JointMobilizations brainscape Flashcards
Joint Play
The assessment f accessry motions at a Joint→examinatin f Joint
Thrust
High velcity, low amplitude therapeutic mvement within r at the end range f motion
Thrust is anther name used for manipulatin r grade 5 mbilizatin.
Nn-thrust
Thse manipulatins that d nt invlve thrust
Anther term used for grade I-IV mbilizatins.
stekinematics
Physilgical mvements that take place at a Joint
The position f one bone in relatinship to other bone
Due tomuscle cntractin r gravity
Arthrkinematics
Mvement between tw articulating surfaces withut reference t any external force being applied t the Joint
Accessory Motion
Mvement ccurring between tw Joint surfaces that are prduced by forces applied by the examiner
Assessed by applying external forces t the Joint
Necessary for normal rangeo f motion and are not under vluntary cntrl
Cmpressin
Decrease in space between tw Joint surfaces
Adds stability t a Joint
Nrmal reactin f a Joint t muscle cntractin
distraction
Tw surfaces are pulled apart
ften used in cmbinatin with Joint mbilizatins t increase stretch f capsule
Cncave n Cnvex
Gliding is in the same direction as the bone mvement
Restrictin and bny motion in the same direction
Knee flexin Restrictin: psterir glide is restricted
Treatment for Wrist Flexin Restrictin
Drsal Glide
Treatment for Wrist Extensin Restrictin
Palmar Glide
Treatment for Ulnar Deviatin Restrictin
Radial Glide
Treatment for Radial Deviatin Restrictin
Ulnar Glide
Treatment for Knee Flexin Restrictin
Psterir Glide
Treatment for Knee Extensin Restrictin
Anterir Glide
Treatment for Shulder Abductin Restrictin
Inferir Glide
Treatment for Shulder External Rtatin
Anterir Glide
Treatment for Shulder Internal Rtatin
Psterir Glide
Cnvex on Cncave
Gliding is in the oppsite direction
Restrictin and bony motion in the oppsite direction
G-H Joint decreased abd: decreased inferir glide restricted
Treatment Plane
Lies n the cncave articular surface
Example f Treatment Plane: Knee
Glidoes are parallel t the tibial Joint surface
distraction is peropendicular t the tibial Joint surface
scillatins (which can be added t glidoes) take place parallel t the tibial
Joint surface
Zer Psitin
Ostekinematic r anatmical position
Usually defined as the starting position for gnimetry
DO NOT MOBILIZE IN THIS position
Resting Psitin
Arthkinematic position where capsule and periarticular structures are most relaxed
Joint surfaces are LEAST cngruent
Joint play is greatest in this position, thus, this is the position t examine the mbility
Actual Resting Psitin
position Joint is placed in when yu can’t btain the resting position
This position is as clse t the resting position as range f motion will allw
Closed pack psitin
Joint capsule and periarticular tissues are most taut
Joint surfaces are most cngruent
Contraindicatedt perform Joint play in this position
Kaltenbrn Grades
distraction
Maitland
Glides
Kaltenbrn Grade I
slow, small amplitude mvement that does nt take the Joint capsule t the limit f the available Joint motion; does nt g t 1st tissue stop; unweighting Joint
Structures affected: pain fibers
Kaltenbrn Grade III:
slow even larger amplitude mvement that takes the Joint through the limit f available Joint motion and int tissue resistance; through the 1st tissue stop
Structures affected: capsule and periarticular structures
Kaltenbrn Grade II:
slow larger amplitude mvement that takes the Joint capsule t the limit f the available Joint motion and int tissue resistance; up t the 1st tissue stop
Structures affected: pain fibers and capsule
Maitland Grade I
slow, small amplitude f oscillatry mvements that does nt take the Joint capsule t the limit f available Joint motion
Nt up t the 1st tissue stop
beginning f range
Structures affected: pain receptrs; little r n stress t the capsule/ligaments
Maitland Grade II:
slow large amplitude f oscillatry mvements that does nt take the Joint capsule t the limit f the available Joint motion
nt up t the 1st tissue stop
First ½ f the range
Structures affected: pain receptrs and Joint capsule and periarticular structures (n change in length)
Maitland Grade III:
slow, large amplitude f oscillatry mvements that takes the Joint up t and slightly through the limit f available Joint motion and int tissue resistance
Up t the 1st tissue stop and back dwn int ½ f the elastic range
Structures affected: Joint capsule and periarticular structures; prgressin glide t grade IV
Maitland Grade IV:
slow, small amplitude f oscillatry mvements performed through the limit f available Joint motion and int the tissue resistance
Up t and slightly through the 1st tissue stop; never cmes back t the elastic range
Structures affected: Joint capsule and periarticular structures
Mailtland Grade V:
High velcity, small amplitude nn-oscillatry mvement that begins at the limit f available Joint motion and takes the Joint int tissue resistance;
