Joint mobilization intro Flashcards
How do you find contractile tissues
Assessed with resisted isometric testing
4 classic patterns of inert tissue
- ROM full and no Px indicating no lesion of inert tissues
- Px and limitation of movement in every direction - indicates entire joint is affected suggesting arthritis or capsulitis
- Px and limitation or excessive movement in some directions, but not in others - ligament sprain or local capsular adhesion, movements that stretch, pinch or move affect structure, causing the pain, could be indicative of an internal derangement
- Limited movement that is Pain free - end feel is usually abnormal, bone to bone type, symptomless arthritis d/t osteophytes
how you assess Inert tissue issues
AROM/PROM
4 classic patterns may be seen with contractile and nervous tissue
- Mvmt that is strong and pain free - no lesion of contractile/nervous tissue
- Mvmt is strong and painful - local lesion of muscle or tendon; could be 1 degree or 2 degree muscle strain, avulsion # (partial); tendinosis, tendinitis, paratendonitis
- Movement is weak and painful - severe leision around that joint such as #
- Movement is weak and pain free indicative of complete rupture of a muscle (3 degree)
Grade of mobilization Grade I
Small amplitude rhythmic oscillations that are performed at the beginning range of joint play, short of tissue resistance
Rate of oscillation (fast) 5x sec
Stage of healing Acute
Grade II of Mobilization
Larger amplitude rhythmic oscillations that do not reach issue resistance
Rate of Oscillation (slow)
3x/sec
Stage of healing - sub acute
Grade III of mobilization
large amplitude rhythmic oscillations that rae applied through the first barrier of tissue resistance
Rate of oscillation (slow) 3x/sec
Stage of healing: chronic
Grade IV of mobilization
Small amplitude rhythmic oscillations performed at the limit of available motion and into tissue resistance but short of anatomical limit
Rate of oscillation (fast) 5x/sec
Stage of healing Chronic
All grades of joint mobilization are performed ——to the treatment plane (joint surface)
Parallel
Joint play refers to
the movement or play available when the joint is in some degree of loose pack and can be assessed
Joint mobilization 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 the modality used to assess, treat and maintain articular health
Joint restrictions compromise/limit…
movement! Because the neuro-musculoskeltal framework of our bodies includes specific articulations, which provide the necessary flexibility for mobility.
What is the classification of the structure of the joint
Fibrous, cartilaginous and synovial.
What is the functional classification of the joint
diathroses, synarthrosis, amphiarthrosis
What are the sub-types of synovial joints (6 types)
Planner Hinge Pivot Condyloid Saddle Ball and socket
What does synovial joint posses?
a joint capsule, articular cartilage synovial membrane and fluid as well as innervation essential to posture and movement.
Joint mobilization has positive physiological effect on these components.
Planer Axis and example
Biaxial, back and forth and side to side movement
Naviculocuneiform joint
Hinge joint axis and example
Monaxial, flexion-extention
Humeroulnar joint
Pivot joint axis and example
Monaxial, rotation
Rdioulnar joint
Condyloid joint axis, example
Biaxial, flexion-extension, abduction-adduction
Radiocarpal joint
Saddle joint axis and example
Multi/triaxial, flexion-extension, abduction-adduction, rotation
Carpometacarpal jt (between the trapezium and thum)
Ball and socket joint axis and example
Multi/triaxial; flexion-extension abduction-adduction, rotation
Glenohumeral and aceabulofemoral joint
Osteokinematic movement is
the gross or physiological movement of a joint (angular, special and rotational)
Arthrokinematic movement are
the movements occurring between articulating the surfaces themselves
The gross or physiological movement of a joint
Osteokinematic movement
The movement occurring between articulating the surfaces themselves
Arthrokinematic
What are Accessory or component movements?
the particular arthrokinematic movement, (like roll, glide/slide and spin etc) that occur as one bone moves on another within the joint
What is Roll?
an accessory/component movement analogous to a wheel rolling on a surface; it always travels in the same direction as the angular/physiological movement of the bone itself.
Roll example
Knee flexion an angular movement, moves in a posterior direction, like wise roll is posterior in knee flexion
What is Glide or slide
Component/accessory movement where bone’s articulating surface slips on the other, similar to the way a puck slides on ice.
