Joint Mobilization (Week 1) Flashcards
What are Joint mobilizations?
Manual therapy techniques used to modulate pain & treat joint impairments that limit ROM by addressing the altered mechanics of the joint.
What is mobilization?
Patient can voluntarily contract a muscle to stop the movement
What is manipulation?
Patient cannot stop the movement
What are Articulations? (Synovial Joints)
Synovial joints rely on the laxity of the joint capsule & surrounding structures & the potential space between the bones for optimal movement
What is Osteokinematic Movement?
• voluntary motion the patient performs
• osteokinematic terms describe the movement (or swing) of bone in space
What are Arthrokinematic Movements?
• involuntary movements within the joint and surrounding tissues that are necessary for normal and pain-free ROM
What are the Arthrokinematic Motions?
• roll
• slide
• spin
• compression
• distraction
• roll, slide, &. spin are the primary movements,
• compression and distraction are accessory movements that affect the joint
What is Arthrokinematic Motion (Roll) ?
• occurs between joint surfaces when new point on moving surface contacts new point on stationary surface
• in normal joint, occurs with slide or spin
• results in movement (swing) of bone
• always occurs in direction that bone is moving, regardless of whether moving surface is convex or concave
What is Arthrokinematic Motion (Slide)?
• occurs when same point on moving surface contacts new points on stationary surface
• direction of slide depends on whether moving surface of joint is concave or convex
• slide occurs in sAme direction as roll if moving surface is concAve
• slide occurs in opposite direction of roll if moving
surface is convex
• relationship is known as CONCAVE-CONVEX RULE
What is Arthrokinematic Motion (Spin)?
• occurs when same point on moving surface contacts same point on stationary surface
• spin involves rotation of segment about a stationary axis
What is Arthrokinematic Motion (Compression)?
• occurs when there is decrease in space between two articulating joint surfaces
• compression normally occurs during weight bearing
• compression can occur when muscles contract – this can provide stability to the joint
• normal compression encourages movement of synovial fluid which helps maintain cartilage health
• abnormally high compression can lead to deterioration of articular cartilage
What is Arthrokinematic Motion (Distraction)?
• force applied perpendicular to treatment plane – it’s a separation or pulling apart of articular surfaces
What is Arthrokinematic Motion (Traction)?
• longitudinal pull/pull along long axis of bone – often called long-axis traction
What is Arthrokinematic Motion (Mobilizing)?
• applied to joint surfaces to decrease pain or restore normal arthrokinematics
• distractions can be applied on their own or in combination with glide
• when possible, grade I distraction should be applied with glide mobilization
• distractions & glides are applied using sustained or oscillatory techniques
What is Arthrokinematic Motion (Glide)?
• glide is when you mobilize bone in direction that is parallel to treatment plane
• treatment plane is plane that lies parallel to concave surface of joint
What are Grades of Mobilization Techniques?
Mobilizations are applied using either sustained or oscillating pressure & with different levels of force (i.e. grades).
What is Sustained Mobilization?
Applied with consistent pressure in specific direction using specific level of force.
There are three grades of sustained mobilization. What are they?
Grade I (loosen): minimal force, no stress on joint capsule
Grade II (tighten): sufficient force to tighten tissues around joint
Grade III (stretch): force large enough to place stretch on capsule & periarticular structures but not to anatomic limit
What is Oscillatory Mobilization?
Applied with specific frequency of movement, in specific direction, using specific level of force
There are four grades of oscillatory mobilization. What are they?
Grade I: small-amplitude, at beginning of range
Grade II: large-amplitude, not up to tissue resistance
Grade III: large-amplitude, into tissue limit
Grade IV: small-amplitude, into tissue limit
What are Parameters of Mobilization?
Provide baseline structure for application. Parameters must be modified to ensure mobilization is safe & effective for given patient.
What are Parameters of Mobilization (Sustained)?
• into specific direction (distraction or glide)
• hold for approximately 10 seconds
• rest for 3-5 seconds
• repeat for total of 1-3 minutes
What are Parameters of Mobilization (Oscillatory)?
• into specific direction (distraction or glide)
• small-amplitude are applied like vibrations
• large-amplitude are applied 2-3/sec
• both small - & large-amplitude oscillations are applied for approximately 1 minute
• rest for 3-5 seconds
• repeat for total of 1-3 minutes
What are Effects of Mobilization?
