Joint MObs (wk 1) Flashcards
1
Q
Loss of motion at a joint could be due to what reasons? (6)
A
a. Pain and muscle guarding
b. Joint hypomobility (Grade ¾ Joint Glides)
c. Joint effusion (inflammation)
d. Contractures or adhesion in joint capsule or supporting structures
e. Combination
2
Q
What are the objectives of manual therapy? (5)
A
a. Pain modulation
b. Address tissue extensibility
c. Address muscle guarding
d. Peripheral effects (improve circulation, fluid/waste uptake, improve healing, etc.)
e. Improve tolerance for other interventions
3
Q
How do you assess the effectiveness of manual therapy?
A
Test re-test
4
Q
What position of the joint do you perform assessment?
A
quality and quantity of joint movement in resting position
5
Q
Open pack position of z joint?
A
midway between flexion/extension
6
Q
Open pack position of TMJ?
A
Mouth slightly open
7
Q
Open pack position of GH?
A
55 deg abduction, 30 hor add, slight ER
8
Q
Open pack position of AC/SC?
A
Arm by side
9
Q
Open pack position of ulnohumeral?
A
70 flex
10 supination
10
Q
Open pack position of radiohumeral?
A
full ext
full supination
11
Q
Open pack position of Proximal radioulnar?
A
70 flex
35 supination
12
Q
Open pack position of distal radioulnar?
A
10 supination
13
Q
Open pack position of Wrist?
A
flight flex and ulnar deviation
14
Q
Open pack position of CMC?
A
midway between abduction/adduction and flexion/extension
15
Q
Open pack position of MCP?
A
slight flexion
16
Q
Open pack position of IP?
A
SLIGHT FLEXION
17
Q
Open pack position of Hip
A
30 flex
30 abduction
0-5 ER
18
Q
Open pack position of Tibiofemoral?
A
25 flex
19
Q
Open pack position of patellofemoral?
A
full extension
20
Q
Open pack position of talocrural (ankle)
A
10 plantarflexion
midway between inversion and eversion
21
Q
Open pack position of subtalar/midtarsal/tarsometatarsal?
A
Midway between extremes of ROM
22
Q
Open pack position of MTP?
A
Neutral
23
Q
Open pack position of IP of foot?
A
Slight flexion
24
Q
What 3 characteristics are you assessing in joint mobility assessment?
A
- Gross quantity (hyper, hypo, normal)
- End-feel (firm, hard, empty)
- Provocation (painful, painless)
25
Manual therapy techniques involving movement of articulating surfaces with intention of: (6)
1. Regaining normal ROM
2. Improving joint capsule extensibility
3. Regaining normal distribution of forces and stresses on a joint
4. Reducing pain
5. Lubricating joint surfaces
6. Providing nutrition to joint structures
26
T/F Manual therapy is most effective when combined with a comprehensive treatment plan
True
27
Absolute or relative contraindication:
| Osteoporosis
Relative Contraindications
28
Absolute or relative contraindication:
| Malignancy in area of treatment
Absolute Contraindications
29
Absolute or relative contraindication:
| Fusion of the joint
Absolute Contraindications
30
Absolute or relative contraindication:
| Arthroplasty
Relative Contraindications
31
Absolute or relative contraindication:
| Practitioner lack of ability
Absolute Contraindications
32
Absolute or relative contraindication:
| Hypermobility
Relative Contraindications
33
Absolute or relative contraindication:
| Upper cervical spine instability
Absolute Contraindications
34
Absolute or relative contraindication:
| Fracture at the joint
Absolute Contraindications
35
Absolute or relative contraindication:
| Excessive pain or swelling
Relative Contraindications
36
Absolute or relative contraindication:
| Neurological deterioration
Absolute Contraindications
37
Absolute or relative contraindication:
| Infectious arthritis
Absolute Contraindications
38
Absolute or relative contraindication:
| Spondylolisthesis
Relative Contraindications
39
Absolute or relative contraindication:
| Cervical arterial dysfunction
Absolute Contraindications
40
Proposed biomechanical mechanism for joint mobilizations:
i. Motion improvement
ii. Positional improvement
iii. Increase joint capsule extensibility
41
Proposed nutritional mechanism for joint mobilizations:
i. Synovial fluid movement
| ii. Improve nutrient exchange
42
Proposed neurophysiological mechanism for joint mobilizations:
i. Stimulates mechanoreceptors to inhibit pain impulses
ii. Gate control theory
iii. Descending pathway inhibition theory
iv. Peripheral inflammatory modulation
43
What region do you have to get to in order to cause long term changes to tissue?
Plastic region (microtears)
44
What are the 4 types of joints mobs?
a. Distractions
b. Oscillation mobilizations
c. Sustained hold mobilizations
d. Mobilization with Movement
45
What is the joint play movement of compression?
- approximation of joint surfaces
| - force perpendicular to joint plane
46
What is the joint play movement of traction/distraction?
