Joint mobilization 300 Flashcards
GH joint – resting position, closed pack position, capsular pattern of restriction
Closed packed position: maximal abduction and lateral rotation
Resting position: 55* of abduction and 30* horizontal adduction
Capsular Pattern: lateral rotation, abduction, medial rotation
GH flexion, roll/glide
anterior roll
posterior glide
NOTE FLEXION IS ALSO INFERIOR GLIDE
GH extension, roll/glide
posterior roll
anterior glide
GH internal rotation, roll/glide
anterior roll
posterior glide
GH external rotation, r/g
posterior roll
anterior glide
GH horizontal adduction, r/g
anterior roll
posterior glide
GH horizontal abduction, r/g
posterior roll
anterior glide
GH abduction, r/g
superior roll
inferior glide
GH adduction, r/g
inferior roll (?)
superior glide (?)
GH miscellaneous pathologies (including shoudler complex misc pathologies)
Winging scapula (paralysis of serratus ant and long thoracic nerve)
Adhesive capsulitis
Subscapular bursitis
Impingement syndrome
Supraspinatus and bicipital tendonitis
Post immobilization
ST joint resting position, closed pack position, capsular pattern of restriction
N/A
ST joint movements
Protraction/Retraction,
Elevation/Depression,
Upward Rotation of glenoid fossa/Downward rotation of glenoid fossa
(GFK 2018).
scapulohumeral rhythm ratio
2:1 ratio
humerus 2x for scapula 1x
0-30 no scap movement
at 30 scap begins rotating superiorly
@ 60 scap 120 humerus
humeral distraction (traction)
pull straight down
traction = sustained pull
distraction = not sustained for long
traction vs distraction
traction = sustained pull
distraction = not sustained for long
RMT generally do distraction, not traction
traction can be done with external force (machine) w/ physio
humeral distraction in other directions
can be straight down
can be laterally
inferior glide GH
abduction flexion
posteiror glide
internal rotation
flexion
horizontal adduction
anterior glide
extension
external rotation
horizontal abduction
AND to decrease pain (?)
note distraction signficance
always a little distraciton between Joint mobiization
distraction:
a less intense version of joint mob glide
note during a glide/mobilization
don’t release tension in capsule all the way to neutral
always keep a bit of tension while doing frequency of glides/oscillation
Humeroulnar/humeroradial flexion, r/g
anterior (distal) roll
anterior glide
humeroulnar/humeroradial extension, r/g
posterior (proximal) roll
posterior glide
proximal radioulnar pronation, r/g
.
proximal radioulnar supination, r/g
.
humeroulnar resting position, closed pack, capsular pattern of restriction
Close packed: extension with supination
Resting position: 70* flexion and 10* supination
Capsular pattern: flexion, extension
HU joint pivot
The HU joint, particularly the trochlea can pivot (rotate) 5 degrees which are accessory (necessary) movements for FX/EXT.
flexion, radial gap
To increase flexion @the HU joint > radial gap allows the radial part of the trochlea to pivot 5 degrees so full flexion can occur.
extension, ulnar gap
To increase extension @the HU joint>ulnar gap allows the trochlea to pivot 5 degrees so extension can occur.
humeroradial closed pack, resting position, capsular pattern of restriction
Close packed: 90* flexion, forearm supinated to 5*
Resting position: full extension and full supination
Capsular pattern: flexion, extension
** JM 300 – first lecture (theory) **
.
end feels
soft (soft tissue approximation)
firm (stretch from muscle, capsule, ligament)
hard (bone on bone)
abnormal soft/hard end feel – and empty end feel
(abnormal)
Soft - wrong timing during movement or abnormal for that joint (e.g. edema or synovitis
Firm or Hard
- bony grating or bony block
- wrong timing during movement or abnormal for that joint (e.g. increased mm tonus, loose bodies, mm or fascial shortening, OA)
Empty - pain prevents sense of end feel (e.g. acute joint inflammation, bursitis, abscess, fracture, psychogenic factor)
Joint play meaning
refers to the movement or “play” available when the joint is in some degree of loose- pack and can be assessed.
joint mobilization define
“is a passive modality that moves a joint through its accessory movements (normally not under voluntary control), to restore pain-free physiological movement. Joint mobilization is a passive movement of the articular surfaces performed by a therapist to decrease pain and/or increase joint mobility. (Mulligan). “
recall: classification of joints (Structural classification)
Synovial: This is the most common and freely moveable articulation. Joint mobilizations are primarily concerned with synovial joints.
Cartilaginous: Examples include the manubriosternal joint and the pubic symphysis
Fibrous: Examples include the sutures of the skull and syndesmoses between certain long bones
recall: classification of joints (Functional classification)
Synarthrosis: an essentially immobile joint (e.g. sutures of the skull and rib 1 of Sternocostal joint)
Amphiarthrosis: a joint with limited movement (e.g. intervertebral joints and pubic symphysis)
Diarthrosis: a freely mobile joint (e.g. Glenohumeral joint and radiocarpal)
6 subtypes of synovial joints
planar
hinge
pivot
condyloid
saddle (Biaxial/Triaxial (GFK 2018))
ball and socket
who established joint mobilization?
