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Kinesiology > Lecture 6- Joint Mobilizations, Selective Tissue Tensioning > Flashcards

Lecture 6- Joint Mobilizations, Selective Tissue Tensioning Flashcards

1
Q

JOINT MOBILIZATIONS

A

JOINT MOBILIZATIONS

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2
Q
  • What type of tissue is the joint capsule?
  • The joint capsule forms a “_______” around the joint.
  • What determines the thickness of the joint capsule?
A
  • dense fibrous connective tissue
  • sleeve
  • stresses placed on it
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3
Q

What are the 3 main roles of the joint capsule?

A
  • seals joint space
  • provides passive stability by limiting movements
  • provides active stability via its proprioceptive nerve endings
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4
Q

Why is the proprioception of the joint capsule important?

A

If a PT starts to dislocate, their proprioceptors will sense that and muscles will respond.

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5
Q

Tight capsular structure will cause early and excessive accessory motion in the _________ direction of the tightness.

A

-opposite

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6
Q

Injury to a joint or structures surrounding a joint will often lead to what?

A
  • pain
  • loss of motion (inflammation)
  • excessive motion (overstretched)
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7
Q

In what position do we perform our joint mobilizations?

A

open pack = resting position

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8
Q

Why do we want to perform our joint mobs in the open pack position?

A

This is where structures are the least tight, allowing for the greatest mobility.

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9
Q

In the open pack position we have:

  • surrounding tissue is as ______ as possible
  • _________ incongruency
  • intracapsular space is as _________ as possible
  • ________ amount of joint play available
A
  • lax
  • maximal
  • large
  • maximal
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10
Q

In the closed pack position we have:

  • joint positions where joint is ________ congruent
  • surrounding tissue (capsules and ligaments) under ______ tension
  • ________ stability of the joint
A
  • most
  • maximal
  • maximal
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11
Q

Why don’t we perform joint mobs in the closed pack position?

A

This is where the bones are maximally congruent, if you “win” when a PT is in a closed pack position, it could cause damage.

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12
Q

What are the 3 things we are testing when assessing joint mobility?

A
  • gross (quantity of movement)
  • end-feel (quality of movement)
  • provocation
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13
Q

What are the 3 gross (quantity of movement) classifications?

A
  • hypomobile
  • normal
  • hypermobile
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14
Q

What are the 3 end-feels (quality of movement)?

A
  • firm
  • hard
  • empty
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15
Q

What is an example of why it is important to know end feels?

A

If you are expecting a firm end-feel but it is hard, it’s important to ask why you are felling bone-to-bone at that joint. If you ignore this and keep joint, you could break bones over stretching a patient.

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16
Q

What is an empty end-feel?

A

When you could have moved the joint further, but the patient stopped due to pain.

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17
Q

The original classification scale for joint mobility was on a scale of 0-6 with 0 being ________, 3 being _________, and 6 being __________.

A
  • no movement
  • normal
  • unstable
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18
Q

What is hypomobility?

What may cause this?

A
  • motion stops short of anatomical limit, instead stops at pathological point of limitation
  • pain, spasm, adhesions, inflammation
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19
Q

What is hypermobility?

A

Joint moves beyond its anatomical limit because of laxity of surrounding structures

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20
Q

What are the indications for performing joint mobilizations as a treatment?

A
  • break pain cycle
  • increase joint extensibility
  • increase extensibility of tendons, muscles, fascia
  • increase joint ROM
  • promote muscle relaxation
  • improve muscle performance
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21
Q

What are the biomechanical effects of joint mobilizations?

A
  • motion improvement
  • positional improvement
  • increase joint capsule extensibility
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22
Q

What are the nutritional effects of joint mobilizations?

A
  • synovial fluid movement

- improve nutrient exchange

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23
Q

What are the neurophysiological effects of joint mobilizations?

A
  • stimulates mechanoreceptors to inhibit pain impulses
  • gate control theory
  • descending pathway inhibition theory
  • peripheral inflammatory modulation
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24
Q

What is the gate control theory?

A

The gate control theory of pain asserts that non-painful input closes the nerve “gates” to painful input, which prevents pain sensation from traveling to the central nervous system. The gate control theory of pain describes how non-painful sensations can override and reduce painful sensations.

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25
Q

What is the descending pathway inhibition theory?

A

Joint mobilizations (grade 5) stimulate PAG which activates neurons that release seretonin which is a “feel-good” chemical. Serotonin descends to spinal cord where it forms connections with neurons that help inhibit pain.

