Joint Manipulation Flashcards
Define
The skilled passive movement of a joint and/or the related soft tissues at varying speeds and amplitudes
Includes small aplitude, high velocity therapeutic movement
Non-thrust manipulation
Slow/patient can stop the movement
Oscillatory or sustained
Thrust manipulation
High velocity, low amplitude motion that the patient cannot prevent
Physiological manipulation
Osteokinematic
Can be performed actively by the patient
Angular movement of the bones
Accessory manipulation
Arthrokinematic
Movement of joint and surrounding tissue necessary for physiological motion but cannot be performed actively
“joint play” - movements not under voluntary control but necessary for full painless joint function
Close packed position
Max tautness of major ligaments Max surface congruity Minimal joint volume Max stability of the joint Limited angular glide here
Open packed position
Slackening of major ligaments Minimal surface congruity Minimal joint surface contact Max joint volume Minimal stability of the joint Most joint play available here
Concave on Convex
Glide and roll in same direction
Glide in same direction as physiological motion
Convex on concave
Roll and glide in opposite directions
Glide in opposite direction of physiological movement
Type I mechanoreceptors
Ruffini
Superficial capsule
Monitor joint position, velocity, mm tone
Type II mechanoreceptors
Pacinian
Deep capsule
Monitor joint acceleration, produce inc mm tone
Type III mechanoreceptors
Similar to GTO
in ligaments
monitor direction of movement, inhibit tone
Type IV mechanoreceptors
Nociceptors in capsule and ligaments
Prduce mm contraction
Neurophysiological effects
o Pain modulation, endorphine release
o Stimulate mechanoreceptors that may inhibit transmission of nociceptive stimuli at spinal cord or brain stem levels
o Reflex muscle relaxation, muscle facilitation
Biomechanical effects
o Circulatory effects/help maintain nutrient exchange and decrease swelling
o Cause synovial fluid motion bringing nutrients to avascular portions of articular cartilage
o Mechanically elongates tissues
Contraindications - absolute
Malignancy Bone disease Unhealed fracture Undiagnosed pain Active infection Joint Ankylosis (fused) Cauda equine lesions Indication of spinal cord involvement Osteoporosis
Contraindications - relative
Systemic CT disease Progressive neuro signs Pregnancy Anticoagulant medication Osteopenia
Pain dominant
o Joint in neutral position )open/loose packed) o Reduce or eliminate pain o Short of P1 (onset of pain) o Accessory motion o Grades I and II o Address treatment soreness o Reassess pain
Stiffness dominant
o Physiological motion near L/Accessory movement near L o Produce pain of stiffness o Move resistance up in range o Grades III, IV, V o Address treatment soreness o Reassess ROM
Inflammation
pain before res
Grade I or II
No stretching
Pain reduction
Granulation/fibroblastic phase
pain concurrent with res
Grade II or IV
Gentle stretching
Treat stiffness
Maturation phase
Pain after res
Grade II IV or V
Aggressive stretching/break adhesion
Rate/Duration
Oscillations - 2 to 3 per second for 1 to 2 min
Sustained - 7 to 10 sec with 3 to 5 sec rests
address treatment soreness
until patient/PT sense change
Vary speed/angle
Force and direction
Apply force as close to joint surfaces as possible Increase patient comfort - position for comfort - inc contact area - relax your hands - suport limb - approp body mechanics Consider convex.concave rule Consider tx plane Vary direction and angle based on comprable sign and resistance encountered
Tx progression
Pain vs stiffness dom Based on pt response Modify grade Modify physiological position Comine phys with access Comine motions
Assess
before during and after
before subsequent intervention
retrospectively
Audible/Cavitation
Sudden dec in intracapsular pressure causes dissolved gases in synovial fluid to be released into joint cavity
Followed by elasic recoil of synovial capsule
