Lecture 4: Joint Mobs

Question 1

Effects on non-thrust joint mobs

Answer 1

1. articular cartilage nutrition (stimulate synovial fluid movement)
2. maintain/increase extensibilty and tensile strength ligaments, capsule (prevent adhesions)
3. provide position and motion sensory information (stimulate propioception system)
4. pain relief (neuromodulation)

Question 2

passive angular stretching vs. joint glide stretching: passive angular stetching

Answer 2

• long lever arm magnifies force at joint surface
• increased joint compression in direction of rolling bone
• roll without glide does not replicate normal movement

Question 3

passive-angular stretching vs joint glide stretching: joint glide (joint mob)

Answer 3

• force applied close to the joint line - controlled intensity
• direction of force replicates normal glide
• forces selectively applied to desired tissue

Question 4

should you use passive angular stretching techniques with hypomobile joints

Answer 4

Yes - good for joints that have normal osteokinematics (flexion, extension, adduction) but abnormal arthokinematics

Question 5

why should you use passive angular stretching techniques with hypomobile joints?

Answer 5

• stretching techniques stretch more than muscle
• need to maintain gains made with joint mob
• be cautious to protect joint surfaces

Question 6

______ provide the information needed to determine direction and type of movement (intensity) indicated for the problem

Answer 6

accessory motion tests

Question 7

generally you are going to mobilize in the direction of:

Answer 7

restriction

Question 8

if the primary restriction is too painful, may choose to adress:

Answer 8

a secondary limitation first

-if pain before resistance, you’re not going to stretch more into that direction

Question 9

does the following exam finding indicate use of joint mob technique?
Humeroulnar distraction grade 2, firm endfeel, pain

Answer 9

Yes; grade 2 we want to stretch, but we don’t know enough about the pain

• pain before resistance = caution
• pain with resistance = can stretch, but with caution
• pain after resistance = can foresure stretching

Question 10

does the following exam finding indicate use of joint mob technique?
radiocarpal volar glide; grade 1, spasm end-feel, pain

Answer 10

Yes, grade 1 we want to stretch
-spasm end-feel be cautious; maybe stretching is not good at this time because a spasm end-feel could be indicative of an inflammatory response

Question 11

Grade 1

Answer 11

loosen

-small amplitude distraction placing no stretch on the capsule

Question 12

grade 2

Answer 12

tighten

tack of the slack, tighten tissues around the joint

Question 13

grade 3

Answer 13

stretch

• amplitude large enough to place a stretch on the joint capsule and surrounding periaricular tissue
• best technique if you’re not worried about pain or symptoms and just want to stretch, but most pt’s can’t handle it so grade 4 oscilliation technique is used instead because you’re in and out of it more

Question 14

choosing grades of movement: pain before resistance

Answer 14

• don’t want to stretch at this time - not using grade 3 and 4
• using grades 1 and 2 (primarily 2) to modulate pain, increase joint nutrition ; no mechanical effect on tissue

Question 15

choosing grades of movement: pain concurrent with tissue resistnace

Answer 15

can start to try stretching; if pt can’t tolerate it you can back off - treat cautiously, begin gentile

If pt hypomobile start with grade 3 “flirting with pain” but if they can’t tolerate it go down to grade 2

Question 16

choosing grades of movement: pain after tissue resistance

Answer 16

• start with grade 4 - still only in painful area not even half of the time
• if can’t handle grade , go down to grade III

Question 17

choosing grades of movement: no pain

Answer 17

missed this

Question 18

Grades I and II oscilatory and sustained translatory technqiues are low intensity and used for

Answer 18

pain relief and joint nutrition

Question 19

Grade III-V oscilitory and III sustained translator techniques are high intensity and used to:

Answer 19

increase joint mobility and propioception

Question 20

recommend sustained grade ___ for decreased joint movement to take advantage of creep and plastic deformation of connective tissue with prolonged stretch

Answer 20

3

Question 21

you should re-examine the pt after and check for:

Answer 21

every technique

• are symptoms altered as a result of treatment
• if pain increased: choose less intensity or a different technqiue

Question 22

objectively reaxmining restricted movement and you find there are no changes in accessory motion and/or arthokinematic motion

Answer 22

then repeat technqiue 3-4 times prior to changing to a different technique

Question 23

number of reps and number of techniques used during a treatment session are based on

Answer 23

the behavior of the pt’s symptoms

Question 24

avg pt will require ___ applications of each technique for ___ per technqiue

Answer 24

3-4 applications for each technique and 30-60 seconds per technique

Question 25

begging each treatment session ask:

Answer 25

• how was pain immediately after last treatment, during evening of last treatment, and next morning after treatment\
• if pt hesitant to respond assume nothing has changed

Question 26

pt reports no pain or mild increases in symptoms with chronic or less irritable condtions during examination of the technique =

Answer 26

continued treatment

Question 27

pt reports increased pain with more acute or irritable conditions during evaluation during treatment =

Answer 27

less the intensity (grade) or change technique

Question 28

most painless and stiff problems will most likely __ exhibit signigcant change with 1 treatment session and therefore

Answer 28

-not exhibit change with 1 treatment session and therefore you may not need to reassess after each individualt technqiue

Question 29

treatment of joint pain

Answer 29

• oscillatory I and II

- time may be less than 30s (start around 15s)

Question 30

treatment of joint sitffness

Answer 30

• oscillations III-IV and HVLA V

- 30-90 seconds

Question 31

treatment of joint stiffness sustained translatory

Answer 31

Grade III, 60+ second hold (take better advantage of creep and plastic deformation)

Question 32

treatment of painful and stiff joints

Answer 32

depends on degree of the problem; whether its pain or stiffness has the prominent role
-adress the primary problem first; if can’t decide, address the pain first

Question 33

non-thrust joint mobs aimed at increasing

Answer 33

capsular mobility

Question 34

activites following non-thrust joint mobs intervention

Answer 34

1. AROM
2. Passive angular stretching
   - goal: maintain gains achieveed with non-thrust joint mob intervention
   - caution with overstretching in the presence of abnormal arhtokinematics
3. muscle performance activites (strength, motor control, endurance, etc)

Question 35

contraindications and precautions to joint mobs

Answer 35

• hypermobility
• joint effusion
• inflammation

Question 36

joint mobs and Rheumatoid arthrits

Answer 36

• generally not effective at relieving pain
• gentle Grade II movement may be beneficial for pain and aching associated with specific trauma
• always avoid upper cevical region

Question 37

joint mobs and osteoarthritis

Answer 37

• very effective
• passive movements direction toward either relieving pain by using large amplitude oscillatory movement (grade II) or towards increasing ROM when using grade III/IV