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26
Q

What are the absolute contraindications to performing joint mobilizations?

A
  • malignancy in area of treatment
  • infectious arthritis
  • fusion of the joint
  • fracture at the joint
  • practitioner lack of ability
  • neurological deterioration
  • upper cervical spine instability
  • cervical arterial dysfunction
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27
Q

What are the relative contraindications to performing joint mobilizations?

A
  • excessive pain or swelling
  • arthroplasty
  • hypermobility
  • osteoporosis
  • spondylolisthesis
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28
Q

There are many varied procedures and philosophies for joint mobs but they are most effective when combined with a comprehensive _______________.

A

treatment plan

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29
Q

What are the 3 joint play movements and describe them?

A
  • Compression- approximation of joint surfaces; force perpendicular to joint plane
  • Traction/distraction- seperation of joint surfaces; force perpendicular to the joint plane
  • Gliding- force direction parallel to joint surface
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30
Q

What are the 4 types of joint mobilizations?

A 
Distraction
-perpendicular to joint surface
Oscillation mobilizations
-glide parallel to joint surface
Sustained hold mobilizations
-beginning range, mid range, end range
Mobilizations with movement
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31
Q

What is the grading scale for distraction mobilizations called and what are the grades?

A

Kaltenborn Distraction Grades

  • Grade I - piccilo (loosen)
  • Grade II - slack (take up the slack)
  • Grade III - stretch
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32
Q

Kaltenborn Grade I – piccolo (loosen)

  • Distraction force that neutralizes pressure in the joint without producing actual __________ of the joint surfaces.
  • No _______ on the joint capsule.
  • Can be used with ________ mobilizations to reduce compressive forces on articular surfaces and thereby pain.
A
  • seperation
  • stress
  • gliding
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33
Q

Kaltenborn Grade II - slack (take up the slack)

  • Slack in joint capsule is reduced through sustained __________.
  • Separates the articulating surfaces and _______ the play in the joint capsule.
  • Can help to determine the _________ of the joint.
A
  • distraction
  • eliminates
  • sensitivity
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34
Q

Kaltenborn Grade III - stretch

-designed to stretch joint capsule and soft tissues surrounding the joint to increase _________.

A

mobility

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35
Q

Would we perform a Kaltenborn Grade III stretch on someone with a normal joint? A hypermobile joint?

A

No, only done with hypomobile patients to get them into plastic region

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36
Q

Toe region = Grade __
Elastic region = Grade ___
Plastic region = Grade ___

A
  • I
  • II
  • III
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37
Q

What is the grading scale for oscillation mobilizations called and what are the grades?

A

Maitland Oscillation Joint Mob.

-Grade I - V

38
Q

Maitland Grade I

  • Small amplitude technique performed at beginning of available ROM (first __%)
  • Primary goal: ____ and ______ reduction
A
  • 25 (0-25)

- pain and spasm

39
Q

Maitland Grade II
-Large amplitude technique performed in middle of available ROM (middle __%)

Primary goal: ____ and _____ reduction

A
  • 50 (25-75)

- pain and spasm

40
Q

Maitland’s Grades I and II Oscillations

  • _____ relief and muscle _________
  • No direct mechanical effect on _________ (not reaching plastic region)
  • influences mechanical __________
  • Often used before and after grade ___ and ____ mobilizations
A
  • pain, guarding
  • restrictions
  • nociception
  • III and IV
41
Q

Maitland Grade III

  • Large amplitude technique performed at end of available ROM (last ___%)
  • Primary goal: stretching __________ and associated structures
A
  • 50 (50-100)

- joint capsule

42
Q

Maitland Grade IV

  • Small amplitude technique performed at end of available ROM (last __%)
  • Primary goal: stretching __________ and associated structures
A
  • 25 (75-100)

- joint capsule

43
Q

Maitland’s Grades III and IV Oscillations

  • Primarily __________techniques
  • Mechanical and ____________ effect
  • May activate inhibitory joint and muscle spindle receptors to aid in __________ restriction of movement
A
  • stretching
  • neurophysiological
  • reducing
44
Q

Maitland Grade V

  • High velocity thrust of small amplitude at end of available range but within its __________ range
  • Movement that exceeds the resistance barrier
  • Commonly referred to as high velocity thrust technique or joint ___________
A
  • anatomical

- manipulation

45
Q

SELECTIVE TISSUE TENSIONING

A

SELECTIVE TISSUE TENSIONING

46
Q

What is a common obstacle of diagnosing painful condition?

