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Biomechanics > Manipulation and Mobilization > Flashcards

Manipulation and Mobilization Flashcards

1
Q

Manipulation vs Mobilization

A

Manipulation: more aggressive, quick thrust involved; technically, little can be done to stop the eternal force once it has been initiated
Mobilization: more gentle; technically, the external force can be stopped

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2
Q

Biomechanical Model for Joint Manipulation and Mobilization (Generally)

*Biomechanics is a model, not the truth, that helps us to understand what is happening in the body

A
  • biomechanical principles can be used to explain joint dysfunction
  • biomechanical information can be linked with neurophysiology to explain the role of joint dysfunction in pain and altered physiological function
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3
Q

What 2 models are used as Biomechanical approaches to joint assessment?

A
  • Static model

* Dynamic model

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4
Q

Describe the Static Model.

How can malpositions be identified?

A

The static model has a structural emphasis … “bone out of place”
• alterations in the position of adjacent bones create changes in the mechanical and neurological function of a joint
• based on the idea of “structure determines function” …
- static position determines how well a joint functions

malposition is determined by …

  • static palpation
  • markings on x-rays
  • special instruments … thermography, electromyograhy, etc.
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5
Q

limitations to static assessment include:

A
  • incorrect assessment due to bony anomalies
  • may have good static alignment but have faulty joint function (movement)
  • joints may be compensating for biomechanical faults elsewhere and falsely identified as the problem
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6
Q

advantages of static assessment include:

A
  • used in acute conditions when moving the body would be too painful
  • can be used in areas where limited motion exists
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7
Q

Define the Dynamic Model.

How are restrictions determined?

A

The Dynamic Model has a functional emphasis … “loss of motion”
• alterations in motion of adjacent bones create altered mechanical and neurological function of a joint. Muscles and ligaments contribute to the cause of the altered motion (mechanical derangement)
• Main idea: function is often more significant than structure
–> a mobile joint (free of restrictions) is a healthy joint

Restriction is determined by:

  • motion palpation … looking for quality and quantity of motion
  • posture and gait analysis
  • motion x-rays (standard side view, chin tucked, head extended)
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8
Q

limitations to dynamic assessment include:

A
  • lack of consistent interexaminer reliability
  • less helpful in acute painful conditions and areas with limited motion
  • may overlook postural stresses …poor posture, but normal joint movement
  • motion may be limited by coexisting disease (normal motion is altered)
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9
Q

advantages of dynamic assessment include:

A
  • identifies components that become dysfunctional i.e., joint, soft tissues
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10
Q

Naturopathic Technique

A

Integrates structural (static) and functional (dynamic) analysis

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11
Q

“malposition of a bone”

A

refers to a static finding

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12
Q

“restriction of joint motion”

A

is a dynamic finding

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13
Q

Joint Dysfunction

A

A diagnostic term
• joint mechanics showing disturbances of function without structural or positional change … a subtle mechanical joint alteration affecting quality and range of motion

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14
Q

Joint Fixation

A

a physical exam finding
• an articulation that has become temporarily immobilized in a position that it would normally occupy during any phase of movement
• an articulation that is immobilized in a position of movement when the joint is at rest, or in a position of rest when the joint is in movement

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15
Q

Joint Restriction

A

physical exam finding
• limitation of movement … describes the direction of limited movement in a dysfunctional joint

Example … a vertebra that does not rotate to the right has a “Right Rotation Restriction”

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16
Q

3 Causes of Joint Dysfunction

A

Mechanical, Chemical and Psychological Stress

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17
Q

Mechanical cause of joint dysfunction

A
  • macrotrauma … a single traumatic event
  • microtrauma … repetitive minor cumulative trauma (more common)
  • postural … habitual sedentary posture or continuous faulty posture
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18
Q

Chemical cause of joint dysfunction

A
  • exposure to toxins from the environment, food, water
  • hormonal, inflammatory, auto-immune, chemical stressors
  • reflex interaction … somato-visceral, viscero-somatic, viscero-viceral reflexes
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19
Q

Psychological Stress

A
  • mental, emotional, psychological, spiritual stress

* psycho-somato-visceral reflexes

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20
Q

Identifying Joint Dysfunction… P.A.R.T.S.

THE EVIDENCE GATHERED TO SUPPORT DIAGNOSIS

A

P - Pain or tenderness

A Asymmetry of joint components

R Range of motion

T Tone, texture and temperature changes in specific soft tissues

S Special tests or procedures … orthopedic tests and challenges

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21
Q

P of PARTS - Pain or tenderness

A

Pain or tenderness produced by palpation and pressure over specific structures and soft tissues
ASK: location, quality (burning, tingling, throbbing), intensity
• static palpation
• motion palpation

22
Q

A of PARTS - asymmetry

A

Asymmetry of joint components identified by static palpation
–> two bones not lined up; the way they are holding their body is not symmetric
• bony landmarks
• muscle tone

