Joint Mobilization

Question 1

Physiological movements

Answer 1

motion that can be created actively

Question 2

Nonphysiological movements

Answer 2

motion that does not occur in isolation voluntarily

Component motion-occur in combo with physiological movement like (ex. tibial ER with knee extension aka screw home mechanism)

Joint play: occurs only in response to an outside force. End feels.
Accessory motions: joint play needed for normal physiological range (distraction, glides, and tilts)

Question 3

Mobilization

Answer 3

-skilled passive movement
-low velocity
-does not go beyond end range
-can be graded I-III or I-IV

Question 4

Manipulation

Answer 4

It’s a kind of mobilization (grade V)
-Low amplitude
-High velocity
-Thrust
-Intentionally moves joint beyond end range

Question 5

Maitland grades of motion I-IV (osscilatory movement)

Answer 5

Grade I: small amplitude movement at the beginning of the available ROM

Grade II: large amplitude movement within midrange of movement to R1

Grade III: Large amplitude movement from R1 to R2. Do not come out all the way.

Grade IV: small amplitude movement at R2

Grade V: high velocity, low amplitude thrust intentionally moving beyond the “final barrier”

Question 6

Nordic System of Passive Joint movement (Kalltenborn)

Answer 6

Types:
1. Compression: a provocation assessment technique only

2. Traction
   Grade I: relieve pain and muscle guarding, move joint fluid
   Grade II: relieve pain and assess joint play/reactivity
   Grade III: increase mobility
3. Translatoric (gliding)
   Grade II: assess joint play and reactivity
   Grade III: improve mobility

Grades of motion
Grade I: just enough to nullify compressive forces applied only to traction mobilization

Grade II: tissue slack is being taken up. Surrounding joint tissues are being tightened assess tissue response and subjective response

Grade III: Actual tissue deformation occurs beyond 1st stop into resistance

Question 7

Kalltenborn Passive Joint Motion Quality & Quantity (0-6)

Answer 7

Quality end feels
Soft, firm, hard

Quantity
0=ankylosed
1-2=hypomobile (ideal for this)
3=normal
4-5= hypermobile
6=unstable

Question 8

Indications for passive joint motion

Answer 8

1. relief of pain and muscle guarding
2. Restoration of normal joint mobility in the presence of stiffness

Question 9

Type I receptors (postural)

Answer 9

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

Question 10

Type II receptors (dynamic)

Answer 10

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

Question 11

Type III receptors (inhibitive)

Answer 11

found in ligamentous structures, specially of spinal column, large myelinated fibers, identical structurally to the GTO, dynamic mechanoreceptors, high threshold, slow adapting fibers (takes higher stimulus), firing leads to reflex inhibition to surrounding muscles

Question 12

Type IV (nociceptive)

Answer 12

found in most joint structures lattice like, unmyelinated fibers and free nerve endings, generally high threshold firing fibers.

-small oscillatory movement fire Type I and IIs, inhibiting pain and muscle guarding
-end range dynamic movement (thrust) fire type III leading to inhibition of muscle guarding

Question 13

Contraindications to use of passive motion

Answer 13

1.hypermobility/instability
2. any active disease process
3. conditions of acuity, substantial inflammation, reactivity