A

often times pain is felt at a distance from true source

47
Q

Information to gather during an examination process

A
  • History
  • Condition at rest
  • Active movements
  • Passive movements
  • Resisted movements
  • Joint mobility
  • Special tests
  • Palpation
48
Q

History

  • The ______ is the best source of information into their condition.
  • History can help to develop __________ order to development of symptoms.
  • _______ questions should be avoided.
A
  • patient
  • chronological
  • leading
49
Q

What information should be gathered during a history?

A
  • demographics
  • past medical history/medications
  • progression/evolution of symptoms
  • previous treatments
  • description of symptoms
  • activity limitations
  • participation restrictions
  • goals
50
Q

What are the 5 Principles of Diagnosis for Soft Tissue Injuries?

A
  1. ) Look for “inherent likelihoods”
  2. ) Look for objective physical signs
  3. ) Palpation
  4. ) Selective tensioning: Non-contractile vs. Contractile Tissue
  5. ) “The” pain is the pain for which the patient is seeking treatment
51
Q

1.) Look for “inherent likelihoods”

-Soft tissue lesion behave in ________ ways (Regularly be faced with the same history and the same response to functional testing)
Examiner with knowledge of these patterns can recognize them quickly

A

-typical

52
Q

2.) Look for objective physical signs

  • Examination of soft tissues is an exercise in applied anatomy
  • Test each group of _______
A

tissues

53
Q

3.) Palpation

  • Can help to narrow down the area/tissue to evaluate
  • Can be _________
A

unreliable

54
Q

4.) Selective tensioning: Non-contractile vs. Contractile Tissue

  • What are some examples of contractile tissues?
  • What are some examples of non-contractile tissues?
  • Contractile tissue is stressed with _______ contraction, stretching, and palpation while non-contractile tissues are stressed with only _________ and ________.
A
  • Tendons, muscle, musculotendinous junctions, bone adjacent to attachment of tendon
  • Joint capsules, ligaments, bursae, aponeuroses, nerves
  • isometric, stretching and palpation
55
Q
  1. ) “The” pain is the pain for which the patient is seeking treatment
    - When pain is evoked must ask “________?”
A

is that your pain?

56
Q

Active movements are a quick way to narrow down the _______ of symptoms and the _________ to test in detail.

A
  • source

- structures

57
Q

With active movements we want to observe for what 4 things?

A
  • pain
  • ROM
  • quality of movement
  • willingness to move
58
Q
  • With active testing we want to compare to _________ side AROM, PROM, resistance testing, and palpation.
  • With active testing, we want to compare to _________ results of PROM, resistance testing, and palpation
A
  • contralateral

- ipsilateral

59
Q

With passive movements, the patient should be completely ________.

A

relaxed

60
Q

With passive movements we want to observe for what 4 things?

A
  • pain
  • ROM
  • willingness to move
  • end feel
61
Q

With passive movements, just like active movements, we want to compare our involved side to what?

A

uninvolved side and results of other testing on involved side

62
Q

Resisted movements do best to isolate _____/________. Resist through full ROM to fully rule out suspicious area; _______ need to do resistance through full ROM for all resistance testing.

A
  • muscle/tendon

- DO NOT

63
Q

With resisted movements we want to observe for what 4 things?

A
  • pain
  • willingness to allow contraction
  • strength
  • compensations
64
Q

Resistance (S12)

  • No pain, normal strength = _______
  • Yes pain, normal strength = ________ disorder
  • No pain, weak strength = __________
  • Yes pain, weak strength = _________
A
  • normal
  • contractile tissue
  • nerve lesion, complete rupture (could still display pain via secondary muscle guarding or compensation*)
  • serious lesion, partial rupture (could also present as tendonitis)
65
Q

With palpation of a stationary joint, what do we want to look out for?

A
  • temperature
  • swelling
  • gaps (possible complete tear)
  • tenderness
  • pulsation
66
Q

With palpation of moving joints, what do we want to look out for?

A
  • crepitis (sign of arthritis; crunching in joint)
  • clicks (good if not painful)
  • end-feel
  • hypermobility
  • hypomobility
  • willingness to move
  • pain
67
Q

What if everything is negative for selective tissue tensioning?

A
  • a negative examination does not necessarily mean that an injury is absent
  • may be a problem in a neighboring tissue which was not systematically tested in examination
68
Q

What if the patient has very slight pain?

  • Examination can be totally ________
  • Palpation is very ________ in these cases
  • May ask patient to come back if symptoms return
  • May provoke signs by having the patient exercise sufficiently to produce ________
  • ________ is of great importance
A
  • negative
  • dangerous
  • symptoms
  • history
69
Q

What if the patient has very severe pain?

