JOINT MOBILIZATION Flashcards
how can joint pain and LOM be addressed?
correcting altered joint mechanics
what can cause altered joint mechanics?
- pain & muscle guarding d/t pull of the muscle
- joint effusion
- capsular adhesions
- ligament adhesions
- aberrant joint motion
why can’t stretching be the chosen intervention for muscle restriction/tightness/imbalance?
it does not address the abnormal articular stresses inherent within the joint d/t the injury
Advantage of PJM vs stretching
PJM replicate arthrokinematics which dec abnormal compressive articular stresses, which in turn addresses capsular tissue restriction
Pre-requisites for an effective PJM application
- anatomy knowledge
- arthrokinematics (OKC/CKC, direction of roll and glide)
- pathology of the neuromuscular system (progressive or reversible)
- when and what to apply
passive, skilled manual therapeutic techniques applied at varying speeds and amplitudes using phsyiologic and accessory motions
mobilization/manipulation
self-stretching techniques that specifically use joint traction/glides that direct the stretch force to the joint capsule
self-mobiliation/automobilization
who developed MWM?
Brian Mulligan
When is MWM applicable?
- there is no contraindication for manual therapy
- (+) local MSK pathology upon eval
- biomechanical analysis reveals localized loss of movement and/or pain associated c function
- (-) pain during and immed after application
concurrent application of sustained accessory mobilization and an active physiologic movement to end range is used to be able to do passive end-of-range overpressure/stretching s pain as a barrier
mobilization with movement
technique performed at the end of pathologic limit, done only once, and is a high-level manual therapy technique
thrust
thrust is done in order to
- alter positional relationships
- snap adhesions
- stimulate jt receptors
active isometric contraction of deep muscles that are attached near the jt and whose line of pull can cause the desired accessory motion
muscle energy
examples of osteokinematics
- extension
- flexion
- abduction
- adduction
- inversion
- eversion
- rotation
- lateral flexion
- dorsiflexion
- plantar flexion
- elevation
- depression
what happens when arthorkinematics/joint play is absent
experience LOM and/or pain
rule which states that the direction of glide of a convex joint is opposite to the roll/swinging bone, while concave joints go towards the same direction
concave-convex rule
what arthrokinematic motion is more common in the shoulder, hip, and humeroradial joint?
spin
type of joint motion where there is new contact from point A to B until point C comes int contact with the opposing articular surface
Roll
arthrokinematics of clavicle elevation
superior roll & inferior glide of the clavicle
T/F: rolling is always in the same direction as the swinging bone, whether the surface is concave or convex
true
arthrokinematics of closed-chain knee flexion (squatting)
posterior roll & anterior glide of the femur on the tibia
arthrokinematics of open-chain knee flexion
posterior roll and posterior glide of the tibia on the femur
arthrokinematic that combines rolling and gliding
spin
give examples when spin can be seen
- shoulder flexion/extension
- hip flexion/extension
- radiohumeral joint during pronation/supination
accessory motion that occurs during weight-bearing
compression
in joint mobilization, traction is used when describing movement ______, while distraction is used when describing movement ________
along the long axis; perpendicular to the treatment plane
effects of joint motion
- stimulates biologic activity within joint (moves synovial fluid which stimulate diffusion of nutrients to avascular articular structures)
- maintains extensibility and tensile strength of articular & periarticular tissues
- provides sensory input for proprioceptive feedback
indication for joint mobilization (give at least 3)
- pain, muscle guarding, spasm
- reversible joint hypomobility
- positional faults/subluxations
- progressive limitation
- functional immobility
Limitations of joint mob
- cannot change the disease process
- skill of therapist directly affects the outcome
contraindications for joint mob
- hypermobility
- joint effusion
- inflammation
give at least 3 conditions requiring special precautions for stretching
- malignancy
- bone disease detectable on x-ray
- unhealed fx
- excessive pain
- hypermobility in associated joints
- total joint replacements
- newly formed/weakened connective tissue
- systemic connective tissue disease such as RA, in which the disease weakens the connective tissue
- elderly individuals c weakened connective tissue and diminished circulation
if capsular pattern is observed during evaluation and assessment, what does that give the examiner?
it gives a clue that the restriction is coming from the joint capsule
what does decreased joint play and pain when fibers of ligaments are stressed imply?
