Joint Mobilization Flashcards
Physiologic Movements
Motion that can be created volitionally (actively)
Non- Physiologic Movements
motion does not occur in isolation Voluntarily “actively”
Ex:
Component movements = occur in combination with physiologic motion (active movement)
* Joint play*= only in response to an outside force
Mobilization
- Skilled passive movement
- Low velocity
- Does NOT go BEYOND end range
- Graded I -II OR 1 - I-IV
Manipulation
- Low amplitude
- High Velocity
- Thrust
- Intentionally MOVES BEYOND end range
Grades of motion (Maitland)
I - IV are all oscillatory with either small amplitude (6-12secs) , Large amplitude (3-6secs)
Before or after “first stop”
V - a high velocity, low amplitude thrust (HVLAT) intentionally moving beyond the “final barrier”
What does the “first stop” feel like according to Maitland?
A change of tissue resistance at end range but BEFORE the final barrier
What Grade is before R1 according to Maitland?
Grade II - large amplitude within mid-range of movement
What is Grade I of Maitland used for?
Pain & Spasm limiting movement early in ROM
What is Grade II of Maitland used for?
Muscle spasm or slow increase in pain halfway through ROM
What is Grade IV of Maitland used for?
Resistance from limits due to tissue tension, or tissue compression in the absence of pain & spasm
Increase Mobility
What is Grade III of Maitland used for?
For Pain & resistance from spasm, tissue tension or tissue compression limit movement near end of ROM
Increase Mobility
Types Nordic System of passive movement according to Kaltenborn
- Compressions
- Traction
- Translatoric (gliding)
What are the Grades of Motion according to Kaltenborn?
Grade I : loosen (unweight)
Grade II: take up slack (towards R1)
Grade III: stretch (Beyond R1 to R2 - tissue deformation)
Passive Joint motion Quality via Nordic System (Kaltenborn)
End feels (quality)
Soft- soft tissue approximation or muscle stretch
Firm- capsular or ligamentous
Hard - bone or cartilage
Quantity: graded on a 0-6 scale
0 = ankylosed
1-2 =hypomobile
3= normal
4-5=hypermobile
6= unstable
Indications for Passive Joint Motion
- Relief of pain & muscle guarding “Relaxation”
- Restoration of normal joint mobility in the presence of hypo-mobility (stiffness)
Benefits of passive Joint Mobilization include which Neuroreceptors?
Type I
Type II
Type III
Type IV
Type I (Postural)
Found in joint capsule
-Low Threshold, continually firing
-Small diameter, myelinated fibers
Type II (Dynamic)
Found in joint capsule & articular fat pads
-medium diameter, myelinated fibers
Type III (Inhibitive)
Found in ligamentous structures, especially spinal column
- Large myelinated fibers
- Think of PNF for relaxation
Type IV (Nociceptive)
Found in most joint structures lattice like, unmyelinated fibers & free nerve endings
- Fire at a HIGH threshold
What do small, oscillatory movements fire?
Type I (postural) & II (dynamic)
- inhibiting pain & muscle guarding
What do end range dynamic movements (thrust) fire?
Type III leading to inhibition of muscle guarding
Contraindications to use of passive motion?
- Hypermobility/ instability
Ex: osteoporosis - Any active disease process
Ex: flu, infection - Conditions of acuity, substantial inflammation, reactivity
Ex: based on history/interview
Compression according to Kaltenborn
A provocation assessment looking for pain
Traction according to Kaltenborn
Grade I : Relieve pain & Muscle guarding Unweight
Grade II : Relieve pain & Assess joint play Slack
Grade III: Increase mobility Deform tissue
Gliding according to Kaltenborn
Grade II : assess joint play & reactivity
Grade III: Improve mobility
