Lecture 4: Joint Mobs Flashcards
Effects on non-thrust joint mobs
- articular cartilage nutrition (stimulate synovial fluid movement)
- maintain/increase extensibilty and tensile strength ligaments, capsule (prevent adhesions)
- provide position and motion sensory information (stimulate propioception system)
- pain relief (neuromodulation)
passive angular stretching vs. joint glide stretching: passive angular stetching
- long lever arm magnifies force at joint surface
- increased joint compression in direction of rolling bone
- roll without glide does not replicate normal movement
passive-angular stretching vs joint glide stretching: joint glide (joint mob)
- force applied close to the joint line - controlled intensity
- direction of force replicates normal glide
- forces selectively applied to desired tissue
should you use passive angular stretching techniques with hypomobile joints
Yes - good for joints that have normal osteokinematics (flexion, extension, adduction) but abnormal arthokinematics
why should you use passive angular stretching techniques with hypomobile joints?
- stretching techniques stretch more than muscle
- need to maintain gains made with joint mob
- be cautious to protect joint surfaces
______ provide the information needed to determine direction and type of movement (intensity) indicated for the problem
accessory motion tests
generally you are going to mobilize in the direction of:
restriction
if the primary restriction is too painful, may choose to adress:
a secondary limitation first
-if pain before resistance, you’re not going to stretch more into that direction
does the following exam finding indicate use of joint mob technique?
Humeroulnar distraction grade 2, firm endfeel, pain
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
does the following exam finding indicate use of joint mob technique?
radiocarpal volar glide; grade 1, spasm end-feel, pain
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
Grade 1
loosen
-small amplitude distraction placing no stretch on the capsule
grade 2
tighten
tack of the slack, tighten tissues around the joint
grade 3
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
choosing grades of movement: pain before resistance
- 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
choosing grades of movement: pain concurrent with tissue resistnace
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
choosing grades of movement: pain after tissue resistance
- 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
choosing grades of movement: no pain
missed this
Grades I and II oscilatory and sustained translatory technqiues are low intensity and used for
pain relief and joint nutrition
Grade III-V oscilitory and III sustained translator techniques are high intensity and used to:
increase joint mobility and propioception
recommend sustained grade ___ for decreased joint movement to take advantage of creep and plastic deformation of connective tissue with prolonged stretch
3
you should re-examine the pt after and check for:
every technique
- are symptoms altered as a result of treatment
- if pain increased: choose less intensity or a different technqiue
objectively reaxmining restricted movement and you find there are no changes in accessory motion and/or arthokinematic motion
then repeat technqiue 3-4 times prior to changing to a different technique
number of reps and number of techniques used during a treatment session are based on
the behavior of the pt’s symptoms
avg pt will require ___ applications of each technique for ___ per technqiue
3-4 applications for each technique and 30-60 seconds per technique
begging each treatment session ask:
- 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
pt reports no pain or mild increases in symptoms with chronic or less irritable condtions during examination of the technique =
continued treatment
pt reports increased pain with more acute or irritable conditions during evaluation during treatment =
less the intensity (grade) or change technique
most painless and stiff problems will most likely __ exhibit signigcant change with 1 treatment session and therefore
-not exhibit change with 1 treatment session and therefore you may not need to reassess after each individualt technqiue
treatment of joint pain
- oscillatory I and II
- time may be less than 30s (start around 15s)
treatment of joint sitffness
- oscillations III-IV and HVLA V
- 30-90 seconds
treatment of joint stiffness sustained translatory
Grade III, 60+ second hold (take better advantage of creep and plastic deformation)
treatment of painful and stiff joints
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
non-thrust joint mobs aimed at increasing
capsular mobility
activites following non-thrust joint mobs intervention
- AROM
- Passive angular stretching
- goal: maintain gains achieveed with non-thrust joint mob intervention
- caution with overstretching in the presence of abnormal arhtokinematics - muscle performance activites (strength, motor control, endurance, etc)
contraindications and precautions to joint mobs
- hypermobility
- joint effusion
- inflammation
joint mobs and Rheumatoid arthrits
- 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
joint mobs and osteoarthritis
- 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