• neurophysiological: small-amplitude oscillatory & distraction movements may stimulate mechanoreceptors that inhibit transmission of pain signals
• mechanical: small-amplitude distraction & gliding movements facilitate synovial fluid motion which
encourages nutrition to avascular structures
• higher grade mobilization (sustained or oscillatory) will distend joint capsule & peri-articular joint
structures
• mobilization (especially with movement) can realign bony segments
What are Uses of Mobilization?
• grade I distraction: prior to glides (when possible)
• grade II distraction: initial Ax to determine joint sensitivity & available movement
• grade I and II oscillatory: decrease pain, increase nutrition
• grade I and II sustained: decrease pain
• grade II oscillatory and sustained: <-> ROM
• grade III sustained/III & IV oscillatory: increase ROM, reduce positional faults/subluxations
What are Indications for Mobilization?
• pain, muscle guarding, & spasm can be treated with low grade oscillatory mobilizations
• reversible joint hypomobility can be treated with ‘progressively vigorous’ mobilizations
• positional faults/subluxations can be corrected with higher grade mobilizations (esp. with movement)
• conditions that limit ROM: mobilizations can maintain ROM & possibly slow progression
• immobilization: mobilization can help maintain ROM & offset degenerative/restrictive effects
Joint mobilizations cannot?
• alter disease processes (e.g., RA)
• alter inflammatory process
Inappropriately applied joint mobilizations can?
• create/exacerbate hypermobility
• traumatize joints/joint surfaces
• initiate spasm/muscle guarding
What are Absolute Contraindications to Joint Mobilization?
• any undiagnosed lesion
• joint ankylosis
• high grade mobilizations only
• hypermobility, ligamentous rupture, instability
• joint effusion
• inflammation
• malignancy
• osteoporosis
• osteomyelitis
• recent fracture
• herniated discs with nerve compression
What are Relative Contraindications to Joint Mobilization?
• be careful & if in doubt, don’t mobilize
• osteoarthritis
• unhealed fracture (also note hand positioning)
• hypermobility
• total joint replacements
• conditions that weaken CT (e.g., RA, advanced diabetes)
• pregnancy (esp. lumbar spine & pelvis)
• internal derangement
What is the CMTO’s Perspective of Joint Mobilization?
• don’t mobilize in close-pack position
• communicate
• assess (grade II distraction) before treating
• distract before mobilizing when possible
• joint tissues must be prepped prior to mobilizing (high grade only)
• high velocity low amplitude (HVLA) thrust mobilizations are not applied to spine
What are the General Principles of Mobilization?
• prepare surrounding tissue prior to higher-grade mobilizations
• make sure patient is comfortable, stable, & body segment being mobilized is supported
• make sure your hand contact & any other means of stabilization is comfortable
• when possible, your hands must be as close to joint as possible
• assess joint movement with grade II distraction prior to mobilization
• when possible, apply grade I distraction prior to any glide mobilization
• your body & mobilizing segment should be moving as one (i.e., use your body effectively & efficiently)
• mobilize one joint, in one direction, at one time
• never mobilize through pain
• never mobilize in close-pack position
How should we be Progressing a Mobilization?
• mobilizing in resting/loose-pack position is safest from which to start but not the most effective position in which to treat
• to progress treatment, position joint at or near end of available & PAIN-FREE ROM prior to mobilizing – this will place restricting tissue in its most tensioned position where stretch force can be more specific & effective
What are patient responses to joint mobilization’s?
• grade III & IV mobilizations can cause post-treatment soreness (but should not cause pain)
• if patient experiences pain, soreness lasting more than 24 hours, worsening symptoms, swelling, or
spasm, your treatment was likely too aggressive
• between treatments, the patient should perform ROM into any newly gained range
• mobilization (including self-mobilizations) should be applied every other day
What are Muscle Energy Techniques (MET)?
• these techniques use active contraction of muscles that attach near joint to correct joint misalignment
• contractions are applied at the ‘barrier’ & progressed
• usual precautions apply but also note any localized muscle pain/strains
What is the Application of Muscle Energy Techniques (MET)?
• contractions are isometric & gentle/submaximal
• contract for 5-10 seconds
• wait for the muscle to completely relax (usually about 3-5 seconds)
• reposition to the next barrier/point of joint restriction
• repeat 3-5x
