Foundational Theory Flashcards
What are osteokinematic movements?
the gross, big movements of bones that occur at joints
What are examples of osteokinematic movements?
flexion, extension, abduction, etc…
What are arthrokinematic movements?
smaller movements that occur within joints, enabling the greater movements that occur at the joints
What are some examples of arthrokinematic movements?
roll, glide, spin
What does passive accessory mobilization/manipulation refer to?
externally imposed, small amplitude passive motion intended to produce gliding or traction at a joint
What does passive physiological mobilization/manipulation refer to?
pROM
What does “loose pack” or “resting position” refer to?
the position where the periarticular tissues/joint capsule is the most lax and there is the most space between the articular surfaces
The most comfortable position for a patient with joint pain is usually…
resting/loose pack
What is “actual resting position”?
whatever the most comfortable position is for the patient, with the least amount of soft tissue tension - unique to the patient
What is the treatment plane?
the plane you are mobilizing within, which is parallel to the articulating surfaces (look at the concave plan and imagine it flattened)
If a concave surface moves on a stable convex surface, roll and slide must occur…
in the same direction as the osteokinematic movement
If a convex surface moves on a stable concave surface, roll and slide must occur…
in the opposite direction of the osteokinematic movement
What occurs in ‘spinning’?
one point of one surface remains in contact with the articulating surface while rotating in relation to it
In rolling, one point comes into contact with another point _____ from the original contact point on both surfaces
equidistant
In glide/slide, the point of contact stays the same on which articulating surface?
the moving surface
Restricted ROM is most often associated with a decrease in which arthrokinematic movement?
gliding
Differentiate sellar vs. ovoid joints
sellar - one surface is concave in one direction and convex in the direction perpendicular to it
ovoid - one surface is completely concave, the other completely convex
What is ‘excursion’?
the amount of movement available in the joint capsule
Which grades of excursion present a corrective opportunity for joint mobilization?
grade 1 or grade 2
You would never try to mobilize/increase mobility in joints with which grades of excursion?
grade 0, or 4, 5, 6
Articulating surfaces are maximally congruent in what position?
closed-pack
The position a joint will assume in the case of synovial effusion is…
resting position
What does ‘capsular pattern of restriction’ refer to?
the predictable pattern of restriction that occurs in a synovial joint when pathological conditions exist, affecting the whole joint capsule. this is listed from most restricted to least
To position the joint to prepare for a mobilization, what should you do?
move the joint to the point of restriction, then back off by approximately 10 degrees before performing it
OR for some you may start from resting position
Joint play assessment should be done in what position?
resting
List the absolute contraindications of joint mobilizations.
recent fracture neoplasm acute inflammatory disease (like RA) joint sepsis bacterial infection acute pain response
What are the non-corrective grades of sustained glide and of corrective oscillations?
sustained glide:
1 + 2
oscillations:
1 + 2
What are the corrective grades of sustained glide and corrective oscillations?
sustained glide:
3
oscillations:
3 + 4
End feel: firm, leathery, with a slight creep, may describe…
a capsular end feel
End feel: firm, with no give/creep, may describe…
ligamentous end feel
A bony end feel may suggest…
hypertrophic bone changes IF accompanied by restricted movement
End feel: rubbery, less abrupt than capsular, may describe…
muscular end feel
“Pronounced, springy rebound - accompanies noncapsular restriction from a mechanical block, such as a loose body or displaced meniscus” may describe which end feel?
internal derangement
What would the end feel be like in the case of adhesions and scarring?
sudden sharp arrest in one direction
What end feel is described? “similar to normal but with pain and mm guarding, stiffness in early range that increases until end is reached”
soft capsular
In the case of a pannus, what would the end feel be like?
soft, crunchy squelch which may be due to synovial infold or trapped fat pad
Hypomobility without pain suggests…
chronic adhesion or contracture
Normal mobility with pain suggests…
mild sprain without capsular fiber disruption
Normal mobility with pain can be treated with…
gentle mobilization to decrease pain and promote normal alignment of fibres in healing process
Hypermobility with pain suggests…
partial sprain of capsular tissue
Hypermobility without pain suggests…
complete sprain of capsular tissue
Hypermobility with pain can be treated with…
gentle mobilization to decrease pain and promote normal alignment of newly forming collagen
Pain that increases with distraction and decreases with compression suggests…
ligamentous or other capsular structures’ involvement rather than the articulating surfaces
What identifies the elastic phase?
tissue will return to original configuration when force is removed
What occurs in the plastic phase?
permanent elongation of tissue even once force is removed
What does the ‘necking point’ refer to?
a decrease in load is accompanied by an increase in deformation, suggests that breaking point is about to be reached
What is the failure or breaking point in the stress-strain curve?
where separation of elongated tissue occurs
____ speed oscillations may relax mm guarding
slow
Oscillatory techniques are recommended for ______
pain management or high tonicity
What is the function of oscillations in a prolonged stretch?
to reduce the amount of discomfort and facilitate maximal relaxation
What are the pathological conditions that would affect the whole joint?
effusion, capsular fibrosis, and pseudo-fibrosis (or relative capsular fibrosis)
Movement that is perpendicular to the treatment plane would mean you are doing a…
distraction
Movement that is parallel to the treatment plane would mean you are doing a…
glide
What are the absolute contraindications?
recent fracture metabolic bone disease acute inflammatory disease neoplasms ankylosing of joint joint sepsis/bacterial infection acute pain response to mobilization hesitancy/no consent
What is the capsular pattern of restriction for the glenohumeral joint?
ER > abd > IR
Describe the resting position for the shoulder joint
55-70 degrees of abduction + 30 degrees horizontal adduction
What would closed pack position be for the shoulder joint?
maximal horizontal abduction + external rotation
Describe an Excursion Grade 1
Considerable limitation
Describe an Excursion Grade 0
Absolutely no movement between articular surfaces
Describe an Excursion Grade 2
Slight limitation
Describe an Excursion Grade 3
Normal!
Which excursion grade is used for ‘normal’ mobility?
3
Describe a joint with an excursion grade of 6?
unstable joint, stabilization exercises likely unsuccessful, most likely a surgical case
There are _ grades of excursion, _ kaltenborn grades, and _ maitland grades.
6, 3, 4
Small or large: describe the amplitude of oscillations for each of the Maitland grades
1 - small
2 - large
3 - large
4 - small
Which Maitland grade would this be: “small amplitude movement at the beginning of the available ROM”
grade 1
Which Maitland grade would this be: “small amplitude within/at tissue resistance”
grade 4
