Joint Mobility Flashcards
In a JMA, we are looking for:
gross quantity of movement
end-feel
provocation (their pain or painless)
what is the current classification scale for JMAs?
hypermobile
normal
hypomobile
what are the different purposes of joint mobs as an intervention technique?
regaining normal ROM
improving joint capsule extensibility
regaining normal force distribution
pain reduction
lubricating the surface
nutrition to joint structures
what are the red flags (absolute contraindications) of joint mobilization (7)
malignancy in that area
active inflammation/infection
ankylosis
fracture
neurological deterioration
diseases affecting ligament integrity
arterial insufficiency
what are the yellow flags (relative contraindications) of joint mobilization (6)
excessive pain or swelling
arthroplasty
hypermobility
metabolic bone disease
pregnancy
spondylolisthesis
what are the 3 proposed joint mobe MOAs?
biomechanical
nutritional
neurophysiological
describe the biomechanical mechanism of joint mobes
motion and positional improvement
increasing joint capsule extensibility
describe the nutritional mechanism of joint mobes
synovial fluid movement
improve nutrient exchange
describe the neurophysiological mechanism of joint mobes
stimulates mechanoreceptors to inhibit pain impulse
-GAIT CTRL THEORY!
-descending pathway inhibition theory (stim periaqueductal grey for pain modulation)
what are the types of joint mobilizations?
distractions
oscillation mobilizations
sustained hold mobilizations
manipulations
what are kaltenborn’s 3 distraction grades and what do they do?
1)piccolo-reduces compression and pain, common w/ glide
2)slack-determine sensitivity; alleviate pain, asses joint play and/or reduce guarding
3)stretch- increases mobility or assess end feel
what are maitland’s mobilization oscillation grades?
1) 0-25% available ROM: reduce pain and muscle guarding; improve joint lubrication/nutrition
2) 25-75%: : reduce pain and muscle guarding; improve joint lubrication/nutrition, cool down
3) 50-100%:stretch capsule and assoc structures
4) 75-100%:stretch capsule and assoc structures
5) high velocity thrust to anatomical limit: to decrease pain and guarding
what are the targets of oscillation mobilization?
guarding, pain, joint hypomobility
what are the targets of sustained hold mobilization?
joint mobility at end range
beginning to mid-range pain (oscillation preferred for pain*)
For joint mobilization, we use resting (open pack) position for:
assessment
acute stage
grade 1 and 2 oscillations (3 and 4 IF this is the only tolerable position)
For joint mobilization, we use end ROM position for
grades 3 and 4 to improve mobility
describe the technique for oscillations
1-3/s; typically 1-5 sets for 15-60s each
describe the technique for sustained holds
1-5 sets for 5-30 sec each
more common for ROM issues
what are the guidelines for Mulligan’s mobilizations with movement?
should be painless
apply TEN times before reassessing joint motion
overpressure to be applied @ end range of AROM
define the open pack position of the GH, AC ,and SC joints
GH: 55*ABD, 30 Horizontal ADD, slight ER
SC and AC: arm by side
what are the roles of the joint capsule?
seals joint space?stability via limiting movements, active stability via nerve endings
what are the 3 joint play movements and what should your force orientation be as the PT?
compression: perpendicular
traction/distraction: perpendicular
gliding: parallel to surface
