Joint mobilisation Flashcards
what are joint mobilizations
passive mobilisations that are within patients control
importance of joint motion
function, movement, nutrition- stimulating synovial fluid to produced- maintains cartilage health and surrounding tissue, cartilage, bone health, soft tissue
the effects of immobilization
loss of function, decrease ROM, muscle atrophy, soft tissue length change, cartilage/ bony changes, pain states
types of joint motion- osteokineamic
physiological movement of the bone- accessory motion needed to assist movement
open chain- no weight, closed chain- weight going through bone
types of joint motion- arthokineimic
motion between joint surfaces, accessory movements, open and closed chain activities
osteokineamic- explained
movement of bones rather than the movement of the articular surfaces, occurs about an axis, measurable as angular displacement in an anatomical plane and referred to as anatomical or physiological range, pathological range may be hyper or hypo mobile
arthrokinematics- explained
the motion occurring between joint surfaces, roll- refers to the rolling of one joint surface on another, one joint partner usually provides a bade for the other to move on, requires adequate capsular laxity, small movements occurring s part of osteokinematic motion- accessory movement, type of movement depends on the shape of the articular surfaces
arthrokinematics- roll, slide, spin, rotation
slide- this is a pure translatory movement, refereting to the gliding of 1 component over another, spin-(combine roll and slide to keep joint where it is), rotation of a segment about a stationary axis
concave convex rule
when a concave surfaces moves on a stable concave surface, the sliding of the convex articulating surface occurs in the opposite direction to the motion of the bony lever
close pack position
position in which the joint ligaments and capsule are maximumly taut, in the majority of joints, the position it is also a position of maximum congruence
what is the relevance of the close pack position for joint movement/ rehabiltitaion?
open pack/ mid-range- have to consider modifying assessment and treatment technique to match the position patients are having symptoms of
limitations to joint movement- function
intra-articular structures- ACL and PCL, peri-articular structures- ligs- MCL and LCL, soft tissue length, bony congruence, soft tissue approximation
limitations to joint movement- dysfunction
swelling, pain inhibition, psychosocial, spasm
indications for joint mobilisation
restoration of movement to a joint- accessory movement, physiological, finding what has caused damage, specific to joint, pain, spasm, joint soft tissue tightness
effect of joint mobilisation
improve range of active/ passive/ active movement, increasing length of joint soft tissue and structures, relief of pain, decrease muscle spasm, placebo effect
if one session restores motion what does it suggest
it suggests some alterations to resting muscle tone, or viscoelastic response in surrounding soft tissue
pain control mechanisms- central pain control
underlying mechanisms- neuromodulation- altering neural input which moderates pain perception at central/ peripheral level- reducing pain, descending inhibition- blocks pain response from above, increases amount of stimulus needed for message to be sent from spinal cord upwards
pain control mechanisms- central pain control- PAG
periaqueductal grey matter (PAG) in the brainstem to spinal cord
Dorsal PAG- non opioid, noradrenaline, blocks substance P at spinal cord level
ventral PAG- opioid mechanisms, serotonin
pain control mechanisms- pain gate theory
low threshold, larger diameter, myelinated AB fibres (mechano fibres), decreased response dorsal horn to A and C fibres, mechanoreceptor coming into spinal cord blocks interneuron within spinal cord, stopping nociceptive transmission- doesn’t perfectly work- reduces pain
arthrogenic effects
osteo-/artho-kineamatic movements, restoration of accessory glide, capsular stretch, soft tissue receptors, increase in joint ROM, influencing deep/superficial joint muscles, dispersal of inflammatory ‘soup’
grades of movements- grade 1 and 2
1- small amplitude performed at the beginning of range,
2- large amplitude within a resistance free part of range
grades of movements- 3 and 4
3- large amplitude performed into resistance up to the limit of range
4- small amplitude movement performed well into resistance
dosage variations
SIN factors, 30 secs up to 2 mins of more- allows period of time to see if things will change, allow constant reassessment, number of sets dependent of SIN factors
dosage variations- severity
intensity of symptoms, symptoms constant VS intermittent, pain/ night scale, level of required medication, level of function, ability to return to work, low/ moderate/ high
dosage variations- irritability
the ease with which a patient’s symptoms are increased or produced, based on the patients aggravating and easing factors , irritable VS non irritable, low/ moderate/ high
dosage variations- nature
tissue mechanics- pathology and stage of healing, pain mechanisms, psychosocial factors, genetics- myogenic, neurogenic, arthrogenic, inflammatory
indications for grades- grade 1/2 and 3/4
1/2-high severity/ irritability, high VAS, acute condition
3/4- stiffness more than/worse than pain, low to moderate severity/irritability, low levels of pain- VAS (2,3,4)., sub-acute to chronic stage, movement related pain, end range pain
contraindications
infection, tumor local, acute inflammatory process, fractures/dislocation, RhA acute flare up
precautions
joint instability, hypermobility, seronegative arthropathies, high severity/ high irritability
joint mobilisation summary
it is used to restore joint function, they use arthrokinematics motion to restore functional range of movement to a joint, techniques can be varied in direction, range and amplitude to achieve the desired therapeutic effect, they. are postulated to achieve a number of biomechanical and physiological effects