The direction of slide is
either the same or opposite of the physiological/osteokinematic movement, depending on the articulation surface’s concave or convex nature
What is spin
is an accessory/component movement where the bone turns around mechanical axis while maintaining a constant contact at a particular point on the reciprocating bone.
Joint mobilization treatment movement
parallel to the treatment plane (glide/slide)
Perpendicular to the treatment plane (traction or compression)
Mechanical axis is
perpendicular o the treatment plane, which is a plane super imposed over the concave articulating surface of a joint
Traction is
the application of a force to draw or pull articulating surfaces apart.
Compression is
the application of a manual force to approximate or press articular surfaces together
What is the benefit of moving the joints
circulates synovial fluid and aids in the health of the intra-articular structures, while it maintains the pliability of the capsule and peri-articular structures as well
Close pack position
is the position of a joint when its articular surfaces are most closely approximated, or congruent and involves a rotational component, where the joint capsule and peri-articular ligaments are tightened so that the joint is fixed or locked.
Can you perform joint movement when joint surfaces are maximally congruent and no movement is possible in close pack position?
No, it is contraindicated. It would damage both intra and extra-articular structures
Loose pack position
is any position of a joint other than closed pack, where there is laxity in some part of the joint capsule.
What does laxity of loose pack position allow?
Arthrokinematic movment
What position does the synovial joint naturally assumes when injury causes maximal synovial effusion (filling of the joint capsule)
Resting position
what do you do when you find restriction in loose pack position is identified?
The therapist backs off 10 degrees and then performs a corrective mobilization
Resting position
is the maximum loose pack position and is ideal for joint play assessment and early treatment.
The particular movements from close to loose-pack are characteristic to
a specific joint moving from relative compression to distraction as a natural consequence of movment
Capsular pattern of restriction
when joint impairment affects the entire joint, the capsule of each joint undergoes a characteristic pattern of restriction in passive range of motion - specific for each joint
Concave-convex Rule
If a concave surface moves on a convex surface, glide/slide occur in the same direction as roll. Conversely, if a convex surface moves on a concave surface, glide/slide occur in opposite direction direction to roll.
Indication for joint mobilization
is to restore pain free ROM
- post immobilization due to sprains, strains, fractures, tendonitis, bursitis, etc.
- To resolve the sequence of fibrosis and relative capsular fibrosis (aka capsular/ligamentous tightening and adherence) and intra-articular damage.
- pain control
- to decrease reflex muscle guarding and restore muscle balance
- improving joint nutrition, eliminating meniscoid impingement
Contraindications of joint mobilization
- neoplasm or any non-diagnosed lesions
- bacterial infection
- recent fracture
- acture/active inflammatory and infective arthritis, i.e.rheumatoid arthritis
- joint ankylosis
- joint is in closed pack position
- active use of corticosteroids
- joint hyper mobility
Precaustions of joint mobilization
These would require omission or modification of treatment
- Joint effusion or inflammation where excess swelling would not allow any movement to occur
- Chronic or non-active inflammatory arthritis/Rheumatoid arthritis
- Diseases affecting the bones structural integrity of connective tissue
- Degenerative joint disease, osteoarthritis, where mobilization may adversely affect bone spur
- Local intra-articular injection (corticosteroids)
- Hormone induced joint hyper extensibility, i.e. relaxin’s effect on joints of the pelvis (late stage of pregnancy)
- Guest has an adverse response to joint mobilization or where the treatment is too painful
Joint mobilization procedure
Give a pain scale Perform joint play/assessment with the joint in loose-pack position -One bone is stabilized -one bone is mobilized -one movement is performed -one joint is mobilized at a time
What you should not do during joint mobilization manipulation?
Do not lever a joint or allow roll to occur during the manipulation
Joint play 3 stages
1st stage: elastic stage (release the tension, it goes back to the original position)
2nd stage: plastic stage (release the tension, it stays to the new length)
3rd stage: failure or breaking point
Grades of application of joint play
Grade I (for acute) stops at normal position Grade II (for subacute) stops at the tissue resistance Grade III (for chronic) goes beyond tissue resistance
Joint mobilization grade I-V
Grade I (acute) Grade II (subacute) Grade III (Corrective chromic) Grade IV (Chronic) Grade V (Thrust, Chiro only)
Why do we oscilliation
To decrease/modify pain
To warm up the joint
Corrective vs Non corrective
Non corrective Grade I and II - is to modify or decrease pain
Corrective Grade III and IV to improve ROM or physiological change
