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Biomechanics Final > Manipulation and Mobilization > Flashcards

Manipulation and Mobilization Flashcards

1
Q

What are two biomechanical approaches to jiont assessment?

A

static and dynamic models

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2
Q

What is the static model to manipulation?

A

structure determines function- idea that alterations in the position of bones creates changes in mechanical and neurological function of a joint

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3
Q

What are some limitations to the static model?

A

incorrect assessment from bony anomalies
faulty movement can occur even with good static alignment
may result in the wrong joint being assessed if the problem is elsewhere

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4
Q

What are some advantages of the static approach?

A

good in acute conditions when moving the body is painful

can be used in areas where limited motion exists

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5
Q

What is the dynamic model to manipulation?

A

function more significant than structure and is determined by bony alignment as well as muscle and ligament alignment

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6
Q

What are some limitations to dynamic assessment?

A

lack of consistent interexaminer reliability
may overlook postural stresses
motion may be limited by disease
less helpful in acute conditions

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7
Q

What are advantages to the dynamic assessment?

A

indentifies components that become dysfunctional

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8
Q

What is the naturopathic manipulative therapeutics approach?

A

integrates static (structural- eg. bone malposition) and dynamic (functional- eg. joint restriction) analysis

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9
Q

What is a joint dysfunction?

A

joint mechanics showing disturbances of function without structural or positional change- a subtle mechanical joint alteration affecting quality and ROM

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10
Q

What is a joint fixation?

A

an articulation that has become temporarily immobilized in a position that it would normally occupy during any phase of movement (either at rest or in movement)

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11
Q

What is joint restriction?

A

limitation of movement in a dysfunctional joint.

eg: a vertebra that doesnt rotate right has a “right rotation restriction”

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12
Q

What are three causes of joint dysfunction?

A 
mechanical (macro/microtrauma/postural)
chemical (toxin, hormonal, reflex interaction)
psychological stress (mental, emotional, psycho-somatic-visceral reflexes)
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13
Q

What does PARTS stand for?

A

Pain/Tenderness
Asymmetry of joint components (via palpation)
ROM
Tone, texture, temperature changes in soft tissue
Special tests/procedures

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14
Q

What are the four steps in assessing joint dysfunction?

A

inspection/observation
palpation (static and motion palpation)
ROM (global, articular and end-feel)
Naming the joint dysfunction (static and motion listings)

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15
Q

What are things to look for during the inspection/observation when assessing joint dysfunction?

A

posture, gait

superficial (size, shapde, skin cuts, brusies, swelling, scars, moles, etc)

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16
Q

What is static palpation?

A

assessment of somatic structures in a neutral state.

soft tissues- muscle, tendon, ligament, bone, dermal and subdermal

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17
Q

What is motion palpation?

A

assessment of passive and active segmental joint ROM

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18
Q

What are 5 things to look for during motion palpation?

A 
quantity of movement (how far?)
quality of movement
joint play
end-feel
symptoms
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19
Q

What are two ways of assessing global motion? What are they specific for?

A

goniometry (limited to extremity joints)

inclinometry (standard for spinal measurements)

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20
Q

What is active ROM?

A 
movement accomplished without outside assistance. the patient moves the part him/herself.
physiological movements (osteokinematics)
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21
Q

What is passive ROM?

A

movement which is carried out by the operator without conscious assistance or resistance by the patient

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22
Q

What is a physiological barrier?

A

the end point of active joint movement

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23
Q

What is joint play?

A

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

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24
Q

What is end-feel/end-play?

A

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 ROM

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25
Q

What are three characteristics of articular ROM?

A

elastic barrier
paraphysiological space
anatomic limit

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26
Q

What is an elastic barrier?

A

the elastic resistance that is felt at the end of passive ROM. further motion toward the anatomic barrier may be induced passively by the practitioner

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27
Q

What is paraphysiological space?

A

the area of increased movement beyond the elastic barrier available after a cavitation within the joints elastic range

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28
Q

What is the anatomic limit?

