Joint Mobilisation Flashcards
What are the two main types of passive joint mobilisation?
- passive physiological mobilisations
- passive accessory mobilisations
What are the different types of end feel?
- soft: from soft tissue apposition
- hard: from a bony block
- elastic: from stretching capsule and ligaments
what are active physiological movements?
movement that someone can consciously perform themselves
what are passive physiological movements?
movement performed by another person or device
what can passive physiological movements be used for? (Assessment and treatment)
Assess:
-ROM
-End feel
-Symptoms
Treatment:
-Increase ROM
-Relieve pain
What is Maitland grade I?
small amplitude movement performed at beginning of range. Gets nowhere near to the end of range. Used to treat pain.
What is Maitland grade II?
large amplitude of movement performed within the resistance free range. Used to treat pain.
What is Maitland grade III?
large amplitude movement performed into resistance or up to limit of range. Used to treat stiffness and decreased ROM.
What is Maitland grade IV?
small amplitude movement performed into resistance or up to limit of range. Used to treat stiffness and decreased ROM.
Speed/Rhythm of movements
can be abrupt or slow. Movement can be held for as long as 5 seconds before reversing movement
How do passive physiological movements work?
-By stretching soft tissues and adhesions to restore ability of joint for normal ROM
- By a synovial sweep which aids lubrication and thus movement
Explain the pain gate theory
A ‘gate’ exists in the dorsal horn of spinal grey matter. This determines which information is received by the brain.
Open gate: painful stimuli are free to travel to the brain
Closed gate: messages about pain are being reduced
what is descending inhibition in the pain gate theory?
this reduces pain by: closing the gate directly and by the secretion of opioids
What are accessory movements (+examples)
small movements that occur between joint surfaces to maintain congruence (cannot be performed consciously)
- Roll
- Slide/Glide
- Spin
What is the concave-convex rule?
-If the convex surface of a joint is moving then roll and slide occur in opposite directions
-If the concave surface is moving then roll and slide occur in the same direction
Which Maitland grades reduce pain?
I and II
Which Maitland grades improve ROM?
III and IV
What are the automatic accessory movements?
Slide, spin, roll
What are the passive accessory mobilisations? (Physio-induced)
slide, spin, compression and distraction (pulling apart of joint surfaces)
Which accessory mobilisation should you use for pain?
The movement that produces the pain
Which accessory mobilisation should you use for increasing movement?
the accessory movement involved in the physiological movement you want to improve. Use concave-convex rule as a guide.
Do you use passive accessory or passive physiological mobilisations for pain?
Accessory (grades I and II)
Do you use passive accessory or passive physiological mobilisations for increasing movement?
combination of accessory and physiological mobilisations (grade III and IV)
Technique for applying passive mobilisations
- Patient relaxed (lying) and comfortable
- Physio comfortable. Grip should not be tighter than required and should make full mechanical advantage of levers
- Stabilise above the joint
- Assess patient symptoms and range before, during and after
- If patient is improved, continue
- If unimproved or worse, change technique or grade.
What are some contraindications for joint mobilisations?
- Osteoporosis
- Anticoagulants within last 6/52
- Long term steroid use
- Hypermobilty
- Inflammatory arthritis
- Malignancy (local)
- Recent radiotherapy (local)
- Tuberculosis
- Ligamentous rupture (local)
- Herniated discs with nerve compression
- Cauda equina lesion
- Central stenosis/ cord pressure
- Recent bone fracture (local)
- Congenital bone deformities
- Vascular disorders
- Spondylolithesis
- Patients unable to give consent
- Bone disease
- Neurological involvement
What are some precautions for joint mobilisations?
- Osteoarthritis (Acute phase)
- Pregnancy
- Children
- Total joint replacement
- Severe scoliosis
- Poor general health
- Patient’s inability to relax
- Downs Syndrome