Starts at the 1st tissue stop and cntinues
Difficult t cntrl
Structures affected: Joint capsule and periarticular structures; adhesins, positional faults
Hand Position-Therapist
Stable hand: positioned clse t the Joint line, with the ability t palpate the Joint line
90% f the time this will be the prximal bone
Mbile hand: clse t Joint line, with forearm peropendicular t the bone
90% f the time this will be the distal bone
Body Position- Therapist
Close to the patient in order to
Ensure resting position is maintained during the examinatin
Minimize aberrant motions during testing and treatment
Purpses of Joint Mbility Testing (Joint Play)
Determine if ↓ RM is due t Joint (capsule) r periarticular structures
Determine mbility f Joint (hyp vs. hyper)
Determine end feel f accessry motion: bny r firm
Determine if ligaments are cmprmised
Establish baseline
Determine prgress
Imdications of Joint Play
Decreased Joint extensibility/hypmbility (and abnrmal end feel Immbilizatin and inflammatin Joint capsule and sft tissues affected Decrease in water cntent f tissue Increase in crss linkage Increase in scar tissue formatin Decreased strength f the cllagen
Purpse f Joint Mbilizatin
Joint mbilizatin is thught t reverse these cnsequences by prmotiong mvement by helping realign the fibers and decrease the crsslinks that have develped
Extensibility and Joint Mbilizatin
Joint mbilizatin shuld be forceful enugh t bring the tissue t the plastic phase but nt t the breaking pint, except if gal is t break through adhesins
Restrictin n Joint Capsule
Kaltenbrn 2 r higher
Maitland 3 r higher
Factrs Affecting Extensibility
Amunt f force
Speed
Rapidly administered scillati
Number f repetitins
Creep
Creep
Stretch int plastic phase for an increased time forame increases the amunt f extensibility than ne f shrt duratin (Gr III-IV glidoes n the Maitland scale/ Gr II/III distractions n the Kaltenbrn scale
Impairments Treated with Joint Mbs
positional Faults, Decreased jing nuritin (motion necessary for nutrients t diffuse), Pain, Bny Cmpressin at Joint
How does Joint mbs affect pain
Grade I Kaltenbrn and Gradoes I and II Maitland primarily wrk n pain
Joint mbilizatin decreases pain by stimulating Joint receptrs that blck pain impulses through the gate cntrl mechanism by prducing reflexive inhibitin in periarticular structures
Stimulating fast cnducting large diameter prpriceptive nerve fibers that blck transmissin f the slow cnducting small diameter pain fibers, decreasing transmissin f pain t the brain
How does Joint mbs affect bny cmpressinq
Meniscal, labral, and capsular entrapment
When examining a Joint with cmpressin yu wuld find a decrease in the distraction→treat with distraction
Pain
Kaltenbrn – Grade I
Mailtland-Grade I and II
Relaxation
Mailtland-Grade I and II
Decreased Joint Nutrition
Mailtland-Grade I-IV
Decreased Joint Extensibiity
Kaltenbrn II-III
Mailtland-Grade III-IV
Adhesions
Mailtland-Grade III-V
Bony Alignment
Mailtland-Grade IV-V
Increased Joint Cmpression
Kaltenbrn: Grade I-III
documentationJoint Mbs
Joint play to include exam grade you gave pt and the position the Joint was in i.e. documentationas normal Joint mbilizatin for treatment position of the Joint Grade (in Rman numbers) Number of sets and reps
Cntraindicatins: Joint Issues
Unstable Joint (hypermbility) Recent foracture over open epiphyseal plates Cnsiderable Joint effusion Aggravate Joint May make Joint appear hypombile Ankylsing/fused Joints
Cntraindicatins: Other
Advanced diabetes Nutritinal issues at skin surface May cause skin tearing Impaired nutritin t bone steprsis Kidney dysfunction Vascular abnrmalities Spine cntraindicatin: vertebral artery test Bacterial infectin in the area t be mbilized
Cntrandicatins: Bony diseases
Osteoprsis Osteomyelitis TB Paget’s disease: prximal bone sftening f crtical bone leading t pssible foractures Undiagnsed pain RA: exacerbated stages
Paget’s Disease
Chrnic disrder that typically results in enlarged and deformed bones.
Excessive breakdwn and formatin f bone tissue that ccurs with Paget’s disease can cause bone t weaken, resulting in bone pain, arthritis, deformities, and foractures.
Precautins to Joint Mbs
Joint irritability? pain
Prtective muscle spasm/inability for the patient t relax
Irritability f adjacent Joint structures Chrnic Debilitating Disease
Capsular Patterns
Patterns f capsular tightness that is characteristic t each Joint and is determined by the amunt f mbility in the Ostekinematic mvements abut that Joint
Usually present when entire capsule is affected (arthritic cnditins)
If lack f RM matches capsular pattern, need t treat all directions
See Kaltenbrn bk
Shulder Capsular Pattern
Shulder ER>ABD>IR
Knee Capsuslar Pattern
Knee- Flexin>Extensin
If NON -CAPSULAR (NO LIMITATIONS IN EXT)
NEED TO TREAT ONLY THE POST CAPSULE (ISOLATED TIGHTNESS)
