Joint Mobilizations Flashcards
joint mobilization/manipulation
manual therapy technique comprising a continuum of passive movements at joints/soft tissues applies at varying speeds and amplitudes
joint play
assessment/examination of accessory motions at a joint
accessory motions
motion occurring between 2 joint surfaces that are produced by the examiner only
thrust/manipulation
high velocity, low amplitude therapeutic movement within or at end range of motion; grade V mobilization–manipulation
non-thrust
manipulations without thrust (grade I-IV)
osteokinematics
physiological movements that take place at a joint–the position of one bone in relation to the other due to muscle contraction/gravity
arthrokinematics
movement between two articulating surfaces without reference to any external force being applied
types of accessory motions
roll, glide, spin, compression, distraction
roll
series of points comes in contact with a series of points on another
glide
specific point on one surface comes into contact with series of points on another
spin
one bone rotates around a stationary longitudinal axis; creates an arc of a circle
compression
Decrease in joint space, adds stability, normal reaction of joint to muscle contraction
distraction
two surfaces pulled apart, used with joint mob to increase capsule stretch
concave on convex
osteokinematic and arthrokinematic occur in the same direction
convex on concave
osteokinematic and arthrokinematic occur in opposite direction
treatment plane
lies on the concave articular surface
glide occurs
parallel to treatment plane
distraction occurs
perpendicular to treatment plane
zero position
osteokinematic/arthrokinematic anatomical position–starting position for goniometry
resting position
loose packed position; arthrokinematic position where capsule is most relaxed, joint play is greatest
Actual resting position
position joint is placed when cant have resting position
closed pack position
arthrokinematic position where joint capsule and periarticular tissues are most taut, joint surfaces are most congruent
kaltenborn
grades for distraction
maitland
grades for glide
kaltenborn grade I
slow, small amplitude within limit of joint motion, not through first stop
kaltenborn grade II
slow, larger amplitude that takes to the limit of joint motion up to first stop
kaltenborn grade I affects
pain fibers
kaltenborn grade II affects
pain fibers and capsule
kaltenborn grade III
slow, even larger amplitude that takes through available motion and into resistance past the first stop
kaltenborn grade III affects
capsule, periarticular structures
maitland grade I
slow, small amplitude, not to limit or first stop, beginning of range
maitland grade I affects
pain receptors, little stress to capsule
maitland grade II
slow, large amplitude not to limit; beginning 1/2 of range
maitland grade II affects
pain receptors, joint capsule, periarticular structure
maitland grade III
slow, large amplitude takes joint to 1st tissue stop and back down into 1/2 of elastic range
maitland grade III affects
joint capsule, periarticular structures, progression glide to grade IV
maitland grade IV
slow, small amplitude performed through limit and into tissue resistance, through 1st stop and never back to elastic range
maitland grade IV affects
joint capsule/periarticular structures
maitland grade V
high velocity, small amplitude non-oscillatory that begins at limit and continues past 1st stop; difficult to control
maitland grade V affects
joint capsule/periarticular structures, adhesions, positional faults
3 categories describing arthrokinetic mobility
- hypomobile
- normal
- hypermobile
documentation of joint play
describe direction, grade for treatment and assessment, reps, duration
stable hand
close to joint line, ability to palpate joint line
mobile hand
close to joint line, forearm perpendicular to bone
why test joint play?
determine if ROM is due to joint capsule or periarticular structures
determine mobility of joint
determine end feel of accessory motion: bony or firm
determine if ligaments are compromised
establish baseline
determine progress
indications for joint mob
decreased joint extensability
immobilization and inflammation: joint capsule and soft tissues affected, decrease in water content of tissue, increase in cross linkage, decreased strength of collagen–joint mob is thought to reverse by promoting movement
factors affecting joint extensibility
tissues respond to external force acc to stress strain curve
force used
speed
number of repetitions
what do we treat with joint mob
positional faults (grade IV/V)
decreased nutrition (grade I-IV)
pain (grade I/I-II)
bony compression of a joint (kaltenborn I-III)
adhesions maitland III IV V
relaxation maitland I II
tissue extensibility maitland IV V, kaltenborn II-III
how does joint mob affect pain
stimulation of joint receptors that block pain impulses through gate control mechanism and stimulating fast conducting large diameter proprioceptive nerve fibers that block transmission of slow small diameter pain fibers which decrease pain transmission to brain
contraindications to JM
unstable joint recent fracture over open epiphyseal plates considerable joint effusion (could aggravate, make joint seem hypomobile) ankylosing/fused joints advanced diabetes bony disease undiagnosed pain exacerbated stages of RA
precautions to JM
joint irritability/pain
protective muscle spasm
irritability of adjacent joint structures
chronic debilitating disease
capsular pattern
each joint has one–if LOM matches pattern, then need to treat each limitation because entire capsule is involved