- separation of joint surfaces
| - force perpendicular to the joint plane
47
What is the joint play movement of gliding?
force direction parallel to joint surface
48
What is grade 1 of the kaltenborn distraction?
piccolo (loosen)
49
Describe the amount of stress on the joint capsule and the purpose of a grade 1 (piccolo) kaltenborn distraction:
When will these distractions be used?
i. Very small amplitude of traction force
ii. Minimal stress on the joint capsule
iii. Reduces compression forces on articular surfaces
iv. Pain reduction
v. Used with gliding mobilizations
50
What is grade 2 of the kaltenborn distraction?
slack (take up the slack - tighten)
51
Describe the amount of stress on the joint capsule and the purpose of a grade 2 (slack) kaltenborn distraction:
When will these distractions be used?
i. Slack in joint capsule and surrounding tissues is taken up
ii. Can help to determine the sensitivity of the joint
iii. Used to alleviate pain, assess joint play, and/or reduce muscle guarding
52
What is grade 3 of the kaltenborn distraction?
Stretch
53
Describe the amount of stress on the joint capsule and the purpose of a grade 3 (stretch) kaltenborn distraction:
When will these distractions be used?
i. Designed to stretch joint capsule and soft tissues surrounding the joint to increase mobility
ii. Used to assess end feel or increase movement
54
What is the primary goal of grade 1/2 maitland joint mobilizations?
reduce pain and muscle guarding, improve joint lubrication/nutrition
55
T/F No direct mechanical effect on restrictions while using grade 1/2 mobilizations
True
56
T/F Grade 1/2 maitland joint mobilizations are often used before and after grade 3/4.
True
57
What is the theory behind grade 1/2 maitland joint mobilizations?
1. Reduces pain by improving joint lubrication and circulation to tissues related to the joint
2. Rhythmic oscillations possibly activate articular and skin mechanoreceptors which play role in pain reduction
58
What is the primary goal of grade 3/4 maitland joint mobilizations?
stretching joint capsule and associated structures (ligaments, muscles attaching in the area)
59
What is a grade 5 maitland joint mobilizations?
High velocity thrust of small amplitude at end of available range but within its anatomical range
60
Primary goal of grade 5 maitland joint mobilizations?
decrease pain and muscle guarding
61
If you are using sustained hold mobs to target pain, what range of motion do you hold at?
beginning range to mid range
62
If you are using sustained hold mobs to target joint mobility, what range of motion do you hold at?
end range.
- Address tissue extensibility directly to allow motion (when enough force applied for enough time according to stress-strain curve for collagen)
63
Resting position of joint used for what 3 things?
1. assessment
2. acute stage
3. during grade 1/2 oscillations
64
Joint mob oscillation frequency and duration?
1. 1-3/seconds
| 2. Typically: 1-5 sets for 15-60 seconds each
65
Joint mob sustained holds frequency and duration?
1. Typically: 1-5 sets for 5-30 seconds each
| 2. More commonly used to treat ROM (end range sustained holds)
66
Ex: What direction would I mobilize the femur to improve hip extension?
Anterior glide mobilization in max hip extension ROM
67
EX: What direction would I mobilize the acetabulum to improve hip extension?
mobilize acetabulum and stabilize femur = concave on convex = to improve extension at hip joint = posterior roll and posterior glide = mobilize acetabulum posterior to improve extension
68
Mobilization with movements golden rule:
should be painless, if pain occurs either need to change direction of force, correct pressure, or not use MWMs
69
Mobilization with movements guidelines: (3)
i. Should be pain free
ii. Apply 10 times before reassessing joint motion
iii. Overpressure should be applied at end range of AROM
70
Ex: MWM increase shoulder flexion?
apply posterior mobilization while patient is actively flexing shoulder
71
EX: What direction of joint glide would you perform in non-weight bearing to improve ROM in ankle dorsiflexion?
posterior glide
72
EX: What direction of joint glide would you perform in non-weight bearing to improve ROM in tibiofemoral flexion?
posterior glide
73
EX: What direction of joint glide would you perform in non-weight bearing to improve ROM in GH IR?
posterior glide
74
EX: What direction of joint glide would you perform in non-weight bearing to improve ROM in Radiocarpal extension?
anterior glide
75
Ex: What grade(s) of joint mobilization glides would you want to perform for GH hypomobility w/o pain?
3/4
76
Ex: What grade(s) of joint mobilization glides would you want to perform for GH pain w/o hypomobiltiy?
1/2
77
Ex: What grade(s) of joint mobilization glides would you want to perform for Gh hypomobility with pain?
1-4
78
Ex: What are working to improve if grade 3 gh distraction is performed?
general mobility
79
Ex: What are working to improve if grade 2 inferior patellofemoral mob is performed?
pain with flexion
80
Ex: What are working to improve if grade 3 anterior hip (femur on acetabulum) mob is performed?
mobility with hip extension/ER
81
Ex: What are working to improve if grade 3 posterior radiohumeral mob= is performed?
mobility extension
