Into to Mobilization Flashcards
What techniques are used to modulate pain and treat joint impairments that limit ROM by addressing altered mechanics of the joint?
Manual Therapy
5 reasons we would alter the mechanics of a joint?
- pain
- muscle guarding
- joint effusion
- contractures
- adhesions
What type of technique is applied to joints and soft tissue?
skilled and passive
a manual therapy technique comprising of continuum of skilled passive movements to the joints and or soft tissue that are applied at various speeds and amps
mobilization/manipulation
manipulations that do not involve thrust
non-thrust manipulation
a high velocity, low amp movement within or at end of ROM
thrust manipulation
What are the 4 indications of manipulation?
- safe and effective means to restore joint play
- to decrease pain
- **must be part of comprehensive exam of joint
- **must be part of comprehensive POC
What is osteopathy?
- body as a unit
- structure and function are reciprocally interrelated
- self-regulatory mechanisms
What is joint play?
quality of motion in joint (Mennell)
What is the study of motion?
Kinematics
What is osteokinematics?
voluntary movement of body part around the joint or fixed axis
- measurable with goni (active and passive)
- gross movements of body parts
What two types of movement make up kinematics?
- osteokinematics
- arthrokinematics
What are two types of movements within osteokinematics (sub of kinematics)?
- Active joint motion
- Passive joint motion
Describe end feel?
“feel” of tissues when passive motion is extended to the end of the joints ROM through overpressure
what is the quality of resistance at the end range of joint motion?
End Feel
What type of barrier is found in the end movement of ACTIVE motion in a joint?
physiological barrier
What are the three main uses of active ROM
- determine joint range
- determine flexibility
- determine muscle function
What type of barrier is found in end range of PROM?
anatomical barrier
what are the two main uses of PROM?
- contrast with AROM
- determine nature of end feel
Three types of NORMAL end ranges?
- soft tissue approx. (knee flexion)
- tissue stretch (dorsiflex)
- bone to bone (elbow ext)
7 Abnormal End Ranges
- empty
- early or late muscle spasm
- capsular
- bone to bone
- springy
- muscle spasticity
patterns of limitation in ROM or restriction of movement which is a result of total joint reaction and involves specific limitations in motion?
Capsular Pattern
Two types of limitation in motion at the joint?
Capsular and Non capsular
ROM limitations that do not correspond to the classic capsular pattern for the joint?
Non capsular pattern
Extension more limited than flexion at elbow?
non capsular
Flexion more limited than extension at elbow?
capsular
what are motions that occur WITHIN the joint at the joint?
also, naturally occurring to allow movements and maintain integrity of joint and CANNOT be measured with goni
Arthrokinematics
What makes up arthrokinematics? (2 subtypes)
- Component motions (rolls, slides, spins)
- Mobilization/Manipulation (distraction grades 1-3 and glides 1-5)
Joint play and accessory motions (compression and distraction) make up what type or motions)
component motions (slides, rolls, spins)
Distractions and glides make up with type of movement?
Manipulation/Mobilization
-Incongruent joint surface
Rolling
Characteristics of Rolling?
- incongruent joint surface
- new surface meets new surface of opposing
- always occur in the same direction of “swinging” bone
Which direction does a roll occur?
-always in direction of swinging bone
Congruent joint surface (or flat or curved)
Sliding
Characteristics of Sliding?
- congruent surface
- same pt on one surface contacts different point on opposing side
- direction of slide depends on concave or context surface
When the concave portion of a bone is moved on a convex surface what direction is the slide?
same direction as the motion
When the convex portion of a bone is moved on a concave surface what direction is the slide?
opposite direction of motion
Concave-Convex Rule
Concave motion=same slide
Convex motion=opposite slide
If the surface is more congruent is there more sliding or rolling?
sliding
if the surface is more INCONGRUENT is there more sliding or rolling?
Rolling
What controls sliding movements?
muscles
What type of component motion is a rotation about a stationary mechanical axis?
Spin, arc is created as it spin
What component motion occurs at the shoulder and hip during flexion and extension?
Spin
Sliding component motion of joint mobilization is used to:
- restore joint play
- reverse joint hyper mobility
What is a small amount of movement that can only be assessed by an external force passively?
joint play
What is necessary for normal, tpainfree ROM and normal end feel?
joint play
A position of joint with maximum congruity and efficient for load bearing, and very dangerous to do joint play?
Closed pack position
Resting position of joint, low capsular tension, inefficient for load bearing, least congruity, and best for joint play assessment?
Open pack position
What manipulation is perpendicular to the treatment plane?
distraction
What manipulation is parallel to the treatment plane?
glides
When should you assess joint play?
- when AROM and PROM is limited
- Abnormal End Feel
When are arthrokinematics considered normal and not need to be assessed?
-AROM and PROM and ENDFEELS are normal
What is it when joint surfaces are distracted and moved in a translatory fashion?
