Lecture 4: Introduction to Joint Mobilization Flashcards
What are the 3 types of accessory motions
roll
slide (glide)
spin
convex on concave rule
When a convex surface moves on a concave surface, the gliding movement occurs in the opposite direction to the bone movement and the roll occurs in the same direction
Concave on convex rule
When the concave surface is moving on a stationary convex surface, the gliding and rolling motion is in the bone movement
How do we increase the osteokinematic motion
change the arthrokinematics
How do we increase the arthrokinematic motion
Joint mobilization
Joint mobilization should be done in the direction of the roll or glide
the joint glide
The direction of force to increase motion should be at what angle
The angle is the plane of the joint. If your force is not in the plane of the joint than you are not doing an effective mobilization
Describe the open packed position of a joint (5 parts)
- slackening of major ligaments and capsule
- minimal surface congruity
- minimal joint surface contract
- minimal stability of a joint
- maximal joint volume (best position for joint mobilization)
Describe the closed packed position of a joint
- maximal tautness of major ligaments and capsule
- maximal surface congruity and compression
- maximal stability of a joint
- Minimal joint volume
Loose packed position for the shoulder
55 abd, 30 horizontal add
Closed packed position for shoulder
Full abd, ER
A torn meniscus in the knee would have what type of end feel
abnormal, springy block
This would feel like a rebound at the end range often accompanied by pain
What is an empty end feel
motion limited by pain, no block felt
what is a loose end feel
hypermobility with no resistance at end-feel
Is a capsular end feel normal
analogous to normal tissue stretch, but the elastic resistance is encountered before normal end ROM; capsular restriction
Name 6 contraindications to doing accessory testing
- cancer
- fracture
- acute rheumatoid condition
- non-mechanical pain
- infection/septic condition
- ankylosed joint
Name 6 precautions to do accessory testing
- joint effusion
- pregnancy
- neurologic signs (impaired sensation)
- hypermobility
- osteoporosis
- steroid use
Grading Joint Mobility
4 point system 0- no movement/ankylosed 1-stiff/ hypomobile 2- normal 3- excessive/hypermobile
How to determine if a pt has a positional fault
Decreased ROM
Static palpation my show a joint not sitting in the right place
How does a PT treat muscular vs. capsular causes of shortness?
Muscle - stretches
Capsular - mobilzations
How can you tell if muscle is short or if there is a spasm
- Spasms: have muscle activation with joint movement (reacts with motion)
- Reduces with PNF
-Shortness: would have not reaction with motion and no change with PNF
Treatment: Muscle shortness vs muscle spasm
shortness- prolong stretching
Spasm- Modalities, PNF
What are the 3 types of PNF stretches
- Contract relax (autogenic inhibition)
- Agonist contraction (reciprocal inhibition)
- CR-AC
What are the clinical uses of PNF AC?
Good to use where the patient is guarding or there are ms spasms
Re educate into new range
If a pt has decreased ROM and the issue capsular, what would the end feel be and what would happen with the accessory motion of the joint
end feel would be capsular
accessory motion would be decreased
If a pt has decreased ROM and the issue is muscular, what would the end feel be and what would happen with the accessory motion
End feel would be springy
normal accessory motion
What are some goals of joint mobilization
- restore accessory motions
- reduce pain
- correct positional fault
- improve joint nutrition
Maitland Mobilization grade 1
amplitude and %
small oscillation
small amp.
first 25% of available ROM
Maitland Mobilization grade 2 amplitude and %
Larger amp
first 50% of ROM
Maitland Mobilization grade 3 amplitude and %
Large amp
Last 50% - do not release from 50%
Maitland Mobilization grade 4 amplitude and %
small oscillation
at end of available range (last 25%)
Maitland Mobilization grade 5 amplitude and %
High velocity thrust, small amplitude at the end ROM
@ 100
Do not release from 100%
What is the purpose of a grade 5 Maitland Mobilization
joint restrictions - where you get resistance
increase strength
Pain - change tone and break up adhesion
What is the purpose of a grade 1 Maitland Mobilization
pain and relaxation
What is the purpose of a grade 2 Maitland Mobilization
Pain and relaxation
What is the purpose of a grade 3 Maitland Mobilization
treat joint restricitons
What is the purpose of a grade 4 Maitland Mobilization
Treat joint restrictions
What rate is a mobilization done for pain
Grade 1 and 2
oscillations at a rate of 2/s
What grade and rate is a mobilization for treating joint restrictions
Grade 3 and 4
20-60 seconds, 4 to 5 times