Joint mobilization definition
Mennell, Cyriax, Kaltenborn, Maitland, Mulligan, Paris & Grimsby
Definition:
“… an externally imposed small amplitude passive motion that is intended to produce gliding or traction at a joint”
“… a specific technique in which the articular capsule is passively stretched …”
Why do RMTs use JM?
Used as an assessment tool.
also
To help restore PAIN-FREE ROM by:
“Modulating pain and treating joint dysfunctions that limit range of motion by specifically addressing the altered mechanics of the joint. “
“Specifically address restricted capsular tissue by replicating normal joint mechanics while minimizing abnormal compressive stresses on the articular cartilage of the joint. “
4 types of JM (Maitland)
1) Passive Accessory Mobilizations - intended to produce glide or traction
2) Passive Physiological Mobilizations – PROM
3) Muscle Energy - passive joint movement induced by active contraction of the patient’s own muscles
4) Mobilization with Movement - passive joint movements that occur simultaneously with AROM
which type of JM will JM300 focus on?
1) Passive Accessory Mobilizations - intended to produce glide or traction
osteokinematic vs arthrokinematic
Osteokinematic: Refers to the movement of the parts of the body in the anatomical planes. These terms are flexion, extension, abduction, adduction, internal rotation, external rotation. They are the gross movements that you can see/visible.
Arthrokinematic: The unobservable (invisible) articular accessory/component movements between adjacent joint surfaces (e.g. roll, spin, and glide). They can not occur independently or voluntarily and if restricted, can limit physiological movement. They are necessary for normal ROM.
accessory/component movements
***“Roll: movement analogous to a wheel rolling on a surface and always travels in the same direction as the physiological movement of the bone itself. E.g. The tibia moves posterior in knee flexion and the roll is also in a posterior direction.”
“Glide/Slide: movement where one bone’s articulating surface slips on the other, similar to a puck sliding on the ice. The direction may be the same or opposite of the gross bone movement.”
“Spin: movement where the bone turns around a mechanical (vertical) axis while maintaining a constant contact at a particular point on the reciprocating bone.”
Roll/glide is main focus (?)
mechanical axis?
Mechanical Axis: perpendicular to the treatment plane
treatment plane?
Treatment Plane: plane superimposed over the concave surface of the joint
distraction (/traction)
Distraction: application of force to pull articulating surfaces apart (type of traction)
compression
Compression: manual force applied to approximate articular surfaces together
(opposite of distraction?)
closed pack position
Close Packed Position: joint position when articular surfaces are most closely approximated; capsule and ligaments tightened. It is a CI for joint mobs.
loose packed position (resting position?)
Loose Packed Position: laxity in some parts of the joint capsule; this allows for arthrokinematic movement and is the position for joint mobs.
capsular pattern of restriction
Capsular Pattern of Restriction: characteristic pattern of ROM restriction for each joint; occurs when condition affects the whole joint.
grades of glide/traction (Kaltenborn)
Grade I: small amplitude
Grade II: take up the slack in tissue
Grade III: stretch joint capsule
Note: grade I and II are non-corrective
grades of oscillation (Maitland)
Grade I: small-amplitude rhythmic oscillations are performed at the beginning range of joint play
Grade II: Large-amplitude rhythmic oscillations are performed within the range, not reaching tissue resistance
Grade III: Large-amplitude rhythmic oscillations are performed up to the limit of the available motion and are stressed into the tissue resistance.
Grade IV: Small-amplitude rhythmic oscillations are performed at the limit of the available motion and stressed into the tissue resistance but short of anatomical limit
Grade V: Small-amplitude high-velocity thrust technique to the limits of available motion. It is beyond the RMT scope of practice.
when to use each grade?
Grade I and II traction and/or grade I and II joint mob oscillations are used to modify/interrupt pain.
Grade III traction and/or grade III and IV joint mob oscillations are considered corrective. They use mechanical distention to promote capsular mobility.
For acute stage of healing, grade I is usually applied.
For subacute stage of healing, grade I and possibly grade II is applied
For chronic stage of healing, grades I to IV may be applied depending on the treatment goal.
all of the above applications are subject to patient presentation and comfort
important points/steps
1) If there is limited or painful motion, assess which tissues are affected and the state of the pathology/stage of healing. Determine the joint mob goal: pain relief or joint nutrition or altering ROM.
2) Position the patient so that they are comfortable and joint being mobilized is well supported and in loose packed position.
3) One bone is stabilized (usually proximal bone) and one is mobilized (usually distal bone).
4) Apply a slight distraction before beginning the joint mobilization in the determined direction and grade (make sure the mobilizing bone is not being levered.)
5) If pain occurs, stop treatment and reassess.
indications for JM
Main purpose is to restore pain free range of motion
-neurophysiological effects (decrease pain)
-increase synovial fluid motion thereby increasing joint nutrition
-reverse joint hypomobility
-correct positional faults
-slow down progressive mechanical restrictions from trauma or conditions
-increase functional mobility post-immobilization
-to decrease reflex muscle guarding and restore muscle balance
CI’s for JM (& precautions)
-hypermobility
-joint effusion
-joint is in close packed position
-conditions needing precautions for stretching or movement (e.g. malignancy, bone disease, fracture, pain, hypermobility, total joint replacements, newly formed connective tissue, systemic connective tissue conditions, ACUTE ARTHRITIS, joint ankylosis)
-bacterial infection
-active use of corticosteroids
-elderly with weakened connective tissue and/or decreased circulation
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