introduction Flashcards
definition of joint mobilization
skilled passive movement by a therapist on articular surfaces to decrease pain or increase joint mobility / ROM
Physiological effects of Joint Mobilization
-fires articular mechanoreceptors
-fires cutaneous and muscular receptors
-abates / stops nociceptors (pain receptors)
-decreases or relaxes muscle guarding
-causes synovial fluid movement & improves
nutrient exchange
-improves mobility and flexibility at the joint
-maintains tensile strength of articular tissues
Arthrokinematics
motions you can feel, movement that occurs inside a joint.
roll, spin, slide/glide
Osteokinematics
motions you can see, movement of body parts that occurs outside a joint.
flexion/extension, abduction/adduction, rotation
ROLL
Accessory motion where one articular surface rolls on another
eg/ tibia rolls on femur
SLIDE / GLIDE or translation
Accessory motion where one articular surface slides on another
Surfaces are usually congruent, flat or curved.
SPIN
Accessory motion where one bone moves but the axis remains stationary
closed packed position
-joint position in which the articulating bones have their maximum area of contact with each other and it is called maximum congruency
-joint capsule becomes twisted causing the joint surfaces to become fully approximated and no further movement is possible
-joint stability = greatest
-Injury in the closed packed position will most likely result in fracture and/or dislocation
open packed (loose) / resting position
-a position of the joint where the joint surfaces become separated and have little congruity and minimal joint surface contact
-joint capsule is relaxed and untwisted as well as the major ligaments
-joint is under the least amount of stress in this position, which is why we do most joint mobilizations in the resting position.
-joint stability = minimal
-sprains and strains occur - when swelling occurs the joint assumes the open packed position
capsular pattern of restriction
-predictable pattern of movement restriction that occurs in a synovial joint when the entire joint capsule is injured / affected
-result of a total joint reaction
-pattern is named from the most restricted ROM to the least restricted
-When testing range of motions in a specific joint, one would find a predictable pattern of limitation to specific joint movements that can be measured and retested
concave / convex motion rule
-when a concave surface moves on a convex surface, roll and slide must occur in the SAME direction
-when a convex surface moves on a concave surface, roll and slide occur in OPPOSITE directions
joint distraction
two opposing joint surfaces are separated from each other, moving towards a loose or open packed position
joint distraction - axial distraction
through the long axis of the joint
joint distraction: lateral distraction
perpendicular to long axis of joint
compression / approximation
two opposing joint surfaces are moved towards each other or approximated
-towards a close packed position
joint play
-Arthrokinetic movements that occur between two articular surfaces within their ranges of motion
-Motion that is available between two articular surfaces in one direction - not under voluntary control
principles of joint play (1-5)
- patient must be relaxed
- therapist must be relaxed & comfortable
- mobilize distal articular surface on proximal articular surface if possible
- do not mobilize when the joint surfaces are fully approximated or close packed
- position joint by moving joint to point of restriction & then back off by approximately 10º, then perform mobilization technique
principles of joint play (6-10)
- mobilize one joint, in one direction and at one time
- do not mobilize joint if patient is experiencing pain during the mobilization. This may increase the inflammatory response, & muscle guarding
- assessment of joint with joint play should always be in the loose packed or resting position
- correct stabilization of other body parts are essential for the joint mobilization to be effective
- do not lever a joint - do not perform long lever roll manipulation. Joint play is a direction mobilization that is performed in direction of glide.
principles of joint play (11-14)
- use pillows, rolled up towels, or high-density foam blocks to help stabilize the proximal joint surface
- watch for patient discomfort
- always re-assess after each treatment and prior to a treatment
- joint play should be used with other adjunct therapies, like soft tissue stretching, deep tissue massage and hydrotherapy
causes of joint dysfunction
-Intra articular adhesions or pericapsular stiffness
-Shortened muscle groups around the joint
-Muscle weakness and imbalance around a joint
-Pain
-Nerve root adhesions
-Soft tissue restrictions
indications for joint play
-most commonly associated with restoring ROM for the peripheral and axial skeleton joints
-primary indication = decreased ROM due to immobilization, usually from fractures, ligamentous sprains, tendonitis, or adhesive capsulitis
-any condition involving fibrosis or pseudo-fibrosis (relative capsular fibrosis) of the joint capsule is indicated for mobilization.
