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musculoskeletal rehabilitation > end feel and joint mobilisations > Flashcards

end feel and joint mobilisations Flashcards

1
Q

what is end feel?

A
  • type of sensation or feeling that the examiner experiences when the joint is at the end of its available passive range of motioning assessment
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2
Q

how do you reach the end feel?

A
  • 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
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3
Q

why do the joints stop?

A
  • different joints stop for different reasons e.g., ligaments get tight in one joint so can see if its normal or strange
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4
Q

what are the three normal end feel?

A
  • soft tissue apposition
  • hard end feel
  • elastic end feel
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5
Q

what is soft tissue apposition? - example

A
  • point where two surfaces touch
    e.g., elbow flexion: forearm muscles hit biceps
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6
Q

what is hard end feel? - example

A
  • bony block
    elbow extension> bone hits bone
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7
Q

what is elastic end feel? - example

A
  • stretching of capsule and ligaments
    wrist extension> wrist will spring back due to elasticity
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8
Q

what are joint mobilisations?

A
  • physiological movements that a person can consciously perform
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9
Q

what are examples of physiological movements?

A
  • major movements like flexion, abduction, extension, etc
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10
Q

what are active physiological movements?

A
  • person performs the movement themselves
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11
Q

what are passive physiological movements?

A
  • another person/ device performs the movement
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12
Q

how can passive physiological movement be used as an assessment tool?

A
  • symptoms
  • range of movement
  • end feel
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13
Q

what can passive physiological mobilisation help with?

A
  • increases ROM
  • relieves pain
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14
Q

what are the different Maitland grades used for?

A
  • ROM = grades III and IV
  • Pain= grades I and II
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15
Q

what differs on a graph showing the end feel?

A
  • width differs depending on type of end feel experienced
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16
Q

when would the width of end feel be narrow?

A
  • no earning that end feel is comping then sudden bone contact
    e.g., elbow extension
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17
Q

when would end feel width be wide?

A
  • when you can push through elasticity until you reach end
    e.g., wrist extension
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18
Q

what happens before we hit the end feel in elastic end feel?

A
  • it comes on a bit earlier and lasts longer
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19
Q

how do grade 3 and 4 help in the treatment of stiffness?

A
  • enters the resistance zone
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20
Q

what is Maitland grade I?

A
  • small amplitude movement performed at beginning of range
  • arrow point both ways
  • isolation movement
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21
Q

what is Maitland grade II?

A
  • large amplitude movement performed within resistance- free range
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22
Q

how is grade 2 split and why?

A
  • space is too large
    II- > near the start of the range
    II > middle of range
    II+ > near resistance
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23
Q

what is Maitland grade III?

A
  • large amplitude movement performed into resistance or up to limit of range
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24
Q

how can you block movement from going further than limit?

A
  • practical positions like laying on front while medially rotating hips; side of thigh blocks movement
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25
Q

what is Maitland grade IV?

A
  • small amplitude movement performed into resistance or up to limit of range
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26
Q

what happens in restricted movement to the grades?

A
  • everything gets smaller but grade 2 and 3 are still longer
  • L to B is the new limit of range
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27
Q

what rhythm and speed is used?

A
  • many different rhythms used; at one extreme = sharp abrupt movement; at other movements = low speeds
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28
Q

how long may a movement be held before reversing direction?

A
  • as long as 5 seconds
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29
Q

what is the grade III and IV theory of action?

A
  • stretching soft tissues (ligaments and capsules) and adhesions
  • synovial sweep aids lubrication
30
Q

what is grade I and II pain gate theory?

A
  • explains how non- painful sensations can override and reduce painful sensations
31
Q

describe A- delta fibre action

A
  • transmit sharp pain quickly
  • transmit to dorsal horn spinal cord then to the brain
  • final pain experienced
32
Q

describe C fibre action

A
  • transmits dull pain e.g., chronic back pain more slowly
  • to the dorsal horn spinal cord then the brain
33
Q

what fibres transmit non- painful sensations?

A
  • A - beta fibres
34
Q

where do A- beta fibres transmit from and to?

A
  • transmit from mechanoreceptors in skin and other soft tissue structures
  • to dorsal horn spinal cord and the brain
35
Q

what happens when the gate opens?

A
  • painful stimuli are free to go up to the brain as well as sensations from non- painful stimuli
36
Q

what links pain fibres and A- beta fibres?

