Lecture 1 Flashcards
Intro
what are mobilizations?
passive manual techniques applied to joints + related soft tissues @ varying speed + amplitude
what is joint play?
amount of movement available between joint surfaces @ capsular level
what are physiologic movements?*osteokinematics
movements px can do voluntarily
what are accessory movements? *Also known as component movements
movements within the joint and surrounding tissues that are necessary for ROM but can not be actively controlled
what are arthrokinematics?
study of the movements that occur between the articular surfaces, inside
the joint (accessory movements)
what is congruency?
max achieved when articular surfaces have the tightest fit
what are normal end feels?
bone on bone
STA
tissue stretch/ ligamentous
muscular
capsular/firm
What are abnormal end feels?
muscle spasm
empty
springy
early bone on bone
boggy
muscular
capsular - before end range
what is subluxation?
incomplete or partial dislocation- often involves secondary trauma to surrounding soft tissue
what is manipulation?
thrust- high velocity, short amplitude-( patient cannot prevent)
what are the 2 shapes of joint surfaces?
ovoid + sellar
what is ovoid?
one surface convex
one surface concave
what is a sellar surface?
one surface convex in one direction - concave in the opposite ex. thumb/saddle
what is distraction?
joint surfaces pulled apart- require specific angle
what is compression?
joint surfaces approximated
what is roll?
one articular surfaces rolls on another
- always in same direc. as bone in motion+ associated with glide
what is spin?
accessory movement- bone moves in circular fashion around stationary imaginary axis
what is glide?
one articular surface glides on another
what are the benefits of joint mobilizations?
pain control
joint lubrication
improves tissue health
what are indications for joint mobilozations?
- pain + mm guarding
- reversible joint hypomobility
- positional faults/subluxations
- progressive limitation
- functional immobility
- poor proprioception
list absolute contraindications of joint mob./assessment
hypermobility + instability
acute inflammation
bone lesions
CT lesions
bacterial infection/ sepsis
excessive pain
spinal cord lesion
joint replacement
what are precautions in joint mobs.?
joint effusion?
prolonged corticosteroid
history neoplasm/radiation
osteoporosis
neurological signs
pregnancy- relaxin
what are the two systems for grading?
graded oscillation technique(maitland)
Sustained translatory techniques (kaltenborn)
what is grade 1 sustained?
small-amplitude distraction or glide applied where no stress is placed on capsule.
pain relief, non-corrective grade of mobilization.
what is grade 2 sustained ?
enough distraction or glide is applied to tighten the tissues around the joint to
tissue resistance. This is also a non-corrective grade and can be used to decrease pain and
maintain ROM.
what is grade 3 sustained?
distraction or glide is enough to put a stretch on the joint capsule and on
periarticular structures. Movement is through the tissue resistance. This is a corrective
grade used to stretch the joint structures and increase ROM and joint play
what is grade 1 oscillation?
small amplitude rhythmic oscillations performed at beginning of the range,
before tissue resistance. Performed at approximately 3-5 cycles per second.
what are grade 2 oscillations?
: large amplitude oscillations performed within the range, before tissue
resistance. Performed at 2 cycles per second.
what are grade 3 oscillations?
: large amplitude oscillations performed within tissue resistance (in and out), but
before the joint limit. Performed at 2 cycles per second
what are grade 4 oscillations?
small amplitude oscillations performed just beyond tissue resistance but before
the joint limit. Performed at approximately 3-5 cycles per second.
what are grade 5 oscillations?
small amplitude, high velocity movement (not oscillatory) that begins at the
tissue resistance and ends up at the anatomical limit of the joint (manipulation). This is
not in our scope of practice
what is the goal of grade 1 + 2 oscillations?
reduce pain (oscillations have an inhibitory effect on
perception of painful stimuli by repetitively stimulating mechanoreceptors to block
nociceptors).
what are the uses of grade 3 + 4 oscillations?
improve ROM
what grades can cause irritation due to higher frequency?
1+4
how long can grade 1 + 4 oscillations be done for?
15- 30 seconds with few seconds rest up to 5 sets
(rapid and may cause irritation)
how long can grade 2+3 oscillations be done for?
up to 1 minute
what grade would you do for a first appointment joint mobilizations?
grade 1 or 2 oscillation
what should be taught to px after increasing ROM
ROM exercises in newly gained range p-free
