Joint Mobilization Flashcards
What are physiologic movements?
Motion that can be created volitionally (actively)
What are non-physiologic movements?
Motion that does not occur in isolation voluntarily
What are component movements? What is an example of this motion?
-Motion that occurs in combination with physiologic motion
-Ex. Clavicular rotation during arm elevation; Tibial external rotation with knee extension
What is joint play?
-Occurs only in response to an outside force
-Involves end feels
-Pertains to accessory motions of joint play that are needed for normal physiological range (distraction, glides, and tilts)
What are the characteristics of mobilization?
-Skilled passive movement
-Low velocity
-Does not go beyond end range
-Can be graded I-III or I-IV
What are the characteristics of manipulation?
-Low amplitude
-High velocity
-Thrust
-Intentionally moves joint beyond end range
What are the grades of motion (for Maitland)?
I-IV are all oscillatory with either:
-Small amplitude (6-12 per second)
-Large amplitude (3-6 per second)
-Before or after “first stop” (change of tissue resistance at end range) but before the “final barrier”
V- A high velocity, low amplitude thrust (HVLAT)
-Intentionally moving beyond the final barrier
Describe Grade 1-4 for Maitland
Grade 1: before R1, small and fast oscillations
Grade 2: Up to R1, big and slow oscillations (push, relax)
Grade 3: between R1 and R2, big and slow oscillations
Grade 4: Up to R2, small and fast oscillations
What are the types of passive joint movement (Kalltenborn joint mobs)?
-Compression
-Traction
-Translatoric (gliding)
Describe the 3 grades of motion for Kalltenborn?
Grade I: There’s still loose slack; Just enough to nullify compressive forces; applied only to traction mobilization
Grade II: tissue slack taken up, surrounding joint tissue tightened (assess tissue and subjective response)
Grade III: Tissue deformation, moving beyond R1
What is the purpose of Grade II for Kalltenborn? Grade III?
Grade II- pain relief; Assess joint play/reactivity
Grade III- Increase mobility
What are the different end feels through Nordic System (Kalltenborn)?
Soft- soft tissue approximation or muscle stretch
Firm- Capsular or ligamentous
Hard- Bone or cartilage
What are the quantity grades for Nordic System/Kalltenborn?
0= Ankyloses (joint has no motion)
1-2= hypomobile (do joint mobs)
3= normal
4-5= Hypermobile
6= Unstable
What are the indications for passive joint motion?
-Pain relief and muscle guarding
-Increase joint mobility in the presence of stiffness
What is compression used for?
Recreating symptoms
What are the grades of traction Kalltenborn?
Grade I: relieve pain and muscle guarding
Grade II: relieve pain and assess joint play/reactivity
Grade III: increase mobility
What are the neurophysiologic benefits/characteristics to passive joint mobilization with regards to Type I receptors (postural)?
- Found in joint capsules
-Small diameter, myelinated fibers
-Low threshold, continually firing, slow adapting
-Both static and dynamic firing mechanoreceptors
-Small motions lead to increased firing
-Promote body awareness in space
-Degenerate with age
What are the neurophysiologic benefits/characteristics to passive joint mobilization with regards to Type II (dynamic) receptors?
-Found in joint capsule and articular fat pads
-Medium diameter, myelinated fibers
-Dynamic mechanoreceptors
-Low threshold, fast adapting
-Movement and direction
-Associated with marked discharge
What are the neurophysiologic benefits to passive joint mobilization with regards to Type III (inhibitive) receptors?
-Found in ligamentous structures, specially of spinal column
-Large myelinated fibers, identical structurally to the GTO
-Dynamic mechanoreceptors
-High threshold, slow adapting fibers
-Involves GTO
-Firing leads to reflex inhibition to surrounding muscles
What are the neurophysiologic benefits/characteristics to passive joint mobilization with regards to Type IV (nociceptive) receptors?
-Found in most joint structures
-Lattice like, unmyelinated fibers and free nerve endings
-Generally high threshold firing fibers/pain receptors
What do small, oscillatory movements do?
-Fire Type I and II’s, inhibiting pain and muscle guarding
What does end range dynamic movements (thrust) do?
Fire Type III leading to inhibition of muscle guarding
What are the contraindications to use of passive motion?
-Hypermobility/instability
-Any active disease process (flu, infection, malignancies)
-Conditions of acuity, substantial inflammation, reactivity (swelling, warmth, or muscle guarding
Examples of hypermobility/instability contraindications for passive motion
Recent fracture, ligamentous sprains, RA, osteoporosis
What are the accessory motions used in assessment and treatment for Kalltenborn?
-Compression (provocation assessment technique only)
-Traction
-Gliding
What does grade II and III do (for gliding) per kalltenborn?
Grade II: pain relief, assess joint play and reactivity
Grade III: Improve mobility
What are grades I-IV used for (Maitland)?
-Grades I and II are used to reduce pain
-Grades III and IV are used to increase mobility
What grade mobilizations are used to begin and end all mobilization sessions to facilitate relaxation and to relieve pain?
Grade I and II mobilizations
What position should initial Maitland mobilization techniques be performed in?
Loose-packed position
What direction are the roll and glide for convex-concave?
Convex moving on concave = opposite
Concave on convex= same
To improve GH flexion, which direction would the glide need to be directed in?
Apply Posterior glide
To improve GH extension, which direction would glide need to be applied in?
Apply anterior glide
To improve GH IR, which direction would glide need to be applied in?
Apply posterior glide
To improve GH ER, which direction would glide need to be applied in?
Apply anterior glide
To improve GH ABD, which direction would glide need to be applied in?
Inferior glide
When GH abduction occurs, which directions does the glide occur?
Humeral head glides inferiorly
Which direction does humeral head move to increase ABD ROM?
Mobilize humeral head in inferior direction
What are the steps for any joint mob?
- Figure out which way joints move (convex on concave and vice versa)
- Assess ROM
- Joint play
- Compression
- Choose technique
- Reassess
What are the 4 neurophysiological benefits to passive joint mobilization?
-Type 1 receptors (postural)
-Type II (dynamic)
-Type III (inhibitive)
-Type IV (nociceptive)