  • All of examination components may be _______
  • Hard for the patient to state accurately _______ and _____ pain is felt
  • __________ testing and its interpretation are also difficult, either because excessive physical signs are presented or because the patient cannot move and is opposed to carrying out certain maneuvers
  • _______ is of great importance
A
  • positive
  • where and when
  • functional
  • history
70
Q

Muscle or Tendon Strain, Tendonitis, or Possible Small Tear

-AROM: Likely limited due to ______ and/or _______, though may be able to move through full range, but with pain.

A

pain, weakness

71
Q

Muscle or Tendon Strain, Tendonitis, or Possible Small Tear

-PROM: if truly passive would have full pain free motion in all directions, EXCEPT direction which __________ involved area may be limited due to pain (empty end feel)

A

stretches

72
Q

Muscle or Tendon Strain, Tendonitis, or Possible Small Tear

-Isometric: likely ____ and _________ when testing involved area

A

weak and painful

73
Q

Muscle or Tendon Strain, Tendonitis, or Possible Small Tear

-Palpation: involved area painful to __________

A

palpation

74
Q

What 3 things are usually indicative of a muscle strain, tendonitis, or small tear?

A
  • hurt on contraction with resistance
  • hurt with stretch
  • hurt with palpation
75
Q

Muscle or Tendon Complete Tear

-AROM: Very limited due to weakness, likely not as much pain as seen with a partial tear, but much more _________

A

weakness

76
Q

Muscle or Tendon Complete Tear

-PROM: if truly passive would have full pain free motion in all directions, EXCEPT direction which stretches involved area may be limited due to pain (empty end feel) if there is muscle _________ in the area

A

guarding

77
Q

Muscle or Tendon Complete Tear

-Isometric: _________ weak

A

extremely

78
Q

Muscle or Tendon Complete Tear

-Palpation: Involved area _________ to palpation

A

painful

79
Q

Joint Capsule

-AROM: Limited, possibly painful at _____ranges*

A

end

80
Q

Joint Capsule

-PROM: Limited in _____ direction as AROM with a firm end feel, possibly painful at end ranges*

A

same

81
Q

Joint Capsule

-Isometrics: If done at mid range should not produce significant pain and should be strong; though may have pain due to __________ or ___________ of surrounding musculature

A

compensation or guarding

82
Q

Joint Capsule

-Palpation: Depends on depth of joint capsule, but more often than not ______ palpate deep enough to feel joint capsule though surrounding structures may also be inflamed and cause discomfort with palpation

A

cannot

83
Q

If AROM and PROM restrictions present with the capsular pattern, what are we suspicious of?

A

joint capsule (still can be joint capsule without a capsular pattern)

84
Q

Ligament Injury

-AROM: Full but pain at ___ range that stretches ligament

A

end

85
Q

Ligament Injury

-PROM: Full but pain at ___ range that stretches ligament

A

end

86
Q

Ligament Injury

-Isometrics: Strong and no pain when tested at mid range, unless there is ________ in the area

A

guarding

87
Q

Ligament Injury

-Palpation: Involved ligaments are ________ to palpation

A

painful

88
Q

What is Shoulder Adhesive Capsulitis?

A

Frozen Shoulder

-joint capsule around GH gets inflammed, then tightens and shrinks down after inflammatory phase

89
Q

Shoulder Adhesive Capsulitis

  • PROM and AROM _______ limited, for this condition it is often in a ________ pattern
  • Isometrics and Palpation: possible secondary pain with palpation and resistance due to possible muscle __________
A
  • equally, capsular

- guarding

90
Q

What is Patellar Tendon Tendonitis?

A

inflammation of patellar tendon

91
Q

Patellar Tendon Tendonitis

  • AROM: possible limited knee _________ due to pain if inflamed enough may be weak as well
  • PROM: Full all directions except likely pain with end range knee ________ possible limitation in end range knee flexion
  • Isometrics: resisted knee __________ painful possibly weak
  • Palpation: painful palpation of patellar tendon
A
  • extension
  • flexion
  • extension
92
Q

Lateral Ankle Sprains (ligaments)

  • AROM: pain into ______
  • PROM: pain into _______
  • Isometrics: if done in mid range, likely _______ and ____ free
  • Palpation: painful over _______ ligaments
A
  • inversion
  • inversion
  • strong and pain
  • lateral

Kinesiology (9 decks)

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