Joint ax & rx

Question 1

PA Springing?

Answer 1

Physio at head of plinth (sitting)
Aim: segmental motion
SH = distal interphalangeal joint of 2nd or 3rd
finger on spinous process or interspinous space
MH= 2nd or 3rd finger overlaps the sensing hand
ACTION: rhythmical PA lift with MH

Question 2

List three treatment uses of PA Springing.

Answer 2

• Initial assessment of intersegmental motion
• Acute, painful cases
• Irritable conditions & the elderly

Question 3

Short Lever Upslopes

Answer 3

HAND POSITION:
a = SH- Find the spinous process of
segment to be mobilised with index
finger (or middle finger) and slide over
onto the articular pillar
b = MH – index or middle finger is placed
over the sensing hand fingers

ACTION:
MH = small PA movement up and
towards opposite eye (no push/pull on
head)
Neck opens in a contralateral
rotation/ipsilateral SF at that level
Rotatory movement in plane of facet
joint sup/ant

Question 4

Long Lever Upslopes

Answer 4

HAND POSITION:
SH = MCP of index finger placed along articular
pillar, ear in palm of hand, supporting head.
Lumbrical action to maintain contact pressure
Other hand = cradles the side of the head and
occiput, controlling amount of lat.
Flexion and rotation at upper spinal segments

ACTION:
* Close down segments above (take up slack)
= rot away and lat flex towards
* Both hands create motion, SH
predominately sensing, other hand
supportive/motive
* Small oscillatory movements
* Direction of movement 45º toward opposite
eye, pull up, wrist pronates.

Question 5

Mulligan concept

Answer 5

Based on Karltenborn (concave-convex rule) – passive arthrokinematics glide (joint plane)
maintained during painful movement
Aim: Reduce pain (not for stiffness) by correcting positional fault of joint
* NOT indicated for very irritable joints
* Use painful / functional movement, Rx should relieve pain and should not cause pain
* If pt feels pain with technique:
o Check contact point (hand technique)
o Correct spinal segment
o Correct or most appropriate technique
o Amount of force
o Direction of mobilization OR technique is not indicated

Question 6

Mulligan Assessment?

Answer 6

• Use the symptomatic movement
• Very good to be able to differentiate spinal level /painful joint / joint vs muscle vs neural pain with movement
• Assess P1 or P2 in active movement test
• Apply accessory glide into R (in joint plane)
• End feel is ‘capsular’ not ‘bony’
• PT = maintain glide for full movement, pt = active movement, then back to neutral
• Repeat x 2-3
• Re-assess new active ROM (hands-off)

Question 7

Mulligan rx?

Answer 7

• Force applied parallel or right angles to movement plane – avoid
  compression
• Peripheral joints: Rx plane lies parallel to concave surface (concaveconvex
  rule)
• Weight bearing (stand/sit) positions
• Explain to pt how movement should feel (as vertebra moves, pain
  should disappear, if they feel pain, they must tell you so you can check
  technique or level)
• Immediate improvement, otherwise alter angle, side or level
• Apply additional physio Rx, such as McKenzie etc.

Question 8

Cx SNAG for Rotation / Flexion

Answer 8

Physio

Stand behind seated patient

Thumb on spinous process above level, reinforce with other thumb (Treat C5-6, put on C5)

Point thumbs towards eyeball

Other fingers around neck to prevent neck flexion

Technique

Glide along Rx plane via superimposed thumb

Push up towards eyeball, in Rx plane

Maintain glide while pt turns head slowly in painful/restricted direction

Follow rotation with your hands to ensure movement occurs in Rx plane

If SNAGS indicated, pt should then have more ROM or less pain

Pt applies own overpressure

Sustain for few seconds in new pain free, EROM rotation, return to neutral

Repeat several times (approx 6), re-assess, ROM should improve