Lecture 3: Peripheral Joint Mobilization

Question 1

When do we use joint mobilization?

Answer 1

• modulate pain
• treat joint impairments limiting ROM (replicate normal joint mechanics while minimizing compressive stresses on cartilage)

Question 2

What is definition of a mobilization/ manipulation?

Answer 2

skilled, passive manual therapy techniques applied to joints and related soft tissues at varying speeds and amplitudes

Question 3

What is osteokinematic motion?

Answer 3

the motion you see as bones move in space (moved by muscles)

DF, PF, flex/ ext

Question 4

What is arthrokinematic motion?

Answer 4

accessory motion between adjacent joint surfaces, occurs with A/PROM the motion you feel

Ex: roll, glide, spin

Question 5

What is joint play?

Answer 5

passive movement

can not be achieved if there is an active muscle contraction

Question 6

What is a component movement?

Answer 6

involuntary obligatory joint motion, occurs with active motion

scap upward rotation with shoulder flexion

Question 7

What is example of a roll?

Answer 7

new points on one surface come in contact with other new points

ER of shoulder- humeral head rolls posteriorly

Question 8

What is an example of glide/slide?

Answer 8

one point of one surface contacts new points on another surface

tibia slides posteriorly during OC knee flexion

Question 9

What is concave convex rule?

Answer 9

concave moving on convex:

osteo and arthro move in same direction

Question 10

What if convex is moving on concave?

Answer 10

osteo and arthro motion in opposite directions

ex: humeral head on glenoid

Question 11

What is obligate translation?

Answer 11

restricted capsular mobility will cause translation away from tightness

ex: tight posterior GH capsule results in anterior translation of humerus

Question 12

What is a treatment plane?

Answer 12

perpendicular to the axis, parallel to joint surface

Question 13

What is traction?

Answer 13

seperation of joint surfaces perpendicular to treatment plane

Question 14

What is gliding?

Answer 14

joint surfaces displaced parallel to treatment plane

Question 15

What are the only 3 grades for traction?

Answer 15

1-3

Question 16

What is grade 1 traction?

Answer 16

good for early pain b/c you are unweighting joint but not putting load on tissues

Question 17

What is grade 2 traction?

Answer 17

taking up tension in tissue but not enough to cause any type of change

Question 18

What is grade 3 traction?

Answer 18

capsule and ligaments are stretched causing actual change in mobility

Question 19

What are important handling techniques during joint play?

Answer 19

soft hands, hands close to joint line

palpate joint line first

pt must be relaxed

Question 20

What is important to note for quality of motion?

Answer 20

where is the onset of resistance or muscle guarding

appropriate end feel?

movement provoking pain?

Question 21

What are the indications for a joint mobilization?

Answer 21

1. if patient has pain, ms guarding or spasm
2. reversible hypo mobility (vigorous techniques)
3. positional fault or sublxation

goal is to achieve full unrestricted pain free ROM

Question 22

Why are mobilizations good for pain/ spasm?

Answer 22

gentle techniques stimulate mechanoreceptors to inhibit transmission of nociceptive stimuli (neurophysiological)

also promotes proprioceptive and kinesthetic awareness

Question 23

What are mechanical effects of grade 3-4 mobilizations?

Answer 23

increases blood supply and nutrients to area

stretch or elongate hypomobile structures

break adhesions

Question 24

What are absolute contraindications for mobilization?

Answer 24

malignancy in area, infectious arthritis , metabolic bone dz, fusion, OM, fracture, ligament rupture

Question 25

What are precautions for mobilizations?

Answer 25

excessive pain/ swelling, arthroplasty, pregnancy, hyper mobility, RA, VA insufficiency

Question 26

What are grades 1-2 for mobilization?

Answer 26

1- small amplitude at beginning of range

2- large amplitude within available range

best for pain won’t produce mechanical effects

Question 27

What are grades 3-4 for mobilization?

Answer 27

3- large amplitude that reaches end range

4- small amplitude movement at very end range

these will increase ROM

Question 28

What is a grade 5 mobilization?

Answer 28

can also be referred to as manipulation depending on state

high velocity thrust that will help increase ROM

Question 29

If patient has low pain in end range what is an appropriate action?

Answer 29

you can most likely skip grade 1 and 2 but see what patient can tolerate