and speed is used?
- many different rhythms used; at one extreme = sharp abrupt movement; at other movements = low speeds
how long may a movement be held before reversing direction?
- as long as 5 seconds
what is the grade III and IV theory of action?
- stretching soft tissues (ligaments and capsules) and adhesions
- synovial sweep aids lubrication
what is grade I and II pain gate theory?
- explains how non- painful sensations can override and reduce painful sensations
describe A- delta fibre action
- transmit sharp pain quickly
- transmit to dorsal horn spinal cord then to the brain
- final pain experienced
describe C fibre action
- transmits dull pain e.g., chronic back pain more slowly
- to the dorsal horn spinal cord then the brain
what fibres transmit non- painful sensations?
- A - beta fibres
where do A- beta fibres transmit from and to?
- transmit from mechanoreceptors in skin and other soft tissue structures
- to dorsal horn spinal cord and the brain
what happens when the gate opens?
- painful stimuli are free to go up to the brain as well as sensations from non- painful stimuli
what links pain fibres and A- beta fibres?
- inhibitory interneuron
what happens when interneurons are stimulated?
- when stimulated by non- painful stimuli it doesn’t let the pain through as much as it limits the painful stimuli by closing the gate
what does descending inhibition secrete and reduce?
- secretion of opioids (pain relieving chemicals) happens naturally
- reduced pain by closing gate directly via signals
what induces the descending inhibition ?
- brain stimulated by certain mechanisms to reduced pain
e.g., meditation, deep breathing, mechanical non- painful sensations, massage
what are accessory mobilisations?
- small movements occurring between joint surfaces during physiological movements to maintain congruence
- occur automatically
what are the three types of accessory movements?
- roll, slide and spin
describe roll
- rolling parallel to joint surface e.g., car wheels rolling on the ground
describe slide
- sliding parallel to the joint surface e.g., car sliding on ice with wheels locked
describe spin
- spinning about axis perpendicular to joint surface e.g., coin spinning on floor
what two accessory movements occur at the same time? give an example
- roll and slide occur at the same time
e.g., at the time of rolling of the femur, it also performs sliding in the opposite direction to prevent dislocation
how does the locking mechanism of knee differ when the foot is on the floor compared to when its not on the floor?
- if the foot is on the floor, femur rotates on tibia to unlock and lock
- if the foot isn’t on the floor, the tibia rotates
what is concave- convex?
concave = rounded inward / hollowed
convex= rounded outward / curved
what happens if the convex surface is moving?
- roll and slide are in opposite directions?
what happens if the concave surface is moving?
- roll and slide are in the same direction
describe a squat movement in terms of convex and concave surfaces
- tibia is fixed while femur is moving
- femur is a convex surface so it rolls posteriorly and glides anteriorly
what happens if the foot is off the floor when bending the knees backwards?
- tibia is moving
- as tibia is a concave surface, the roll and glide are in one direction
what three ways can passive accessory movements be used as an assessment tool?
- range of movement
- end feel
- symptoms
describe the passive accessory mobilisations as treatment
- grades I and II relieve pain
- grades III and IV increase/ restore ROM
what happens to Maitland grades in accessory movements?
- they are smaller in accessory movements
how would you use grade III and IV?
- put patient near/ at limit of range
- then perform accessory move
is grade III or IV more vigorous and what does this mean?
- grade IV is more vigorous as more time is spent in resistance
- so you should do grade III first to see how the patient responds
what automatic accessory movements can’t be passively manipulated?
- roll
- because roll happens as part of physiological movement
what two accessory movements that don’t naturally occur can physios induce?
- compression
- distraction
what is compression? give an example
- joint surfaces pushed together e.g., patella squashes joints together
what is distraction? give an example
- joint surfaces pulled apart e.g., leverage used to pull humerus from glenohumeral joint
what are the six directions of joint mobilisation?
- posteroanterior glide
- anteroposterior glide
- medial glide
- lateral glide
- caudad glide
- cephalad glide
what is caudad glide?
- distal glide
- towards feet
what is cephalad glide?
- towards head
what rotations can joint mobilisations achieve?
- medial
- lateral
what accessory mobilisations should be used?
- for pain= accessory movements (I and II)
- for movement= accessory and physiological (III and IV)
what is the duration and frequency of grade I and II compared to III and IV?
- I and II = short; 30 seconds to 2 minutes , 1 to 2 times
- III and IV= longer; 2 minutes+ ; several times
what should you make use of and stabilise when applying joint mobilisations?
- make use of mechanical advantage of levers
- stabilise above joint
what should you assess when applying joint mobilisations?
- assess patient symptoms and range before, during and after
what should you do if patient is improved vs not improved when applying joint mobilisation?
- if patient is improved, continue the specific treatment
- if not improved/ worse, change technique or grade
what are the manual therapy precautions?
- osteoarthritis
- pregnancy
- children
- total joint replacement
- severe scoliosis
- poor general health
- patients inability to relax
- downs syndrome
what are the manual therapy contradictions?
- osteoporosis
- anticoagulants within last 6/52
- long term steroid use
- inflammatory arthritis
- hypermobility
- local malignancy
- recent radiotherapy
- tuberculosis
- ligamentous rupture
- disc prolapse with nerve compression
- cauda equina lesion
- central stenosis
- recent bone fracture
- congenital bone deformities
- vascular disorders
- spondylolisthesis
- patients unable to give consent
- bone disease
- neurological involvement