A
  • inhibitory interneuron
37
Q

what happens when interneurons are stimulated?

A
  • 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
38
Q

what does descending inhibition secrete and reduce?

A
  • secretion of opioids (pain relieving chemicals) happens naturally
  • reduced pain by closing gate directly via signals
39
Q

what induces the descending inhibition ?

A
  • brain stimulated by certain mechanisms to reduced pain
    e.g., meditation, deep breathing, mechanical non- painful sensations, massage
40
Q

what are accessory mobilisations?

A
  • small movements occurring between joint surfaces during physiological movements to maintain congruence
  • occur automatically
41
Q

what are the three types of accessory movements?

A
  • roll, slide and spin
42
Q

describe roll

A
  • rolling parallel to joint surface e.g., car wheels rolling on the ground
43
Q

describe slide

A
  • sliding parallel to the joint surface e.g., car sliding on ice with wheels locked
44
Q

describe spin

A
  • spinning about axis perpendicular to joint surface e.g., coin spinning on floor
45
Q

what two accessory movements occur at the same time? give an example

A
  • 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
46
Q

how does the locking mechanism of knee differ when the foot is on the floor compared to when its not on the floor?

A
  • 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
47
Q

what is concave- convex?

A

concave = rounded inward / hollowed
convex= rounded outward / curved

48
Q

what happens if the convex surface is moving?

A
  • roll and slide are in opposite directions?
49
Q

what happens if the concave surface is moving?

A
  • roll and slide are in the same direction
50
Q

describe a squat movement in terms of convex and concave surfaces

A
  • tibia is fixed while femur is moving
  • femur is a convex surface so it rolls posteriorly and glides anteriorly
51
Q

what happens if the foot is off the floor when bending the knees backwards?

A
  • tibia is moving
  • as tibia is a concave surface, the roll and glide are in one direction
52
Q

what three ways can passive accessory movements be used as an assessment tool?

A
  • range of movement
  • end feel
  • symptoms
53
Q

describe the passive accessory mobilisations as treatment

A
  • grades I and II relieve pain
  • grades III and IV increase/ restore ROM
54
Q

what happens to Maitland grades in accessory movements?

A
  • they are smaller in accessory movements
55
Q

how would you use grade III and IV?

A
  • put patient near/ at limit of range
  • then perform accessory move
56
Q

is grade III or IV more vigorous and what does this mean?

A
  • 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
57
Q

what automatic accessory movements can’t be passively manipulated?

A
  • roll
  • because roll happens as part of physiological movement
58
Q

what two accessory movements that don’t naturally occur can physios induce?

A
  • compression
  • distraction
59
Q

what is compression? give an example

A
  • joint surfaces pushed together e.g., patella squashes joints together
60
Q

what is distraction? give an example

A
  • joint surfaces pulled apart e.g., leverage used to pull humerus from glenohumeral joint
61
Q

what are the six directions of joint mobilisation?

A
  • posteroanterior glide
  • anteroposterior glide
  • medial glide
  • lateral glide
  • caudad glide
  • cephalad glide
62
Q

what is caudad glide?

A
  • distal glide
  • towards feet
63
Q

what is cephalad glide?

A
  • towards head
64
Q

what rotations can joint mobilisations achieve?

A
  • medial
  • lateral
65
Q

what accessory mobilisations should be used?

A
  • for pain= accessory movements (I and II)
  • for movement= accessory and physiological (III and IV)
66
Q

what is the duration and frequency of grade I and II compared to III and IV?

A
  • I and II = short; 30 seconds to 2 minutes , 1 to 2 times
  • III and IV= longer; 2 minutes+ ; several times
67
Q

what should you make use of and stabilise when applying joint mobilisations?

A
  • make use of mechanical advantage of levers
  • stabilise above joint
68
Q

what should you assess when applying joint mobilisations?

A
  • assess patient symptoms and range before, during and after
69
Q

what should you do if patient is improved vs not improved when applying joint mobilisation?

A
  • if patient is improved, continue the specific treatment
  • if not improved/ worse, change technique or grade
70
Q

what are the manual therapy precautions?

A
  • osteoarthritis
  • pregnancy
  • children
  • total joint replacement
  • severe scoliosis
  • poor general health
  • patients inability to relax
  • downs syndrome
71
Q

what are the manual therapy contradictions?

A
  • 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

musculoskeletal rehabilitation (12 decks)

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