joint play CI’s
hypermobility
joint effusion
inflammation
methods of joint examination
Inspection
Palpation
Range of Motion (active vs passive)
Radiography (x-ray)
Computed tomography (CT scan)
Magnetic Resonance Imaging (MRI)
Conventional & Contrast Arthrography
Ultrasound Arthrography
Inspection and Palpation - looking for…
-Swelling
-Skin changes
-Muscles, above and below the joint (wasting) compare to non injured side
-Deformity of any kind, bones misaligned, valgus or varus
range of motion
-measurement of the amount of movement around a specific joint
-measures the amount of movement allowed by the shape of the joint & by the surrounding soft tissues
-may show the joint’s movement is limited, normal or excessive
PROM
-therapist makes the motions of the joint while the patient is relaxed through the unrestricted range
-the patient does not contract muscles
-anatomic barrier = end of PROM
AROM
-patient “actively” contracts the voluntary muscles crossing the joint, moving the joint through its ROM
-physiologic barrier = end of AROM
grading joint play
-when applying joint mobilizations to specific joints, always start with the least stress on the joint and go to more and more stress
-use a grading system for both sustained glides or distractions & for oscillations
-each grade has a purpose & function within the grading system for a therapeutic effect on joints
GRADE 1 - sustained
-initiation of movement of the opposing joint surfaces
-perpendicular to the joint surfaces for a distraction joint mobilization or parallel for a glide joint mobilization
=non-corrective
GRADE 2 - sustained
-initiation of movement of the opposing joint surfaces
-perpendicular to the joint surfaces for a distraction joint mobilization or parallel for a glide joint mobilization
=non-corrective
GRADE 3 - sustained
-movement of the opposing joint surface is up to and through the first tissue stop.
=corrective grade
-this grade of mobilization stretches joint capsule - perform this grade with caution
grade 1 & 2 sustained - purpose
for pain management, introductory assessment and joint play (Grade 2) and assessment techniques
grade 3 sustained - purpose
corrective technique to stretch the joint capsule & restore glide motions within the joint
GRADE 1 - oscillations
-small amplitude
-between initiation of movement & tissue resistance
-5 cycles per second
GRADE 2 - oscillations
-larger amplitude
-between initiation of movement & tissue resistance
-2-3 cycles per second
GRADE 3 - oscillations
-large amplitude
-within tissue resistance & backing out again
-2-3 cycles per second
GRADE 4 - oscillations
-small amplitude
-within tissue resistance to end of limited ROM
-5 cycles per second
GRADE 5 - oscillations
-high velocity, small amplitude
-non-oscillatory movement, starts at tissue resistance & follows through in a thrust manipulation
-
grade 1 & 2 oscillations - purpose
pain relief, warm ups or introductory techniques
grade 3 & 4 oscillations - purpose
corrective oscillatory type mobilizations to mobilize and stretch joint capsules
end feels
-when assessing passive movements, therapist applies overpressure at end of the range to determine the quality of the end feel -sensation the therapist “feels” in the joint as it reaches end of ROM of each passive movement
normal end feels
-bony: hard, painless
-soft tissue approximation: mushy
-tissue stretch: firm, springy, elastic, slight give, may be hard / soft
abnormal end feels
-early:caused by muscle/ligament tear, often acute
-late: caused by instability
-capsular: hard (chronic) & soft or boggy (acute), caused by capsule damage
-empty: caused by ligament rupture or tear, very painful
-bone to bone: caused by osteophyte, early restriction in ROM
-springy block: caused by internal derangement inside joint, common in meniscus, early restriction