Glide mobilization
use of translatoric glide to stretch tight capsule, replicates a slide, PROM can compress joint and this minimizes joint surface contact
Joint-glide stretch
what is a plane that passes through the joint and lies at the right angle to a line running from the axis of rotation to the middle of the contacting articular surface
Treatment plane
what is a 2 dimensional approximation on the articular surface of concave bone
treatment plane
What is a distraction? Grades?
when articular surfaces are separated, perpendicular to treatment plane
Joint surfaces are “unweighted”; no appreciable joint separation; only enough force to nullify joint compression forces
ex: removing tight skin
Distraction Grade 1
slack in the capsule is taken up; other periarticular tissues tighten
Distraction Grade 2
Capsule and ligaments are stretched
Distraction Grade 3
What grade distraction goes through available joint play range and to the tissue resistance but does no proceed to the anatomical limit?
Grade 2 distraction
What grade distraction goes through complete available joint play range, past tissue resistance, and almost to anatomical limit?
Grade 3 distraction
What grade glides are done only if there is a restriction?
3,4,5
Grade 1 Slide
small amplitude at beginning of range
Grade II slide
large amplitude within range which does not extend to the end of available range
Grade III slide
large amplitude up to a pushing into limit of range
Grade IV slide
small amplitude up to and pushing into limit of range
Grade V slide
thrust; small amplitude, high velocity at or beyond limit of range
Statics and dynamics are two components of what?
kinematics
what is the study of bodies at rest and includes posture, and solid mechanics such as (stress/strain)
Statics
a static system, minimizes forces acting on the body
posture
study of mechanical property of materials; stress and strain;
Solid Mechanics
what is resistance of material to deformation
stress
Stress is:
- resistance of material to deformation
- response to an applied load
- force/area
- directly related to magnitude of force
- inversely related to unit area
- stress=force divided by cross sectional area
deformation that occurs in response to applied load; expressed as a percent change
strain
application of a force, moment, or some combination to a material
load
Five types of load
- compression
- tension
- torsion
- bending
- shearing
a force that is equal and opposite forces are applied toward the surface
compression force
a force that is equal and opposite forces are applied away from the surface
tension
a force opposing forces cause twisting
torsion
opposing forces parallel to surface
shearing
a force that is a combination of 3 or more loads causing it to bend around an external axis
bending
Know the seven levels of stress strain curve
1: toe region (slack region)
2: elastic region; no damage; linear
3: elastic limit
4: plastic region (initial failure, loss of mechanical properties)
5: ultimate stress (max stress)
6: necking region (thinning of tissue toward failure)
7: failure point (max strain)
What region of the curve is taking up slack and collagen fibers straighten without elongation?
Toe Region (1)
What region of the curve is: linear; stress is directly proportional to strain (hooks law); and once stress is removed it returns to normal length (slope is stiffness of material(
Elastic region 2
transition be tween linear portion and where curve flattens; tissues do not return to original length
Elastic limit 3
region where tissue lengthens disproportionally to stress; permanent deformation; microscopic tearing of fibers
Plastic region 4
What may allow tissue structures to return to original length after some plastic deformation has occurred below the level of ultimate stress?
biological memory
peak of curve; maximum load tolerated; beyond this point necking and failure occurs
Ultimate stress 5
region that follows ultimate stress; in plastic region; micro failure progresses to macro failure; total failure results
necking 6
absence of stress region, total rupture of tissu
Failure point 7
what is load that is applied for extended time, tissues stretch and does not return to normal length?
Creep
what is a load applied to stretch tissue, length of tissue kept constant and decreased force is needed to maintain the stretch for prolonged stretching?
Stress-relaxation
repetitive loading increase in heat production, may result in failure even if below yield point
Cyclic loading
What are the variables for mobilization:
- freq/duration
- force/amplitude
- speed/rhythm or type
- location
- temperature
Mobilization: force criteria:
- larger surface area of application=more comfort
- apply force close to joint like
- gentle touch
What grades of manipulation have a psychological effect?
Grade I and II
What grades of manipulation have neurophysiological effects?
Grades I and II
What grade distraction and glides have a mechanical effect?
Grade III distraction, Grade III-V glides
What type of effect: elongation of connective tissue and contractile tissue
physiological effect
What type of effect: reducing pain, decreasing muscle guarding, inhibiting stretch reflex and improving kinesthetic awareness
neurophysiological effect
what type of effect: restoration of joint play which allows for appropriate component motions and subsequent increase in active and passive ROM; decrease joint pain
mechanical effect
What are the joint classifications? 0-6
0: ankylosed (fused)
1: considerable restriction
2: slight restriction
3: normal
4: slight increase hyper mobile
5: considerable increase in hyper mobile
6: path. unstable
-reasses, provide exercise/stretching to maintain gains, provide HEP, provide patient education
after moblization
Structure governs function, but in time…
function will modify if not dictate structure