23
Q

R of PARTS - Range of motion

A

decrease or loss of specific movements identified through motion palpation or global range of motion
• may be active, passive or accessory movements

24
Q

T of PARTS - Tone, Texture and Temperature changes

A

Tone, texture and temperature changes in specific soft tissues identified with palpation … warmth, puffiness, fibrous, nodular, ropey, hypertonic, induration, contracture

25
S of PARTS - Special tests or procedures
orthopedic tests and challenges
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Assessment of Joint Dysfunction
- Inspection/Observation - Palpation • Static palpation • Motion palpation - Range of Motion • Global range of motion (osteokinematics) • Articular range of motion (arthrokinematics) - End-feel - Naming the joint dysfunction ... Listing • Static Listings • Motion Listings (dynamic)
27
Inspection/Observation
* superficial ...size, shape, skin, cuts, bruises, swelling, scars, moles, etc * posture * gait
28
Palpation
• static palpation ... assessment of somatic structures in a neutral state • motion palpation ... assessment of passive and active segmental joint range of motion - quantity - quality - joint play - end-feel - symptoms
29
Methods to measure Global Range of Motion:
* goniometry: limited to extremity joints (goniometer) | * inclinometry: standard for spinal measurements (inclinometer)
30
Define Active Range of Motion (AROM).
movement accomplished without outside assistance ... the patient moves the part him/herself • physiological movements ... osteokinematics
31
Define Passive Range of Motion (PROM).
movement which is carried through by the operator without conscious assistance or resistance by the patient --> stopped by the elastic range
32
Define Physiological Barrier.
the end point of active joint movement
33
Define Joint Play
discrete, short range movement of a joint independent of the action of voluntary muscles, determined by springing a bone of an articulation in a neutral position
34
Define End-feel (end play)
discrete, short range movement of a joint independent of the action of voluntary muscles, determined by springing a bone of an articulation at the limit of its passive range of motion
35
Define Elastic Barrier
the elastic resistance that is felt at the end of passive range of motion ... further motion toward the anatomic barrier may be induced passively by the examiner
36
Define Paraphysiological Space .
area of increased movement beyond the elastic barrier available after a cavitation within the joint’s elastic range
37
Define Anatomic Limit .
the limit of anatomical integrity ... the limit of motion imposed by anatomical structures. Forcing movement beyond this barrier would produce tissue damage (joint trauma).
38
Assessment of Joint Dysfunction
Interpretation of Joint Motion
39
Interpretation of Joint Motion ...
* each joint has a characteristic end-feel | * a normal end-feel at one joint may be a pathological end-feel at another
40
Types of End-feel
* Capsular * Ligamentous * Soft tissue approximation * Bony * Muscular
41
• Capsular End Feel
firm, but giving; resistance builds with lengthening, like stretching a piece of leather - Normal ... external rotation of the shoulder - Abnormal ... capsular fibrosis and adhesions
42
• Ligamentous End Feel
like capsular, but may have a slightly firmer quality - Normal ... knee extension - Abnormal ... resistance as a result of ligamentous shortening
43
• Soft tissue approximation
giving, squeezing quality ... results from the approximation of the soft tissue ... typically painless - Normal ... elbow flexion - Abnormal ... muscle hypertrophy, soft tissue swelling 
44
Bony End Feel
• Bony ... hard, non-giving abrupt stop
45
Muscular End Feel
• Muscular ... firm but giving, builds with elongation ... not as stiff as capsular or ligamentous
46
Types of End Feel in ONLY abnormal conditions
* Muscle spasm * Interarticular * Empty
47
• Muscle spasm
.guarded ... resisted by muscle contraction... end-feel cannot be assessed because of pain and/or guarding - Abnormal ... protective muscle splinting that is a result of joint or soft tissue disease or injury
48
• Interarticular
bouncy springy quality | - Abnormal ... meniscal tear, joint mice
49
• Empty
normal end-feel resistance is missing ... end-feel is not encountered at the normal point and/or the joint demonstrates unusual give or deformation - Abnormal ... joint injury or disease leading to hyper-mobility or instability
50
Listings How do you acknowledge peripheral joints? vertebrae?
• the term “listing” refers to a description of the manner in which the joint is dysfunctional ... naming and recording joint abnormalities • a listing can be either static or motion (dynamic) - peripheral joints ... name the position of the most moveable bone - for vertebrae ... name the upper vertebra relative to the lower one of the motion segment (two adjacent vertebra and the soft tissues that connect them)
51
Static Listings
* based on findings from static palpation and x-ray markings * uses standard joint motion terminology to describe the position of the joint • uses the term “malposition” at the end of the phrase * to label a static malposition, determine the anatomical position of the bone and add the term “malposition”
52
Motion Listings (dynamic)
* based on findings from motion palpation or dynamic x-ray markings * uses standard joint motion terminology to describe the direction the joint will not move or has lack of springy end-feel * uses the term “restriction” at the end of the phrase * to label a motion restriction, determine the direction the joint will not move and add the term “restricted”

Biomechanics (6 decks)

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