Joint Mobilization Flashcards
Physiologic movements
motions that can be created volitionally (actively)
Non-physiologic movements
motion that does not occur in isolation voluntarily
component movements
occur in combinations with physiologic motion (ex. scapular motion with GH flexion)
joint play
occur only in response to an outside force. (end feels)
Accessory motions
Distraction, glides, and tilts. joint play that is needed for normal physiological range
Mobilization
- skilled passive movement
-low velocity - does not go beyond end range
- can be grated 1-3 / 4 depending on system used
Manipulation
-low amplitude
-high velocity
-thrust
- intenstially moved beyond end range
-grade 5 mob
Maitland grade 1
oscillatory movement with small amplitude fast velocity right at the start of motion (way before R1)
Maitland grade 2
oscillatory movement with a large amplitude and slow velocity. Goes right to R1 but not past.
Maitland grade 3
oscillatory movement with a large amplitude and slow velocity. Goes from R1 to R2
Maitland grade 4
oscillatory movement with a small amplitude and fast velocity at the end of end range
Kalltenborn compression
Not graded. Only used to see if symptoms can be reproduced
Kalltenborn traction grade 1
the unweighting of the joint. Use to relieve pain, muscle grading, and move joint fluid.
kalltenborn traction grade 2
taking the tissue to slack. used to releive pain and assess joint play and reactivity
Kalltenborn traction grade 3
used to stretch the muscle to get tissue deformation. used to increase mobility
Kalltenborn gliding grade 2
assess joint play and reactivity (take to R1)
used to increase mobility
Kalltenborn gliding grade 3
used to improve mobility and take to R2
Kalltenborg definition of soft end feel
soft tissue approximation or muscle stretch
Kalltenborg definition of a firm end feel
capsular or ligamentous
Kalltenborg definition of a hard end feel
bone or cartilage
Mobility 0 ranking
ankylosed (not moving)
Mobility 1-2 ranking
hypomobile (this is where you should preform joint mobs)
Mobility 3 ranking
normal
Mobility 4-5 ranking
hypermobile (do not do joint mobs on these patients)
Mobility 6 ranking
unstable (dislocation)
Indications for Passive Joint Motion
1) relief of pain and muscle guarding
2) restoration of normal joint mobility in the presence of stiffness
Type 1 Postural Receptors
- Found in joint capsules
- Small in diameter, myelinated fibers
- Low threshold, continually firing, and slow adapting
- Both static and dynamic firing mechanoreceptors
-Small motions lead to increased firing
-degenerate with age
—- Stimulated by small oscillatory mobs to decrease pain and muscle guarding
Type 2 Dynamic Receptors
- found in the joint capsule and articular fat pads
- mediam in diameter, myelinated fibers
-dynamic mechanoreceptors - low threshold and fast adapting
- movement and direction
- associated with marked discharge
——-Stimulated by small oscillatory mobs to decrease pain and muscle guarding
Type 3 Inhibitive Receptors
- found in ligamentous structures
- large myelinated fibers, identically structurally to the GTO (fastest of the 3)
- dynamic mechanoreceptors
- High threshold, slow adapting fibers
- Firing leads to reflex inhibition to surrounding muscles
——- stimulated by grade 5 joint mob (thrust) to inhibit muscle guarding
Type 4 nociceptive receptors
- found in most joint structures
-unmyelinated fibers and free nerve endings - generally high threshold firing fibers
what type of fibers does small, oscillatory movements fire?
type 1 and type 2; inhibiting pain and muscle garding
what types of fibers does end range dynamic movements (thrust) fire
type 3; leading into inhibition of muscle guarding
Contraindications to use of Passive motion
1) hyper mobility/ instability (fracture, sprain, RA, Osteoporosis)
2) any active disease process
3) conditions of acuity, inflammation, and reactivity
Which grades of Maitland should be used to reduce pain
grades 1 and 2
which grades of Maitland should be used to increase mobility
grades 3 and 4
where should you begin and end all mobilization sessions
with grade 1 and 2 to facilitate relaxation and pain management
Direction of mobilization to improve ankle talus dorsiflexion glide
anterior to posterior (AP)
Direction of mobilization to improve ankle planter flexion glide
posterior to anterior (PA)
Direction of mobilization to improve knee extension glide moving the tibia on the femur
Posterior to anterior (PA)
Direction of mobilization to improve knee extension glide moving the femur on the tibia
Anterior to posterior (AP)
Direction of mobilization to improve knee flexion glide moving the tibia on the femur
Anterior to Posterior (AP)
Direction of mobilization to improve knee flexion glide moving the femur on the tibia
posterior to anterior (PA)
Direction of mobilization to improve hip flexion glide
Anterior to posterior (AP)
Direction of mobilization to improve hip extension glide
Posterior to anterior (PA)
Steps with joint mobilization
1) assess ROM
2) assess end feel
3) compression
4) distraction (if needed)
5) go through the grades start with grade 1
6) reassess pain or ROM
7) use new range
Shoulder Flexion Joint Glide Mobilization
Anterior to posterior glide (AP)
Shoulder extension joint glide mobilization
Posterior to anterior glide (PA)
Shoulder Abduction joint glide mobilization
superior to inferior glide
Shoulder external rotation glide
posterior to anterior glide (PA)
Shoulder internal rotation glide
anterior to posterior glide (AP)
Wrist extension (carpels on ulna and radius) glide
posterior to anterior glide (PA)
Wrist flexion (carpels on ulna and radius) glide
anterior to posterior glide (AP)
Elbow (ulna on humerus) flexion glide
posterior to anterior (PA)
Elbow (ulna on humerus) extension glide
anterior to posterior (AP)
Elbow (humerus on ulna) flexion glide
anterior to posterior (AP)
Elbow (ulna on humerus) extension glide
Anterior to posterior (AP)
what receptor type has a low threshold
1 and 2
what receptor types has a high threshold
3 and 4
what are the sizes of the fiber types smallest to largest
1,2,3
what fiber types are found in joint capsules
1, 2 (also in fat pads), 4
what fiber type is found in ligaments and spine
3
what fiber type’s stimulation encourages more firing
1
what fiber type has a marked discharge
2
what fiber type leads to reflex inhibition
3
what fiber type is not myelinated
5