there is adhered or contracted ligament
joint manipulation or thrust techniques are commonly done in?
pts c subluxation, dislocation, or loose intra-articular surfaces
Grade I and II oscillatory techniques are for?
painful joints
Large-amplitude rhythmic oscillations within the available range but not reaching end-range
Grade II oscillatory techniques
usual parameters for grade II and grade III oscillatory techniques
2 or 3 cycles/oscillations per second for 1-2 mins
Oscillatory techniques used for stretching maneuvers
grade III and grade IV
large-amplitude rhythmic oscillations up to the end-range of available motion, stressed into tissue resistance
grade III oscillatory technique
small-amplitude rhythmic oscillations done at the beginning of range
grade I oscillatory technique
Small-amplitude rhythmic oscillations done at the end-range, stressed into tissue resistance
grade IV oscillatory technique
small-amplitude, high velocity thrust technique
grade V oscillatory technique
which grades are done smoothly c regular oscillations at 2 or 3 cycles, and is done for 1-2 mins?
grades II and III
grades which involves rapid movement?
grades I & IV
technique that is done for 1 rep only
grade V
small amplitude distraction c no stress on the capsule which equalizes cohesive forces, muscle tension, & atmospheric pressure acting on the joint and is used for pain relief & all gliding motions
grade I sustained distraction
enough distraction to tighten tissues around the joint and is used for initial treatment to determine the sensitivity of the joint
grade II distraction
large-enough amplitude to place a stretch on the joint capsule and is used to increase joint play by stretching the joint structures
grade III distraction
Speed, rhythm, and duration of sustained translatory joint play for joint pain
apply distraction for 7-10 sec c 1-2 seconds of rest in between for several cycles
parameters for stretching (grade 3)
minimum of 6 sec c a partial release, then repeat c slow, intermittent stretches of 3-4sec intervals for 1-2 mins
t/f: contraction and guarding will not cause problems in parameters and dosage since muscles have no influence in joint play
false, muscles have influence on joint play, thus, contraction & guarding may cause problems
What tools are commonly used to firmly and comfortably stabilize the proximal segment of the joint to be treated
belt or pt’s Body-weight
determinants for dosage of joint mob
patient’s response to treatment and state of disease
what is the difference between grade III & IV oscillations and grade III sustained stretch techniques?
rhythm or speed of repetition of the force
open-packed position of the humeroulnar joint
70* flexion, 10* supination
open-packed position of the shoulder joint
55* abduction, 30* horizontal adduction
open-packed position of the hip joint
30* flexion, 30* abduction, slight ER
open-packed position of the talocrural joint
10* plantarflexion, neutral inversion/eversion
open-packed position of the knee joint
25* flexion
plane perpendicular to a line running from the axis of rotation to the middle of the concave articular surface
treatment plane
where is the force applied?
close to the opposing jt surface
direction of movement of treatment force
parallel/perpendicular to the treatment plane
distraction are applied ______ to the treatment plane
perpendicular
gliding techniques are applied _____ to the treatment plane
parallel
sustained and oscillatory dosage used to maintain joint play
grade II
how to progress stretch techniques?
start at resting position > progress to a greater degree of movement
move bone at the end of ROM, then apply a sustained grade III distraction or glide technique
what dictates the direction of the glide and rotation?
joint mechanics
what dosage of distraction is used in grade III/IV gliding techniques?
grade I distraction
What should you always do prior to joint mob?
warm tissues around the joint using modalities, massage, or gentle muscle contractions
muscle relaxations techniques and grade I/II oscillatory techniques may inhibit muscle guarding and should be alternated with _____
sustained stretching techniques
what to do when applying stretching techniques?
move through available ROM (take up slack), then apply stretch force
what does increased pain 24 hrs after tx imply and what should be done?
dosage/duration was too much, decrease until pain is under control
What should be done post-treatment & before next treatment?
joint and ROM reassessment
How to document joint mob?
Grade __ <sustained distraction/oscillations> x distraction/oscillation & release time x minutes x sets on <joint> towards <direction> in <pt> to <rationale></rationale></pt></direction></joint>
ex: Grade II distraction x 7 secs distraction & 3 secs release x 2 mins x 1 set on R glenohumeral joint in supine to check initial response to joint mobilization
