Joint Play Flashcards
what is Joint Play
Arthrokinetic movements that occur between two articular surfaces within their ranges of motion.
Motion that is available between two articular surfaces in one direction. Not under voluntary control.
There is a small amount of ROM that can be obtained only passively (not under voluntary control) by the therapist-this movement is called joint play or accessory movement
Joint play movement is necessary for full, pain-free voluntary movement to occur
Joint dysfunction signifies a loss of joint play movement
Movement in a joint must be restored before full functional voluntary movement is regained
In most joints, joint play movements are less than 4mm in any one direction
Includes motions that occur between the joint surfaces and the “give” in a joint capsule
Movements available between the joint surfaces
Distraction
Compression
Sliding/Gliding
Rolling
Spinning
In some cases, joint play movements may be similar or the same as PROM or ligamentous testing
Distraction & Traction
Distraction & Traction are not synonymous
Distraction is a separation, or pulling apart
Ex. GH jt – requires a right angle pull
Traction is a longitudinal pull, which doesn’t always result in the joint being pulled apart
Long-axis traction is when a pulling force is applied to the long axis of a bone
what is Distraction
Distraction: two opposing joint surfaces are separated from each other, moving towards a loose or open packed position.
Axial distraction: through the long axis of the joint
Lateral distraction: perpendicular to long axis of joint
Compression or Approximation
A decrease in the joint space between the bony articulations
Normally occurs in the extremities and spinal joints on weight bearing
Muscle contraction causes some compression of the joints that are crosses, which provides stability
To help maintain cartilage health, normal intermittent compressive loads help circulate the synovial fluid
High compressive loads may lead to joint deterioration
Slide/Glide
Slide/Glide
One bone sliding (translating) across another
During active voluntary movement it occurs in combination with rolling
Roll
The angle of the bone changes (swings) and creates compression on one side and separation on another
In normal joint movement, occurs in combination with sliding or spinning
Spin
A rotation around a stationary axis
Rarely occurs alone, but in combination with rolling and sliding
Example of a joint spinning: shoulder flexion and extension
Joint Play vs. Joint Mobilization(when you see joint restriction , you do joint movement)
Although sometimes used interchangeably, joint play and joint mobilizations are two different things.
Joint play is the assessment of the joint; moving it in all directions to see if there are restrictions in the capsule. After assessment, if restrictions are found in certain directions, we can treat the joint using joint mobilizations.
Joint mobilizations are specific applications applied in one direction to work through the restrictions and decrease joint dysfunction.
Indications for Joint Mobilization
Most commonly associated with restoring ROM for the peripheral and axial skeleton joints.
Primary indication for this is decreased ROM due to immobilization, usually from fractures, ligamentous sprains, tendonitis, or adhesive capsulitis.
Any condition involving fibrosis or pseudo-fibrosis (relative capsular fibrosis) of the joint capsule is indicated for mobilization.
Loose Packed (Resting) Position
Minimal congruence between the articular surfaces and the joint capsule with the ligaments being in the position of greatest laxity and passive separation of the joint surfaces being the greatest
Provides proper joint lubrication and allows the arthrokinematic movements of spin, slide and roll
The position in which the joint is in the least amount of stress. It is also the position in which the joint capsule has its greatest capacity
Loose Packed (Resting) Position
Minimal congruence between the articular surfaces and the joint capsule with the ligaments being in the position of greatest laxity and passive separation of the joint surfaces being the greatest
Provides proper joint lubrication and allows the arthrokinematic movements of spin, slide and roll
The position in which the joint is in the least amount of stress. It is also the position in which the joint capsule has its greatest capacity
Close Packed Position
In this position, the majority of the joint structures are under maximum tension as the two joint surfaces fit together precisely (fully congruent)
This position should be avoided as much as possible during an assessment except to stabilize an adjacent joint
Ligaments, bone or other joint structures, if injured, become more painful as the close packed position is approached
Ligaments, bone or other joint structures, if injured, become more painful as the close packed position is approached
If a joint is swollen, the close packed
position cannot be achieved
No accessory movements are possible in this position
Rules for Joint Play testing
- The patient must be relaxed and fully supported
This is to ensure no muscle guarding occurs across the joint to be mobilized, as this may make the mobilization ineffective. - The therapist must be relaxed and use a firm but comfortable grasp
This allows the patient to feel supported and comfortable enough to “let go” - One joint should be examined at a time
An exception to this rule is in the wrist, hand and foot where there is often more than one joint being affected. - One movement should be examined at a time
Sometimes you need to distract the joint slightly before performing a slide - The unaffected side should be tested first
The same as all assessment techniques—this allows you to see what is “normal” for that person. - One articular surface is stabilized, while the other surface is moved
If needed, use pillows, the table, or your body to help support and stabilize - Movements must be normal and not forced
Assessment of a joint with joint play should always be in the loose packed or resting position. - Movements should not cause undue discomfort
Watch for muscle guarding and patient discomfort.
Patients do not always verbally express their levels of discomfort, however pain may become evident with facial expression and/or muscle guarding.
Causes for Joint Dysfunction
Intra articular adhesions or pericapsular stiffness
Shortened muscle groups around the joint
Muscle weakness and imbalance around a joint
Pain
Nerve root adhesions
Soft tissue restrictions
Precautions
Hypermobility
Inflammation
Joint effusion TRÀN DỊCH KHỚP
Neoplasm or cancer
Recent fracture
Excessive pain
Acute inflammatory disease
Joint sepsis ( NHIỄM TRÙNG)
Bacterial infection
Joint replacements
Previous dislocation (communicate well to make them relax )
Systemic connective tissue diseases (RA) & Elderly with weakened connective tissue
