Joint mobilisation

Question 1

what are joint mobilizations

Answer 1

passive mobilisations that are within patients control

Question 2

importance of joint motion

Answer 2

function, movement, nutrition- stimulating synovial fluid to produced- maintains cartilage health and surrounding tissue, cartilage, bone health, soft tissue

Question 3

the effects of immobilization

Answer 3

loss of function, decrease ROM, muscle atrophy, soft tissue length change, cartilage/ bony changes, pain states

Question 4

types of joint motion- osteokineamic

Answer 4

physiological movement of the bone- accessory motion needed to assist movement
open chain- no weight, closed chain- weight going through bone

Question 5

types of joint motion- arthokineimic

Answer 5

motion between joint surfaces, accessory movements, open and closed chain activities

Question 6

osteokineamic- explained

Answer 6

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

Question 7

arthrokinematics- explained

Answer 7

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

Question 8

arthrokinematics- roll, slide, spin, rotation

Answer 8

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

Question 9

concave convex rule

Answer 9

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

Question 10

close pack position

Answer 10

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

Question 11

what is the relevance of the close pack position for joint movement/ rehabiltitaion?

Answer 11

open pack/ mid-range- have to consider modifying assessment and treatment technique to match the position patients are having symptoms of

Question 12

limitations to joint movement- function

Answer 12

intra-articular structures- ACL and PCL, peri-articular structures- ligs- MCL and LCL, soft tissue length, bony congruence, soft tissue approximation

Question 13

limitations to joint movement- dysfunction

Answer 13

swelling, pain inhibition, psychosocial, spasm

Question 14

indications for joint mobilisation

Answer 14

restoration of movement to a joint- accessory movement, physiological, finding what has caused damage, specific to joint, pain, spasm, joint soft tissue tightness

Question 15

effect of joint mobilisation

Answer 15

improve range of active/ passive/ active movement, increasing length of joint soft tissue and structures, relief of pain, decrease muscle spasm, placebo effect

Question 16

if one session restores motion what does it suggest

Answer 16

it suggests some alterations to resting muscle tone, or viscoelastic response in surrounding soft tissue

Question 17

pain control mechanisms- central pain control

Answer 17

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

Question 18

pain control mechanisms- central pain control- PAG

Answer 18

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

Question 19

pain control mechanisms- pain gate theory

Answer 19

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

Question 20

arthrogenic effects

Answer 20

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’

Question 21

grades of movements- grade 1 and 2

Answer 21

1- small amplitude performed at the beginning of range,

2- large amplitude within a resistance free part of range

Question 22

grades of movements- 3 and 4

Answer 22

3- large amplitude performed into resistance up to the limit of range
4- small amplitude movement performed well into resistance

Question 23

dosage variations

Answer 23

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

Question 24

dosage variations- severity

Answer 24

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

Question 25

dosage variations- irritability

Answer 25

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

Question 26

dosage variations- nature

Answer 26

tissue mechanics- pathology and stage of healing, pain mechanisms, psychosocial factors, genetics- myogenic, neurogenic, arthrogenic, inflammatory

Question 27

indications for grades- grade 1/2 and 3/4

Answer 27

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

Question 28

contraindications

Answer 28

infection, tumor local, acute inflammatory process, fractures/dislocation, RhA acute flare up

Question 29

precautions

Answer 29

joint instability, hypermobility, seronegative arthropathies, high severity/ high irritability

Question 30

joint mobilisation summary

Answer 30

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