L2 - ARTICULAR KINEMATICS: ARTHROKINEMATIC & OSTEOKINEMATIC Flashcards
Areas of biomechanics
Kinematics and kinetics
Definition of kinematics
= branch of mechanics that deals with geometry of motion of objects,
including displacement, velocity and acceleration, without considering forces that
produce motion
Division of movements & description of each
- Rotation: movement that takes place through circular pattern around
pivot (axis of rotation) - Translation: linear motion occurring in a straight and curvilinear line
Definition osteokinematics
= describe angular motions of bone segments in 3 planes of space & which are visible
Plane & axis of each mvt of GH joint
Flexion / extension:
- Plane: sagittal
- Axis: transverse
ABD / ADD:
- Plane: frontal
- Axis: sagittal
Rotation:
- Plane: transverse
- Axis: vertical
Definition of degrees of freedom
= number of directions of angular motion allowed in a joint
Define degrees of freedom (number and type): GH, wrist and elbow
GH: 3 sagittal, frontal and horizontal (= transverse) plane
Wrist: 2: sagittal and frontal planes
Elbow: 1: sagittal
What are the things that restricted the degrees of freedom in translation movement ?
Joint capsule
Ligament
Surrounding structures
Define the possible direction of movements and the corresponding axis
Anterior post = x axis
Medial lateral = y axis
Superior inferior = z axis
What are the functional importance of degrees of freedom
- Joint stability: slight translational adjustments help maintain joint congruency
during motion - Shock absorption: small translations dissipate forces during impact
- Pathological assessment: excessive or restricted translation can indicate injury
(ex: ligament tears in knee)
Definition arthrokinematics
= movement occurring between joint surfaces: accessory displacements between joint
heads in relation to each other occurring during body movements
Name 3 main movements of arthrokinematics
Roll, spin and slide
Definition glide
translatory motion given by sliding of joint surfaces
Definition slide
occurs when a single point on surface of bone end contacts multiple
points on opposite end
Definition roll
occurs when multiple points of joint end contact multiple points of opposite
end
Definition swing
angular motion occurring in same direction of movement of segment under consideration
Definition spin
- Occurs when 1 point of joint end contacts only one point of opposite end
- Rotary motion occurring when segment bone under consideration rotates around
its own axis
Describe 2 types of combined movement
- Roll & slide: associated with each other during physiological movements in
planes of motion when convex surface moves over a concave one - Swing & glide: associated with each other during physiological movements in
planes of motion when concave surface moves over a convex one
Concave-convex rules
- Always at foundation for guiding clinicians in making choices related to execution
of manual therapy techniques - Rules can be reasonable starting point for making such decisions as long as
factors such as joint’s resting position and local tensions within muscles,
ligaments or other connective tissues are considered
Description of joint position
- Joint congruence not perfect
- Contact area between joint at different points in ROM is minimum compared to total available joint surface area
5 main infos about closed-packed position + description
Closed-packed position
1. Position of maximum joint stability
2. Usually at end-range
3. Ligaments, capsular component, and other peri-articular tissues in moderate-to-maximum tension
4. Minimal or no accessory movements
5. Minimal intra-capsular space in joint
Closed-packed position is:
- Effective for loading (static)
- Dangerous for movement (dynamic)
- Testing position
5 main infos and description of open-packed position
- Position of minimum joint stability
- Usually mid-range
- Ligaments, capsular component, and other peri-articular tissues in minimal tension
- Ancillary movements allowed
- Maximum intra-capsular space in joint
Loose-packed position is:
- Position allowing maximum joint play (useful for treatment)
- Resting position of joint
- Ineffective for load (static)
- Safe for movement (dynamic)
Table joint and open / closed packed position
Table 1
Description of capsular pattern
Capsular obligated translation
- Concept that restrictions in extensibility (stiffness) of joint capsule may cause early and/ or excessive translations or accessory movements in opposite
direction of stiffness
Features of capsular patterns
Proportional restriction:
o Movement limitations occur in specific & predictable order of severity
o Different movements are restricted in proportional pattern, not necessarily equally
Causes of capsular patterns
Associated with pathology affecting entire joint capsule
o Arthritis
o Capsulitis
o Post-immobilization joint stiffness
Diagnostic value of capsular pattern
→ Recognizing capsular pattern helps identify joint pathologies & differentiate them
from other causes of movement restriction
Capsular pattern of articulations
Table 2
Definition of end-feel
= sensation felt by examiner at end of joint’s passive ROM. Provides information about
nature of tissues limiting motions and helps identify normal or pathological conditions
Definition of normal end-feels
= expected sensations encountered in healthy joints & tissues
3 examples of normal end-feels with description, example and causes of each
Definition of abnormal end-feels
= occur when end feel is inconsistent with expected motion or occurs prematurely
6 abnormal end-feels with description, examples and causes
Table
Treatment description
- Pain + reduced joint mobility = restriction in activity & participation = disability (ICF)
- ROM = one of crucial aspects of MSK rehabilitation & its restriction (hypomobility)
impairment as important as pain
needed to treat efficiently abnormal endfeel
To treat efficiently, need to know:
1. Type of MSK disorder
2. Joint biomechanics
3. Joint and muscle anatomy & physiology
4. Movements between respective joint profiles (arthrokinematics)
Movement limited, capsule involved and accessory movement for treatment of different articulations
Table
Types of treatment
Combining accessory & physiological movement
Strain-counterstrain (positional release therapy)
Graded mobilizations (Maitland)
Purpose and technique of Combining accessory & physiological movement
- Purpose: improve ROM by integrating passive accessory glides with active or
passive physiological movements - Technique:
1. Position of joint: place joint in starting position where limitation occurs
2. Apply accessory movement: mobilize joint along glide direction (ant, post,
inf…) while maintaining appropriate hand placement & force
3. Add physiological movement:
a. Passive: therapist moves joint through ROM while maintain glide
b. Active: patient actively performs movement while therapist applies
glide
4. Reassess: check for improvement in ROM or reduce symptoms
Purpose and technique of Strain-counterstrain (positional release therapy)
- Purpose: reduce muscle guarding & pain by positioning joint in its most relaxed
and least painful position - Technique
1. Find tender point: identify painful or tight area related to joint or movement
limitation
2. Position for comfort: passively position joint to shorten involved tissue and
relieve tension
3. Hold position: maintain position for 90 sec while monitoring patient’s comfort
& symptoms
4. Reassess: return joint to neutral & test ROM or pain reduction
Purpose, grades and technique of Graded mobilizations (Maitland)
- Purpose: gradually increase joint’s ROM & reduce stiffness or pain
- Grades:
o Grade I-II: small amplitude movements for pain relief & relaxation
o Grade III-IV: larger amplitude movements toward end range to stretch
capsule
o Grade V (manipulation): high-velocity, low amplitude thrusts used
sparingly by trained professionals - Technique:
o Amplitude and rhythm
o Apply smooth, rhythmic oscillation at chosen grade
o Typically, 2-3 oscillations per second for 30 seconds to 2 min - Start with grade I-II to reduce pain & spasm
- Progress to grades III-IV to improve ROM
CCL: advantage of osteokinematics, advantages of arthrokinematics, concave-convex pattern
CONCLUSION
- Osteokinematics aids understanding of mutual behavior of joint profiles & to
visualize in mind behavior of joints in angular movements
- Arthrokinematics provides useful insights into administration of joint techniques
- “Bare bones” study of joint kinematics alone is meaningless
- Concave-convex pattern = one principles that guide our decision making clinical
& will be integrated with new findings on pain-related neuroscience
