General Joint Mobs Intro Flashcards
Define joint play
refers to the mvmt of “play” available when the joint is in some degree of loose-pack and can be assessed
define joint mobilization
a passive modality that moves a joint through its’ accessory mvmts (normally not under voluntary control), to restore pain-free physiological mvmt.
What are the sub-types for synovial diarthrotic joints? and what are their axis types?
- planar - biaxial
- hinge - monaxial
- pivot - monaxial
- condyloid - biaxial
- saddle - multi/triaxial
- ball and socket - multi/triaxial
Define osteokinematic
The gross or physiological mvmt of a joint (angular, special and rotation)
Define arthrokinematic
the mvmts occurring between the articulating surfaces themselves
Define accessory or component mvmts
the particular arthrokinematic mvmts, (like roll, glide/slide, spin, etc), that occur as one bone moves on another w/in the joint.
Define Roll
an accessory/component mvmt analogous to a wheel rolling on a surface; it always travels in the same direction as the angular/physiological mvmt of the bone itself.
ie. knee flexion, an angular mvmt, moves in a posterior direction; like wise, roll is posterior in knee flexion
Define glide/slide
a component/accessory mvmt where bone’s articulating surface slips on the other; similar to the way a puck slides on ice.
-the direction of slide is either the same or opposite of the physiological/osteokinematic mvmt, depending on the articular surface’s concave or convex nature.
Define spin
an accessory/component mvmt where the bone turns around a “mechanical axis” while maintaining a constant contact at a particular paint on the reciprocating bone. ie the radius on the humerus or a spinning top.
What do you base the tx plane off of during a joint mob?
the tx plane is based off the concave sides’ bone shaft.
When doing tractions or compressions are you treating perpendicular or parallel to the treatment plane?
You are treating perpendicular to the tx plane during traction and compression.
When you are doing glide/slide mvmts are you treating perpendicular or parallel to the treatment plane?
You are treating parallel to the treatment plane.
Where is the mechanical axis?
It is perpendicular to the treatment plane.
What is traction?
the application of a force to draw or pull articulating surfaces apart.
Define compression?
the application of a manual force to approximate or press articular surfaces together.
Define close-pack position.
the position of a joint when its articular surfaces are most closely approximated, or congruent, and involves a rotational component, where the joint capsule and peri-articular ligaments are tightened so that the joint is fixed or locked.
- no mvmt is possible.
- joint mobs are CI’d because it would cause damage.
Define loose-pack position.
any position of the joint other than closed-pack, where there is laxity in some part of the joint capsule; this laxity allows arthrokinematic mvmts to occur
-joint mobs are performed in this position (the restriction is identified, the therapist backs off 10 degrees and then performs a corrective mob).
Define resting position.
the maximum loose-pack position and is ideal for joint play assessment and early treatment.
-the synovial joint naturally assumes this position when injury causes maximal synovial effusion (filling of the joint capsule)
Define capsular pattern of restriction
when joint impairment affects the entire joint, the capsule of each joint undergoes a characteristic pattern of restriction in PROM - specific for each joint.
What is the concave-convex rule?
- if a concave surface moves on a convex surface, glide occurs in the SAME direction as roll.
- if a convex surface moves on a concave surface, glide occurs in the OPPOSITE direction to roll
What are some indications for joint mobs?
- the purpose of joint mobs is to restore pain-free ROM*
- post immobilization d/t sprains, strains, #, tendonitis, bursitis, etc
- to resolve the sequence of fibrosis and relative capsular fibrosis, (aka capsular/ligamentous tightening and adherence) and intra-articular damage
- pain control
- to decrease reflex muscle guarding and restore muscle balance
- improving joint nutrition, eliminating meniscoid impingement.
What CI’s for joint mobs?
- neoplasm or any non-diagnosed lesions
- bacterial infection
- recent #
- acute/active inflammatory and infective arthritis, ie. rheumatoid arthritis
- joint ankylosis
- joint is in closed-pack position
- active use of corticosteroids (Risk of Harm)
- joint hypermobility
What are some precautions for joint mobs? these would require omission or modification of tx and are therefore cautionary
- joint effusion or inflammation where excess swelling would not allow any mvmt to occur
- chronic or non-active inflammatory arthritis
- diseases affecting the bones structural integrity. ie. osteoporosis
- advanced diabetes - affects integrity of CT
- degenerative joint disease, osteoarthritis; where mobilization may adversely affect bone spurs etc.
