Joint Mobs ch5k & ch15s

Question 1

Joint mobilizations are manual therapy techniques utilized to?

Answer 1

• Modulate pain

* Treat joint dysfunctions that limit ROM by specifically addressing altered mechanics of the joint.

Question 2

What do you think may cause joint mechanics to be altered?

Answer 2

• Pain and muscle guarding
• Joint effusion (abnormal buildup of intra-articular fluid) a.k.a -water in the knee
• Contractures or adhesions in the joint capsule or supporting ligaments

Question 3

How do Joint mobilization stretching techniques DIFFER from other forms of passive or self stretching?

Answer 3

Joint mobilization stretching techniques DIFFER from other forms of passive or self stretching in that they specifically address restricted capsular tissue
p.119 k/c

Question 4

Convex-Concave Rule

Answer 4

Basis for determining the motion of mobilizing force when joint mobilization gliding techniques are used
Convex–> Concave = opposite
Concave–> Convex = same
Apply the pressure in the direction that the bone is moving. p.122k/c
Hand joints (concave) wrist (convex)
elbow (concave) shoulder (convex)

Foot joints (concave) ankle (convex)
knee (concave)  hip (convex)

Question 5

What is the difference between Traction and Distraction?

Answer 5

Traction is a longitudinal pull
Distraction causes separation of opposing joint surfaces. Is a separation, or pulling apart used to relieve pain or stretch the capsule

Question 6

What are some of the effects of joint motion?

Answer 6

• Synovial bathing -brings nutrients
• Tissue extensibility- tensile strength
• Sensory input - proprioceptive feedback
• Neurophysiological
  p. 124k/c

Question 7

Indications for Joint Movement

Answer 7

• Muscle spasm, guarding, pain
• Reversible joint hypomobility- stretching forces used to distend the shortened tissue
• Positional faults/Subluxations- MWM or thrust tech.
• Progressive limitation - diseases progressively limit movement
• Functional immobility- pt cant move jt for a period of time
  p. 124k/c

Question 8

What are the Limitations of Joint Mobilization

Answer 8

Mobilization can not change the disease process of disorders or stop the inflammatory process of an injury.
Ex: RA
*In these cases, treatment is directed toward minimizing pain, maintaining available joint play, and reducing the effects of any mechanical limitations. p.125 k/c

Question 9

There are only three (3) true contraindications to stretching techniques/joint mobilization….

NOTE: Absolute - also means Contraindications

Answer 9

*Hypermobility – The joints of patients with potential necrosis of the ligaments or capsule should not be mobilized with stretching techniques
.
*Joint Effusion(swelling) – The capsule is already on a stretch by being distended to accommodate the extra fluid. The limited motion is from the extra fluid and muscle response to pain, not from shortened fibers.

• Inflammation – stretching increases pain and muscle guarding and results in greater tissue damage.
  p. 125k/c

Question 10

Precautions to Joint Mobilizations:
“THE MES BUN”

NOTE: Relative Contraindications also mean Precautions

Answer 10

Total joint replacements
Hypermobility
Excessive pain
Malignancy
Elderly individuals
Systemic connective tissue diseases
Bone disease
Unhealed fracture
Newly formed or weakened connective tissue

Question 11

EXTREME CAUTION should be used when considering mobilization in patients with:

Answer 11

Osteoporosis
RA
Joint hypermobility
The presence of neurologic symptoms
P.207shank

Question 12

Spinal mobilizations, contraindications include:

Answer 12

Pregnancy
Spondylolisthesis
Bone diseases
Malignancy
Acute inflammatory and infectious arthritis
CNS disorders
P.207shank

Question 13

What are the limitations of motion that can be caused by lesions specific to the capsule or synovial tissues of a joint

Answer 13

The pattern of restriction in the shoulder joint involves ER>ABD>IR>FLEX

Question 14

Graded Oscillation Techniques (Non-Thrust)

Answer 14

Grade I
Small amplitude rhythmic oscillations are performed only at the beginning of available ROM
Grade II
Large amplitude rhythmic oscillations are performed within the range, not reaching the limit
Grade III
Large amplitude rhythmic oscillations are performed up to the limit of the available motion and stressed into the tissue resistance
p.127k/c

Question 15

Indicate the Oscillation grades that would be used for pain, stretching or snapping adhesions.

Answer 15

Grade 1-2 for pain
Grade 3-4 for stretching increase ROM
Grade 5 for snapping adhesions

Question 16

Why oscillation techniques?

Answer 16

Grades 1-2
*May have an inhibitory effect on the perception of painful stimuli (Gate Theory of Pain)
*May also help move synovial fluid thereby increasing nutrition to the cartilage
Grade3-4
Are primarily used as stretching maneuvers.
p.127k/c

Question 17

This grading system describes only joint-play techniques that separate (distract) or glide/translate (slide) the joint surface.

Answer 17

Non-Thrust “Sustained” Joint-Play Techniques

p.127k/c

Question 18

Sustained Joint-Play Techniques

Answer 18

Grade I (Loosen) beginning of range
Small-amplitude distraction is applied where no stress is placed on the capsule. It equalizes cohesive forces, muscle tension, and atmospheric pressure acting on the joint.

Grade II (Tighten) end of range
Enough distraction or glide is applied to tighten the tissue around the joint. Kaltendborn called “taking up the slack.”

Grade III (Stretch) past range getting a good stretch
A distraction or glide is applied with an amplitude large enough to place stretch on the joint capsule and surrounding structures.

Question 19

Indication for Sustained Joint-Play Techniques

Answer 19

◦Grade I
Distractions are used with all gliding motions and may be used for relief of pain.
Grade II
Distraction is used for the initial treatment to determine the sensitivity of the joint. Treatment dosage is ↑ or ↓ accordingly.
May be used to inhibit pain or maintain joint play when ROM is not allowed
Grade III
Distraction or glades are used to stretch the joint structures and thus increase joint play

Question 20

What technique is recommended when dealing with patients suffering from loss of joint play and decreased functional range.

Answer 20

Sustained techniques

Question 21

When attempting to maintain available ROM by using joint-play techniques, which oscillations or sustained dosages would be appropriate??

Answer 21

Either grade ll oscillating or sustained grade ll techniques can be used
p.128 k/c

Question 22

Loose-packed position

When to use and why?

Answer 22

• Articulating surfaces are maximally separated
• Joint will exhibit greatest amount of joint play
• Position used for both traction and joint mobilization
• Best position to perform joint mobs
  p. 203 shank

Question 23

Close-packed position

When to use and why?

Answer 23

• Joint surfaces are in maximal contact to each other
• Generally used for testing the integrity and stability of ligaments and capsular structures and NOT joint mobilization techniques
• Joint mobs are NOT performed
  p. 202shank