Lecture 1: introduction Flashcards
Definition: Joint Mobilization
A skilled passive movement by a therapist on articular surfaces to decrease pain or increase joint mobility or range of motion.
Physiological effects of Joint Mobilization:
Fires articular mechanoreceptors JOINT
Fires cutaneous and muscular receptors SKIN MUSCLE
Abates or stops nociceptors (pain receptors) PAIN
Decreases or relaxes muscle guarding SPASM
Causes synovial fluid movement and improves nutrient exchange NUTRIENT
Improves mobility and flexibility at the joint MOBILITY FLEXIBILITY
Maintains tensile strength of articular tissues STRENGTH
- Kích hoạt các cơ quan cảm thụ cơ khớp. 2. Kích hoạt các thụ thể ở da và cơ bắp. 3.Giảm hoặc ngừng các thụ thể đau (thụ thể đau). 4. Giảm hoặc thư giãn cơ bảo vệ. 5. Gây ra sự chuyển động của chất lỏng hoạt dịch và cải thiện trao đổi chất dinh dưỡng. 6. Cải thiện khả năng vận động và tính linh hoạt ở khớp. 7. Duy trì độ bền kéo của mô khớp
Terminology
Arthrokinematics: motions you can feel, movement that occurs inside a joint.
roll, spin, slide/glide
Osteokinematics: motions you can see, movement of body parts that occurs outside a joint.
flexion/extension, abduction/adduction, rotation
Roll: Accessory motion where one articular surface rolls on another
eg/ tibia rolls on femur
Slide/glide or translation: Accessory motion where one articular surface slides on another.
Surfaces are usually congruent, flat or curved.
Spin: Accessory motion where one bone moves but the axis remains stationary.
Closed Packed Position
This is a joint position in which the articulating bones have their maximum area of contact with each other and it is called maximum congruency. The joint capsule becomes twisted causing the joint surfaces to become fully approximated and no further movement is possible.
It is in this position that joint stability is the greatest.
Each synovial joint has a point in its range of motion where its surfaces are maximally congruent, its capsule and ligaments are maximally taut and elongated and its surfaces are maximally compressed.
Injury in the closed packed position will most likely result in fracture and/or dislocation
Open Packed (Loose) Position
or Resting Position
This is a position of the joint where the joint surfaces become separated and have little congruity and minimal joint surface contact. The joint capsule is relaxed and untwisted as well as the major ligaments. The joint is under the least amount of stress in this position, which is why we do most joint mobilizations in the resting position.
The joint has minimal stability in this position.
Most sprains and strains occur in the open packed or loose position. When swelling occurs the joint assumes the open packed position.
Capsular Pattern of Restriction
The capsular pattern of restriction is a predictable pattern of movement restriction that occurs in a synovial joint when the entire joint capsule is injured or affected. It is a result of a total joint reaction. The pattern is named from the most restricted range of motion to the least restricted range of motion.
When testing range of motions in a specific joint, one would find a predictable pattern of limitation to specific joint movements that can be measured and retested.
Concave / Convex Motion Rule
When a concave surface moves on a convex surface, roll and slide must occur in the same direction.
When a convex surface moves on a concave surface, roll and slide occur in opposite directions.
Joint Distraction/Compression
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/approximation: two opposing joint surfaces are moved towards each other or approximated. Towards a close packed position
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.
14 Principles of Joint Play
- The patient must be relaxed.
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 comfortable.
Full attention must be paid to the mobilization. The therapist may have to sustain the therapy for as long as needed. - Mobilize the distal articular surface on the proximal articular surface if possible.
An exception to this is the ankle or if the patient is unable due to pain. - Do not mobilize when the joint surfaces are fully approximated or close packed.
This will create too much friction between the articular surfaces. - Position the joint by moving the joint to the point of restriction and then back off by approximately 10 degrees, then perform the mobilization technique.
- Mobilize one joint, in one direction and at one time.
An exception to this rule is in the wrist, hand and foot where there is often more than one joint being affected. - Do not mobilize the joint if the patient is experiencing pain during the mobilization. This may increase the inflammatory response, and muscle guarding.
- Assessment of a joint with joint play should always be in the loose packed or resting position.
This helps to determine the amount of glide available in the joint. - Correct stabilization of other body parts are essential for the joint mobilization to be effective.
- Do not lever a joint. Do not perform a long lever roll manipulation. Joint play is a direction mobilization that is performed in the direction of glide.
- Use pillows, rolled up towels, or high-density foam blocks to help stabilize the proximal joint surface.
- Watch for patient discomfort.
Patients do not always verbally express their levels of discomfort, however pain may become evident with facial expression and/or muscle guarding. - Always re-assess after each treatment and prior to a treatment.
This will provide a clear baseline of measurement and tell us whether or not the treatment is effective or if it needs modifying. - Joint play should be used with other adjunct phụ trợ therapies, like soft tissue stretching, deep tissue massage and hydrotherapy.
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
Indications for Joint Play
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 giả xơ hóa (relative capsular fibrosis) of the joint capsule is indicated for mobilization.
Contraindications
