Joint Mobility Flashcards
Provide 3 examples when AROM would be more indicated than PROM.
- Person can perform full or near full PROM with no pai
- If they are not bedridden or have neurological issues that limits their ability to move
- To strengthen the muscle
What are the potential reasons if someone has decreased AROM in knee flexion?
1) Tight knee extensors are limiting the range (Prescribe stretching)
2) Problems with the Accessory movements (Prescribe joint mobilization)
What are the three types of joints that can be found in the human body?
Arthroses = joints
Synarthroses = immovable, fixed/ fibrous.
Eg., Sutures of the skull —irregular bones interlocks and are bound tightly together by fibrous connective tissues. Eg., Syndesmosis: distal tibiafibular
Amphiarthroses = slightly moveable/ cartilaginous
Eg, pubic symphysis, Interosseous membrane: the sheet of connective tissue joining neighboring bones. These joints are connected by fibrocartilage that adhere to the ends of each bone.
Diathroses = movable. Synovial joints: plane, hinge, pivot, saddle, ball-in-socket, ellipsoid
Could performing Passive ROM (Including stretching) help with preventing muscle contractures and decrease pain?
What are the contraindications ?
Yes.
Contraindications:
- acute injury to the joint, ligaments or muscles
- Early fractures
Describe the structure of joints
Components of joint
- Bones: articular surface
- Cartilage: cover the bone articular surfaces → articular cartilage
- Joint capsule: tissues covering joints
- Synovial membrane: inner lining of capsule → secrete synovial fluid (reduce joint friction)
- Ligaments: by stability by connecting structures
Other Structures:
- disc/ minisci - structural integrity and shock absorption
- labra/ fat pad - increase joint surface area → increase stability, shock absorption
* bursa - reduce friction between rubbing surfaces
What are the factors that facilitate normal joint range of motion?
- Bone shape (concave, convex) → the surface area for the joint to move
- Accessory movement will help increase the available rom of the joint
- Hyaline cartilage → a) provide a smooth surface over the bone to occur… allow for spin/ glide/ roll w/out damaging friction, b) thus protect joint from wear and tear
- Synovial membrane - produce synovial fluid that runs over the joint surfaces (reduce friction when movement occur, shock absorption, nutrition) and enhance the function of the hyaline cartilage
- Joint capsule - most of the capsule surrounding joints are laxed → ease of ROM
- Additional structure - menisci in the knee, labrum in the shoulder, hip → increase joint surface, congruity or affecting stability within the joint
- Neuro-system
- muscle strengthn (help produce movements and stabilize the joint)
List and describe 4 factors that can decrease range of motion.
Factors:
- Tearing or displacements of intracapsular structures, eg. meniscus tear
- soft tissue lesions, eg., frozen shoulder
- immobilization: muscle shortens around the joint
- Pain: may lead to muscle guarding and lack of movement are factors that lead to hypomobility
- Neurological impairment can change muscle control, eg, spaticity
What plane of movement occurs along the vertical axis?
What plane of movement occurs along the anteroposterior axis? Transverse axis?
Vertical axis: Transverse plane (rotational movements)
Transverse axis - sagittal plane (flexion and extension)
Anterioposterior axis (aka sagittal) frontal plane, adduction and abduction
How do hyaline cartilage and synovial membrane helps faciliate normal joint movement?
- Hyaline cartilage → a) provide a smooth surface over the bone to occur… allow for spin/ glide/ roll w/out damaging friction, b) thus protect joint from wear and tear
- Synovial membrane - produce synovial fluid that runs over the joint surfaces (reduce friction when movement occur, shock absorption, nutrition) and enhance the function of the hyaline cartilage
How do we assess ROM?
By using a device to calculate the angle of that joint, refer to as the goniometry. AROM, PROM, end feel or other ways physical therapist used to assess ROM.
With AROM, we could note how much movement is present compared to the normal ROM for the specific joint.
PROM: we could determine the end feel of a joint, it is how the joint feel at the end of the passive range. It is important to determine the normal and abnormal end feels as it would give you info about the joint
What are accessory movements? role?
Accessory movements are the spin, glide, rotation movements that we cannot see that occurs during physiological movements.
Accessory movements could increase joint surface contact (closed pack position) ensuring joint congruity/stability. Alternatively, accessory movements help to improve joint range of motion.
Describe the four types of passive passive range of motion.
When do you use one versus the other?
If someone has muscle weakness, what technique would you select?
- Relaxed passive ROM: an external force is applied without muscle contraction and performed within available ROM. It is used when full active ROM is not possible due to weak muscle, neurological problem, pain, spinal injury, unconsiousness. (Either performed by the therapist, by the patient or by a machine)
- Stretching: an external force is applied by the individual that takes the joint beyond available physiological range of motion and result in a change in soft tissue length.
- Mobilization: is a PROM technique performed within the joint available range by the therapist to test or restore accessory movements of the joint. It is used to treat capsule and ligament tightness. Eg., a shoulder capsule stretch
4. Manipulation: is a PROM technique that uses small amplitude forceful movements to move the joint beyond its physiological range. Eg., traction, backcracking.
It is used to increase ROM due to end range blockage by loose bodies or a period of immobilization. - break down adhesions, clearing blockage that has been formed through the healing process.
What are the methods to treat abnormally limited ROM?
- Passive ROM
- Stretches
- Mobilizations
- Manipulation
- Active ROM
In what case would you prescribe stretching?
Would you prescribe stretching if someone has muscle spasmS?
- If they have pain caused by muscle spasms
- person is susceptible to muscle contractures
- Person do not have joint hypermobility, bone fractures or soft tissues damage and they want to improve their flexibility.
What is the interaction between muscle and joints?
Muscles are attached to bones via tendons. Muscle contraction create forces on bones (pull). In order for movement to occur the bones have to be able to move freely.
