Joint Mobilizations Flashcards
What is physiologic movements?
Motion that can be created volitionally
What is non-physiologic movements?
Motion that does not occur in isolation voluntarily
What are component movements?
Occur in combination with physiologic motion
-Ex: clavicular rotation during arm elevation
What is joint play?
Occur only in response to an outside force
What are accessory motions?
Joint play needed for normal physiologic range
What is joint mobilization?
-Skilled passive movement
-Low velocity
-Does not go beyond end range
-Can be graded I-III or I-IV
What is joint manipulation
-Low amplitude
-High velocity
-Thrust
-Intentionally moves beyond end range
-Grabe V mobilization
What are the 2 different grading systems of joint mobilizations?
-Maitland
-Nordic/Kalltenborn
What is the grading system for Maitland?
-I-IV and all are oscillatory with either small amplitude (6-12/sec) or large amplitude (3-6/sec) and are before or after the first stop, but before the final barrier
-V is a high velocity, low amplitude thrust (HVLAT) intentionally moving beyond the final barrier
-Mostly for capsular restrictions
What is a grade I Maitland mobilization?
-Far before the first stop
-6-12/sec
-Barely unweighting the joint
-For pain relief
What is a grade II Maitland mobilization?
-Oscillates between 1st stop and relaxing the tissue
-3-6/sec
-For pain relief
What is a grade III Maitland mobilization?
-Oscillates between 2nd stop and 1st stop, does not let the tissue relax
-3-6/sec
-Increase mobility
What is a grade IV Maitland mobilization?
-Oscillates between 2nd stop and just before 2nd stop
-6-12/sec
-Increase mobility
What are the types Nordic/Kalltenborn mobilizations?
-Compression
-Traction
-Translatoric (gliding)
What is compression used for in Kalltenborn joint mobilizations?
It is a provocation assessment to see if the patients symptoms are reproduced from compression
What is grade I Kalltenborn mobilizations?
Just enough to nullify compression forces and is only used in traction mobilization
What is grade II Kalltenborn mobilizations?
-Tissue slack is being taken up
-Surrounding joint tissues are being tightened to assess tissue response and subjective response
What is grade III Kalltenborn mobilizations?
Actual tissue deformation by moving beyond 1st stop
What are the Kalltenborn end feels?
-Soft: soft tissue or muscle stretch
-Firm: capsular or ligamentous or muscular
-Hard: bone or cartilage
What are the Kalltenborn end feel quantities/grades?
0=ankylosed (not moving/stuck)
1-2= hypomobile
3= normal
4-5= hypermobile
6= unstable
What are indications for passive joint motion/mobilizations?
-Pain and muscle guarding
-Stiffness and decreased joint mobility
What are type I receptors (postural)? What are the neurophysiologic benefits of passive joint mobilization on type I receptors (postural)?
-Found in joint capsules
-Small diamter, myelinated fibers
-Low threshold, continually firing, slow adapting
-Both static and dynamic firing mechanoreceptors
-Small motions lead to increased firing
-Promotes body awareness in space
-Degenerate with age
What are type II (dynamic) receptors? What are the neurophysiologic benefits of passive joint mobilization on type II receptors (dynamic)?
-Found in joint capsule and articular fat pads
-Medium diameter, myelinated
-Dynamic mechanoreceptors
-Low threshold, fast adapting
-Movement and direction
-Associated with marked discharge
What are type III (inhibitive) receptors? What are the neurophysiologic benefits of passive joint mobilization on type III receptors (inhibitive)?
-Found in ligamentous structures, especially in spinal column
-Large myelinated fibers, identical structurally to the GTO
-Dynamic mechanoreceptors
-High threshold, slow adapting fibers
-Firing leads to reflex inhibition to surrounding muscles
What are type IV (nociceptive) receptors? What are the neurophysiologic benefits of passive joint mobilization on type IV receptors (nociceptive)?
-Found in most joint structures
-Lattice like, unmyelinated fibers and free nerve endings
-Generally high thresholds for firing
What are contraindications to passive joint mobilizations?
-Hypermobility/instability
-Recent fracture, ligamentous sprains, RA, osteroporosis
-Any active disease process
-Flu, infection, malignancies
-Conditions of acuity, substantial inflammation, reactivity
-Based on history/interview
-Presence of swelling, warmth, or muscle guarding
What motions fire type I and type II receptors? What are the benefits of firing these receptors?
-Small, oscillatory movements
-Inhibits pain and muscle guarding
What motions fire type III receptors? What are the benefits of firing these receptors?
-End range, dynamic thrusts
-Inhibits muscle guarding
What is the benefit of grade I traction Kalltenborn mobilizations?
-Relieve pain and muscle guarding
-Move joint fluid
What is the benefit of grade II traction Kalltenborn mobilizations?
-Relieve pain
-Assess joint play/reactivity
What is the benefit of grade III traction Kalltenborn mobilizations?
Increase mobility
What is the benefit of grade II gliding Kalltenborn mobilizations?
Assess joint play and reactivity
What is the benefit of grade III gliding Kalltenborn mobilizations?
Improve mobility
What are the Maitland principles?
-Use grade I and II to reduce pain
-Use grades III and IV to increase mobility
-End all joint mob. sessions with grade I and II to facilitate relaxation and relieve pain
-Initial mob. techniques should be performed in loose pack position
What concept guides what direction to perform glides in?
-Convex-concave rule
-Ex: Humerus is concave and glenoid fossa is concave, so the roll and glide occur in OPPOSITE directions. If flexion is limited, a posterior glide should be performed
