Joint Mobility

Question 1

In a JMA, we are looking for:

Answer 1

gross quantity of movement
end-feel
provocation (their pain or painless)

Question 2

what is the current classification scale for JMAs?

Answer 2

hypermobile
normal
hypomobile

Question 3

what are the different purposes of joint mobs as an intervention technique?

Answer 3

regaining normal ROM
improving joint capsule extensibility
regaining normal force distribution
pain reduction
lubricating the surface
nutrition to joint structures

Question 4

what are the red flags (absolute contraindications) of joint mobilization (7)

Answer 4

malignancy in that area
active inflammation/infection
ankylosis
fracture
neurological deterioration
diseases affecting ligament integrity
arterial insufficiency

Question 5

what are the yellow flags (relative contraindications) of joint mobilization (6)

Answer 5

excessive pain or swelling
arthroplasty
hypermobility
metabolic bone disease
pregnancy
spondylolisthesis

Question 6

what are the 3 proposed joint mobe MOAs?

Answer 6

biomechanical
nutritional
neurophysiological

Question 7

describe the biomechanical mechanism of joint mobes

Answer 7

motion and positional improvement
increasing joint capsule extensibility

Question 8

describe the nutritional mechanism of joint mobes

Answer 8

synovial fluid movement
improve nutrient exchange

Question 9

describe the neurophysiological mechanism of joint mobes

Answer 9

stimulates mechanoreceptors to inhibit pain impulse
-GAIT CTRL THEORY!
-descending pathway inhibition theory (stim periaqueductal grey for pain modulation)

Question 10

what are the types of joint mobilizations?

Answer 10

distractions
oscillation mobilizations
sustained hold mobilizations
manipulations

Question 11

what are kaltenborn’s 3 distraction grades and what do they do?

Answer 11

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

Question 12

what are maitland’s mobilization oscillation grades?

Answer 12

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

Question 13

what are the targets of oscillation mobilization?

Answer 13

guarding, pain, joint hypomobility

Question 14

what are the targets of sustained hold mobilization?

Answer 14

joint mobility at end range
beginning to mid-range pain (oscillation preferred for pain*)

Question 15

For joint mobilization, we use resting (open pack) position for:

Answer 15

assessment
acute stage
grade 1 and 2 oscillations (3 and 4 IF this is the only tolerable position)

Question 16

For joint mobilization, we use end ROM position for

Answer 16

grades 3 and 4 to improve mobility

Question 17

describe the technique for oscillations

Answer 17

1-3/s; typically 1-5 sets for 15-60s each

Question 18

describe the technique for sustained holds

Answer 18

1-5 sets for 5-30 sec each
more common for ROM issues

Question 19

what are the guidelines for Mulligan’s mobilizations with movement?

Answer 19

should be painless
apply TEN times before reassessing joint motion
overpressure to be applied @ end range of AROM

Question 20

define the open pack position of the GH, AC ,and SC joints

Answer 20

GH: 55*ABD, 30 Horizontal ADD, slight ER
SC and AC: arm by side

Question 21

what are the roles of the joint capsule?

Answer 21

seals joint space?stability via limiting movements, active stability via nerve endings

Question 22

what are the 3 joint play movements and what should your force orientation be as the PT?

Answer 22

compression: perpendicular
traction/distraction: perpendicular
gliding: parallel to surface