A

the limit of anatomical integrity, limit of motion imposed by anatomical structures.
forcing movement beyond this barrier would produce tissue damage (joint trauma)

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29
Q

What are 8 types of end-feel?

A 
capsular, 
ligamentous
soft tissue approximation
bony 
muscular
muscle spasm
interarticular
empty
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30
Q

What is capsular end-feel? give a normal and abnormal example

A

firm but giving, resistance builds with lengthening (like leather)
normal : shoulder external rotation
abnormal: capsular fibrosis/adhesions

31
Q

What is ligamentous end-feel? give a normal and abnormal example

A

like capsular but may have a firmer quality

normal: knee extension
abnormal: resistance as a result of ligamentous shortening

32
Q

What is soft-tissue approximation end-feel? give a normal and abnormal example.

A

giving, squeezing quality, typically painless

normal: elbow flexion
abnormal: muscle hypertrophy/soft tissue swelling

33
Q

What is bony end-feel? give a normal and abnormal example.

A

hard, non-giving, abrupt stop

normal: elbow extension
abnormal: bony extosis, articular hypertrophic changes

34
Q

What is muscular end-feel? give a normal example

A

firm but giving, builds with elongation. not as stiff as ligamentous or capsular
normal:hip flexion

35
Q

What is muscle spasm end-feel? give an abnormal example

A

guarded, resisted by muscle contraction- endfeel cannot be assessed.
abnormal: protective muscle splinting as a result of joint or soft tissue disease or injury

36
Q

What is interarticular end-feel? give and abnormal example

A

bouncy, springy quality

eg: meniscal tear/ joint mice

37
Q

What is empty end-feel? give an example

A

normal endfeel resistance is missing

joint injury/disease leading to hypermobility or instability

38
Q

What does the term “listing” mean?

A

a description of the manner in which the joint is dysfunctional- naming and recording abnormalities (can be either static or dynamic)

39
Q

How do we list peripheral joints?

A

name the position of the most moveable bone

40
Q

How do we list vertebrae?

A

name the upper vertebra relative to the lower one of the motion segment

41
Q

How do we make a static listing?

A

based on static palpation and xray findings
describe the position of the joint, uses ‘malpositon’ at the end of the phrase
eg: “right lateral flexion malposition”

42
Q

How do we make dynamic listings?

A

based on motion palpation and dynamic xrays
determine the direction the joint will not move in, add the term restricted
eg: right rotation restricted

43
Q

What is manipulation?

A

passive joint movement for increasing joint mobility and reducing pain
uses a high velocity, low amplitude thrust that is beyond patients control applied at the end of the elastic barrier into the paraphysiological space

44
Q

What is mobilization?

A

passive joint movement for increasing ROM and decreasing pain. light force applied that a patient can stop, applied from resting position to the elastic barrier

45
Q

How are the cervical facet joints oriented?

A

45 deg transverse, parallel to frontal

46
Q

How are the thoracic facet joints oriented?

A

60 deg transverse, 20 degrees frontal

47
Q

How are the lumbar facet joints oriented?

A

90 deg transverse, 90 deg frontal

48
Q

What are three effects of mobilization?

A

neurophysiological, nutritional and mechanical

49
Q

What are five motions used for mobilization?

A

roll, spin, slide/glide, distraction/traction, compression

50
Q

If a convex surface is moving on a stationary concave surface, gliding occurs in the______ (same/opposite) direction of roll. mobilization is in the ________(same/opposite) direction of roll.

A

gliding occurs in the opposite direction

mobilization occurs in the same direction

51
Q

If a concave joint is moving on a stationary convex surface, gliding occurs in the _________(same/opposite) direction of roll. mobilization occurs in the _________ (same/opposite) direction of roll.

A

gliding in the same direction,

mobilization occurs in the opposite direction

52
Q

What are three general rules for mobilization techniques?

A

the patient must be relaxed
the operator must be relaxed
one hand will usually stabilize while the other hand performs the movement

53
Q

What are three things that the operator must consider when doing mobilization techniques?

