joint mobilisations 3 Flashcards
what are important pointers / checklist for performing accessory movements on a patient?
- position the patient comfortably
- examine joint on unaffected side first (nb for comparison)
- exmaine initially without feedback - helps learning
- use largest area of skin contact possible for patioent comfort
- force is applied using body weight of physio
- apply force smoothly and slowly through a range to either assess or treat
compare grade I-II to grade III-IV
- grade I and II- for pain relief
- Grade III & IV - for joint stifness
what are indications for joint mobilisations?
- joint dysfunction - eg ankle sprains
- joint pathology eg osteoarthritis
- analgesia - pain relief
- imrrove joint hypomobility
- improve functional ability
what are the 2 types of fibres that carry information from nociceptors?
- A delta fibres
- C fibres
Describe** A delta fibres**
- mechanical
- myelinated - carry signals fast
- carry well localised pain, sharp or prickling pain
describe c fibres
- non myelinated
- carry dull, aching and burning pain
briefly describe the ‘pain’ pathway
- nociceptors recieve a noxious stimuli eg paper cut
- fibres travel up to the dorsal horn of the spinal cord and release pain neurotransmitters eg substance P
- the** 2nd order neuron **will recieve these nt’s and will cross over the spinal cord
- 2nd order neuron will bring this info from the spinal cord to the brain via the spinothalamic tract/pathway
- tract goes towards the **thalamus **in the brain
- 2nd order neuron will synapse with a 3rd order neuron in the thalamus which is located in 2 important nuclei
- nociceptive info then projects to the somatosensoy cortex for further processing and pain perception
what are the evidence based effects of mobilisation?
- increase in joint ROM
- decrease in peri-articular muscle spasm (muscles surrounding the joint)
- decrease in intra-articular pressure (pressure in joint) - remmeber joint effusion (excessive fluid) after trauma can cause a build up of joint pressure
- decrease in joint afferent nociceptor activity
what mechanisms may cause a decrease in pain after end of range joint mob treatment?
- muscle inhibition- through decrease in peri-articular muscle spasm
- decrease in intra-articular pressure
- decrease in nociceptor activity
what is the pain gate theory?
- a theory that suggests that non painful sensations can override and reduce painful sensations
- involves a **nerve gate **which is located in the dorsal horn of the spinal cord
explain briefly what the nerve gate (pain gate theory) does in the spinal cord?
- the nerve gate is located in the dorsal spinal cord and has inhibitory interneurons that inhibit signal transmission from the 1st to 2nd order neurons in the spinal cord
- however, if there are more non- noxious stimuli eg touch, pressure or changes of temp - a diff type of fiber called A beta can stimulate the inhibitory interneuron and stops the tranmission of pain signals
- pain relieving effect of skin rubbing, heat or cold packs
what are the psychological effects of mobilisations / manual therapy?
- analgesia
- placebo effect on pain - perceived improvement on pain
what are the biomechical effects of manual therapy?
- altered tisue extensibility
- altered fluid dynamics
- ie repair and tissue remodelling
what are the physiological effects of manual therapy?
- stimulation of gating system - pain gate
- muscle inhibition
- reduced intra-articular pressure
- ie pain relief
are the positive effects that are felt as a result of manual therapy permenant?
no - they are temporary - could last 24-48 hours … does depend on whether it is a joint dysfunction or joint pathology