- local intra-articular injection (corticosteroids)
- hormone induced joint hyper extensibility, ie. relaxin on pelvic joints
- guest has adverse response or is too painful.
Explain the procedure for joint mobs.
(maintain a dialogue with client; position for safety and efficiency)
- joint play/assessment is performed in loose-pack position.
- only ONE bone is stabilized, ONE bone is mobilized, ONE mvmt is performed, ONE joint is mobilized at a time.
- DO NOT lever a joint or allow roll to occur during the manipulation
- joint mobs are a passive modality, combining assessment and treatment.
How many grades of joint play are there?
Three.
Describe when you use each grade of joint play
Grade I - for acute
Grade II - for subacute
Grade III - for chronic
What is the “first stop” vs the “anatomical limit”?
First stop is the capsular limit.
the anatomical limit is the max distance you can go.
Of the three grades of traction, which are corrective?
Grade III is corrective.
Which grades of traction and joint mobilization do you use to modify/interrupt pain?
Grade I & grade II of traction and/or grade I & grade II of joint mobilization
Define oscillation
a combination of amplitude and frequency, or size and rate; applied at a specific relationship to tissue resistance. usually 3x/sec or 5x/sec.
How many grades of joint mobs are there?
Five. only four are within our scope of practice.
Describe a grade I joint mob
small amplitude rhythmic oscillations that are performed at the beginning range of joint play, short of tissue resistance.
- fast rate of oscillation (5x/sec)
- grade I traction
- acute stage of healing
- non-corrective
Describe grade II of joint mob
larger amplitude rhythmic oscillations that do not reach tissue resistance
- slow rate of oscillation (3x/sec)
- grade I traction
- subacute stage of healing
- non-corrective
Describe grade III joint mob
large amplitude rhythmic oscillations that are applied through the first barrier of tissue resistance
- slow rate of oscillation (3x/sec)
- grade I traction
- chronic stage of healing
- corrective
Describe a grade IV joint mob
small amplitude rhythmic oscillations performed at the limit of available motion and into tissue resistance, but short of anatomical limit.
- fast oscillation rate (5x/sec)
- grade I traction
- chronic stage of healing
- corrective
Define amplitude in terms of a joint mob.
the size of the oscillation
Define inert tissues
all structures that would not be considered contractile or neurological, such as joint capsules, ligaments, bursae, blood vessels, cartilage, and drura matter.
what are the four classic patterns of inert tissue in terms of ROM?
- ROM full and no pain. - indicating no lesion of inert tissue
- pain and limitation of mvmt in every direction - indicates entire jt is affected suggesting arthritis or capsulitis.
- pain and limitation or excessive mvmt in some directions - ligament sprain, or local capsular adhesion; mvmts that stretch, pinch or move affect structure, causing the pain; could also indicate an internal derangment
- limited mvmt w/o pain - end feel is usually abnormal, bone-bone type; symptomless arthritis d/t osteophytes.
What are the four classic patterns seen with contractile and nervous tissue in terms of ROM?
- mvmt is strong and Px-free - no lesion of contractile/nervous tissue
- mvmt is strong and Px-ful - local lesion of mm or tendon; could be first or second degree mm strain; avulsion # (partial); tendinosis, tendinitis, paratendonitis
- mvmt is weak and Px-ful - severe lesion around that joint such as a #
- mvmt is weak and Px-free - indicates complete rupture of a mm (3 degree strain) or its tendon or peripheral nerve/nerve root supplying that mm.
Protective muscle spasm injury
Early muscle spasm
Deep tissue instability
Late muscle spasm
Abnormal end feels…. Tight muscles
Mushy tissue stretch
Abnormal end feels…..upper motor neuron lesions
Spasticity
Abnormal end feels……Frozen shoulder
Hard capsular
Abnormal end feels…..synovitis soft tissue edema
Soft capsular
Abnormal end feels…. Osteophytes
Bone to Bone
Abnormal end feels…acute subacromial bursitis
Empty
Abnormal end feels….meniscus tear
Spring Block
Normal end feels….elbow extension
bone to bone
Normal end feels….knee flexion
Soft tissue approximation
Normal end feels…Examples of ankle dorsiflexion, shoulder lateral rotation, finger extension
Tissue stretch
