Joint Mobilizations Flashcards
how will a tight capsule impact motion?
it will cause early and excessive accesory motion in the opposite direction of the tightness
injury to a joint/structures surrounding a joint will often lead to what?
- pain
- loss of motion
- excessive motion
what does the term open pack position mean?
- surrounding tissue is as lax as possible
- maximal incongruency
- intracapsular space is as large as possible
- maximal amount of joint play available
describe what is meant by the closed pack position
- joint position where joint is most congruent
- surrounding tissue (capsule and ligaments) under maximal tension
- maximal stability of joint
when assessing joint mobility what 3 things are looked at?
- gross (quantity of movement)
- end-feel (quality of movement)
- provocation
what is the current classification scale used for joint mobility?
hypomobile
normal
hypermobile
what is meany by the term hypomobile?
the motion stops short of anatomical limit instead it stops at a pathological point of limitation
(can be due to inflammation, pain, spasm, or adhesions)
what is meant by the term hypermobile?
joint moves beyond its anatomical limit due to laxity of surrounding structures
what are some indications for joint mobilizations?
- break pain cycle
- increase joint extensibility
- increase extensibility of tendons, muscle, and fascia
- increase joint ROM
- promote muscle relaxation
- improve muscle performance
what 3 categories cover the benefits of joint mobilizations?
- biomechanical improvements
- nutritional effects
- neurophysiological effects
what are the neurophysiological effects of joint mobilizations?
- stimulates mechanoreceptors to inhibit pain impulses
- gate control theory
- descending pathway inhibition theory
- peripheral inflammation modulation
what is the gate control theory?
there are large myelinated fibers that synapse onto neurons. If these large fibers are activated they can overwhelm the smaller C fibers transmitting pain sensation
what type of joint mobilization is associated with the descending pathway inhibition theory?
grave V mobilization
stimulates the PAQ which results in serotonin secretion and decreased pain
list some absolute contraindications to joint mobilizations
- malignancy in area of treatment
- infectious arthritis
- fusion of joint
- fracture at the joint
- practioner lack of skill
- neurological deterioration
- upper cervical spine instability
- cervical arterial dysfunction
list some relative contraindications for joint mobilizations
- excessive pain or swelling
- arthroplasty
- hypermobility
- OA
- Spondylolisthesis
when are joint mobilizations most effective?
when they are followed up by a comprehensive treatment plan including strengthening of some kind
joint play comes in 3 types of movements. What are they?
- Compression - perpendicular to joint surface
- Traction/Distraction - perpendicular to joint surface
- Gliding - parallel to joint surface
what are the types of joint mobilizations?
- Distractions
- Oscillation mobilizations
- sustained hold mobilizations
- mobilizations with no movements
what/how many grades are there for distraction mobilizations?
Three
- Grade I = piccolo (loosen)
- Grade II = slack (take up the slack)
- Grade III = stretch
what is a Grade I Distraction Mobilization?
distraction force that neutralizes pressure in the joint w/o producing actual separation of the joint surfaces
no stress on joint capsule
can be used w/gliding mobs to reduce compression forces on articular surfaces
what is a Grade II distraction mobilization?
slack in joint capsule is reduced through sustained distraction
separates the articulating surfaces and eliminates the play in the joint capsule
can help determine the sensitivity of the joint
what is a Grade III distraction mobilization?
designed to stretch the joint capsule and soft tissues surrounding the joint to increase mobility
trying to get into the plastic region
what region of the stress strain curve do each distraction mobilizations take place?
- grade 1 = toe region
- grade 2 = elastic region
- grade 3 = plastic region
how many grades are there for oscillation joint mobilizations?
5
per Maitland Oscillation Joint Mobilization
describe a grade I Maitland Oscillation Joint Mobilization
small amplitude technique performed at beginning of available ROM (first 25%)
describe a grade II Maitland Oscillation Joint Mobilization
large amplitude technique performed in middle of available ROM (middle 50%)
(going from 25-75%, back and forth)
what is the goal of Grade I and II Maitland Oscillation Joint Mobilizations?
pain and spasm reduction
describe a grade III Maitland Oscillation Joint Mobilization
large amplitude technique performed at end of availabel ROM (last 50%)
(going from 50-100%, back and forth)
describe a grade IV Maitland Oscillation Joint Mobilization
small amplitude technique performed at end of availabel ROM (last 25%)
(going from 75-100%, back and forth)
what is the goal of Grade III and IV Maitland Oscillation Joint Mobilizations?
stretch joint capsule and associated structures
what is the theory behind pain reduction from Grades I and II Maitland Oscillation Joint Mobilizations?
reduces pain by:
- improving joint lubrication and circulation to tissues related to joint
- rhythmic oscillations possibly activate articular and skin mechanoreceptors which play a role in pain reduction
T/F: Grades I and II influence mechanical nociception?
TRUE
what are the effects of Grades III and IV Maitland Oscillation Joint Mobilizations?
- stretches capsule and associated structures
- mechanical and neurophysiological effects
- may activate inhibitory joint and muscle spindle receptors to aid in reducing restriction of movement
Describe a grade V Maitland Oscillation Joint Mobilization
high velocity thrust of small amplitude at end of available range but within its anatomical range
movement that exceeds the resistance barrier