A

direction of movement
velocity of movement (slow stretch for large capsules, faster oscillation for minor degree restrictions)
amplitude of movement

54
Q

In mobilization, which bone is stabilized, the proximal or distal one?

A

proximal bone

55
Q

What is a Maitland Grade 1 oscillation? What is it used for?

A

small-amplitude movement at the beginning of ROM

used to manage pain and spasm

56
Q

What is Maitland Grade 2 oscillation? What is it used for?

A

large-amplitude movement between beginning and mid ROM

used to manage pain and spasm

57
Q

What is Maitland Grade 3 oscillation? What is it used for?

A

large-amplitude movement reaching limit of available ROM

used to increase ROM and decrease stiffness

58
Q

What is Maitland Grade 4 oscillation? What is it used for?

A

small amplitude movement at end of available ROM

used to increase ROM and decrease stiffness

59
Q

What is Maitland Grade 5 oscillation? What is it used for?

A

small amplitude, high-velocity thrust beyond end ROM

used to increase ROM, decrease pain and decrease stiffness

60
Q

What are some (4) physiological effects of Grade 1-3 oscillations?

A 
neurophysiological effect (muscle tone, axoplasmic flow)
stimulate mechanoreceptors
vascular effect
mechanical effect (collagen, joint lubrication, neuromeningeal tissue)
61
Q

What are some physiological effects of Grade 4 mobilization?

A

same as grade 1-3, with greater
mechanical mobilizing effect
enhanced joint lubrication

62
Q

What are some physiological effects of Grade 5 mobilization?

A 
as per Grades 1-4, with greater:
mobilizing effect,
neurophysiological effect,
cavitation,
enhanced joint lubrication
63
Q

For Maitland oscillations, what is the recommended oscillations/second and # of sets of oscillations?

A

2-3 oscillations per second

3-6 sets of oscillations

64
Q

What is the recommended Maitland treatment for tightness (hypomobility) of a joint? Is this the same for Kaltenborn techniques?

A

20-60 seconds of oscillations
Grades 3-4
3-4 times per week
same for Kaltenborn technique

65
Q

What is the recommended Maitland treatment for pain?

Is this the same for the kaltenborn technique?

A

1-2 minutes of oscillations
Grades 1-2
treated daily
same for kaltenborn technique

66
Q

What should be treated first, pain or hypomobility?

A

pain

67
Q

What is the Kaltenborn technique? What is it used for?

A

combines traction and mobilization, applied in a perpendicular plane.
used to decrease pain or increase joint hypomobility

68
Q

What is Grade 1 Kaltenborn traction? What does it do?

A

LOOSEN: neutralizes pressure in the joint without actual surface separation.
produces pain relief by reducing compressive forces

69
Q

What is Grade 2 Kaltenborn traction? What is it used for?

A

TIGHTEN/TAKE UP SLACK: separates articulating surfaces, taking up slack or eliminating play within joint capsule, up to tissue resistance.
used initially to determine joint sensitivity

70
Q

What is Grade 3 Kaltenborn traction? What is it used for?

A

STRETCH: involves stretching of soft tissue surrounding a joint past tissue resistance
used to increase mobility

71
Q

In the Kaltenborn technique, traction in applied _____ and gliding is applied ______ to the treatment plane (parallel/perpendicular).

A

traction is applied perpendicular

gliding is applied parallel

72
Q

How might one use the kaltenborn technique?

A

Grade 1 to start, reduce chance of painful reaction
10 second intermittent Grade 2 traction
distract with grade 3 and release
allow for return to resting position

73
Q

What are some contraindications to mobilization and manipulation?

A

malignancy, fracture/dislocation, active bone disease, acute inflammation, acute infection, acute arthritis, vertebral artery disease, ligamentous instability, cauda equina lesions, spinal cord lesions, multiple nerve root involvement, anticoagulant/steroid usage, congenital abnormalities

Biomechanics Final (4 decks)

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