Joint Manipulation Flashcards
definition of joint manipulation/mob
skilled passive movements to the joints and or related soft tissues that are applied at varying speeds and amplitudes
thrust joint manipulation
high velocity, low amplitude therapeutic movements within or at end range of motion
what grade is high velocity low amplitude mob?
5
maitland’s theory
move a peripheral or vertebral segment to increase motion or decrease pain
who identified graded passive movements
maitland
kaltenborn’s theory
restore movement allowed by shape of surface (convex/concave)
cyriax’s theory
stretch joint capsule
alter shape/reduce strain of disc
evjenth’s theory
stretch muscles spanning joint
mennell’s theory
restore joint play
strain/counterstrain theory
decrease soft tissue strain to facilitate muscle relaxation
myofascial release theory
decrease tension in soft tissue to increase segmental movement to decrease likelihood that dysfunction returns
A ______ is something the patient complains of while a _______ is an objective finding
symptom, sign
T or F: a joint sign is an objective finding
T: anything found within a joint, its structures or movements that is abnormal
comparable sign
- reproduction of the patient’s complaint of pain through examination
- reproduces the pt’s symptoms
asterisk sign
outstanding signs used for quick reassessment of a patient’s progress
how many asterisk signs should you try to find
1-2
for pain, what is the goal of treatment
reduce, centralize, and eliminate the pain
for stiffness, what is the goal of treatment
reproduce the pain (with respect) moving further into range to reduce stiffness
pain is often _______ while stiffness is localized
diffuse
is pain or stiffness usually worse at night?
pain
does stiffness usually cause limitations? what about pain?
stiffness no, pain yes
in pain-dominant patients, pain is usually constant while in stiffness dominant it is ___________
intermittent
T or F: stiffness is usually chronic
T
pain is aggravated by ________ activity and is slow to reduce while stiffness is aggravated by ________ activity and only lasts a short time
mild, vigorous
in pain dominant, pain is usually ______ than a 5/10 while in stiffness-dominant pain is usually _________ than a 5/10
greater, less
T or F: pain dominant is often aggravated by repeated movements
T: but for stiffness dominant repeated movements often increase range
_______ dominant has pain at rest, early, and mid-range whereas ________ dominant usually only has pain at end range
pain, stiffness
T or F: stiffness dominant usually has spasms
F: but pain does!
Your pt c/o constant 7/10 shoulder pain that gets worse at night. He is very guarded and doesn’t want to move his shoulder. On objective exam you find he has pain at rest, early, and mid-range. He also has spasm and as you continue your exam his pain increases. Is this pt most likely pain or stiffness dominant?
pain
**your exam on someone who is pain-dominant may not be as in depth
Your pt c/o 5/10 shoulder pain only w/ overhead movements. On objective exam, you find he has limited abduction, flexion, and ER. No spasms are found. As you continue your exam and moving his shoulder around his range slightly increases. Is this pt most likely pain or stiffness dominant?
stiffness
what grades of mobs do you use for pain? what about stiffness?
grade 1-2
grade 3-4
goal of mobs for pain
stay short of resistance to reduce pain
goal of mobs for stiffness
go into/through barriers to produce pain in order to increase range
for ________ dominant you use most free movements for manual treatment and exercise while for _______ dominant use most restricted movements for treatment
pain
stiffness
pain is likely an ______ condition, while stiffness is likely a ______ condition
inflammatory, mechanical
3 signs of irritable patient/pain
1 - easily provoked, 10 mins or less of activity
2 - constant or severe intermittent pain
3 - takes 10 mins or more to settle pain back to baseline
treatment for irritable pain
- grade 1 or 2 mobs for brief and few bouts
- PROM, AAROM, AROM
- light resistance exercise with fewer reps to be repeated throughout the day
treatment for non-irritable pain
- grade 3-4 mobs for longer and more bouts
- ROM also into barrier and end range
- higher resistance and reps
R1
onset of resistance
R2
resistance limit
P1
onset of pain
P2
pain limit
S1
onset of spasm
S2
spasm limit
A (on movement diagram)
beginning of movement
B (on movement diagram)
end of normal ROM
L (on movement diagram)
abnormal limit to a ROM
passive physiological
typical PROM
passive physiological intervertebral movements
used to assess movements at individual spinal levels
passive accessory intervertebral motions (PIVMS)
movements available in a joint performed passively by the therapist
TJM
thrust joint manipulation
grade 5
3 motions occurring when you do mobs
1 - osteokinematics
2 - arthrokinematics
3 - compression and distraction
bone motion (flexion, abduction, rotation) is what kind of kinematics
osteokinematics
osteokinematics are described from anatomical __________
neutral
rolls and glides are what kind of kinematics? these are also known as accessory motions
arthrokinematics
how many grades of movement are there
5
grade 1
small amplitude, short of resistance
grade2
large amplitude, short of resistance
grade 3
large amplitude to 50% of R1-R2
grade 4
small amplitude to 50% of R1-R2
grade 5
small amplitude, high velocity thrust at end of available range
type 1 and 2 mechanoreceptors
in joint capsules
low threshold, excited with oscillations
type 3 mechanoreceptors
in joint capsules, extracapsular ligs
excited by stretching
type 4 mechanoreceptors
in capsules, ligaments, fat pads, and blood vessels
- pain receptors
what type of mechanoreceptrs do you NOT want to excite
type 4
what are some contraindications of joint mobs
- vertebral artery insufficiency
- acute RA
- instability
- unhealed fracture
- cauda equina
- acute inflammation
- psychological or undiagnosed pain
- pain that doesn’t relate to movement
- bone disease
- joint effusion
- malignancy
precautions for joint manipulation
- excessive pain
- total joint replacement
- fusion
- neuro deficit
- osteoporosis
- spondylolishesis
- pregnancy
- acute trauma
- foraminal encroachment
- steroids or anticoagulants
you should stabilize ________ and mobilize ________
proximally, distally
