Manipulation and Mobilization Flashcards
What are two biomechanical approaches to jiont assessment?
static and dynamic models
What is the static model to manipulation?
structure determines function- idea that alterations in the position of bones creates changes in mechanical and neurological function of a joint
What are some limitations to the static model?
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
What are some advantages of the static approach?
good in acute conditions when moving the body is painful
can be used in areas where limited motion exists
What is the dynamic model to manipulation?
function more significant than structure and is determined by bony alignment as well as muscle and ligament alignment
What are some limitations to dynamic assessment?
lack of consistent interexaminer reliability
may overlook postural stresses
motion may be limited by disease
less helpful in acute conditions
What are advantages to the dynamic assessment?
indentifies components that become dysfunctional
What is the naturopathic manipulative therapeutics approach?
integrates static (structural- eg. bone malposition) and dynamic (functional- eg. joint restriction) analysis
What is a joint dysfunction?
joint mechanics showing disturbances of function without structural or positional change- a subtle mechanical joint alteration affecting quality and ROM
What is a joint fixation?
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)
What is joint restriction?
limitation of movement in a dysfunctional joint.
eg: a vertebra that doesnt rotate right has a “right rotation restriction”
What are three causes of joint dysfunction?
mechanical (macro/microtrauma/postural) chemical (toxin, hormonal, reflex interaction) psychological stress (mental, emotional, psycho-somatic-visceral reflexes)
What does PARTS stand for?
Pain/Tenderness
Asymmetry of joint components (via palpation)
ROM
Tone, texture, temperature changes in soft tissue
Special tests/procedures
What are the four steps in assessing joint dysfunction?
inspection/observation
palpation (static and motion palpation)
ROM (global, articular and end-feel)
Naming the joint dysfunction (static and motion listings)
What are things to look for during the inspection/observation when assessing joint dysfunction?
posture, gait
superficial (size, shapde, skin cuts, brusies, swelling, scars, moles, etc)
What is static palpation?
assessment of somatic structures in a neutral state.
soft tissues- muscle, tendon, ligament, bone, dermal and subdermal
What is motion palpation?
assessment of passive and active segmental joint ROM
What are 5 things to look for during motion palpation?
quantity of movement (how far?) quality of movement joint play end-feel symptoms
What are two ways of assessing global motion? What are they specific for?
goniometry (limited to extremity joints)
inclinometry (standard for spinal measurements)
What is active ROM?
movement accomplished without outside assistance. the patient moves the part him/herself. physiological movements (osteokinematics)
What is passive ROM?
movement which is carried out by the operator without conscious assistance or resistance by the patient
What is a physiological barrier?
the end point of active joint movement
What is 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
What is 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 ROM
What are three characteristics of articular ROM?
elastic barrier
paraphysiological space
anatomic limit
What is an elastic barrier?
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
What is paraphysiological space?
the area of increased movement beyond the elastic barrier available after a cavitation within the joints elastic range
What is the anatomic limit?
the limit of anatomical integrity, limit of motion imposed by anatomical structures.
forcing movement beyond this barrier would produce tissue damage (joint trauma)
What are 8 types of end-feel?
capsular, ligamentous soft tissue approximation bony muscular muscle spasm interarticular empty
What is capsular end-feel? give a normal and abnormal example
firm but giving, resistance builds with lengthening (like leather)
normal : shoulder external rotation
abnormal: capsular fibrosis/adhesions
What is ligamentous end-feel? give a normal and abnormal example
like capsular but may have a firmer quality
normal: knee extension
abnormal: resistance as a result of ligamentous shortening
What is soft-tissue approximation end-feel? give a normal and abnormal example.
giving, squeezing quality, typically painless
normal: elbow flexion
abnormal: muscle hypertrophy/soft tissue swelling
What is bony end-feel? give a normal and abnormal example.
hard, non-giving, abrupt stop
normal: elbow extension
abnormal: bony extosis, articular hypertrophic changes
What is muscular end-feel? give a normal example
firm but giving, builds with elongation. not as stiff as ligamentous or capsular
normal:hip flexion
What is muscle spasm end-feel? give an abnormal example
guarded, resisted by muscle contraction- endfeel cannot be assessed.
abnormal: protective muscle splinting as a result of joint or soft tissue disease or injury
What is interarticular end-feel? give and abnormal example
bouncy, springy quality
eg: meniscal tear/ joint mice
What is empty end-feel? give an example
normal endfeel resistance is missing
joint injury/disease leading to hypermobility or instability
What does the term “listing” mean?
a description of the manner in which the joint is dysfunctional- naming and recording abnormalities (can be either static or dynamic)
How do we list peripheral joints?
name the position of the most moveable bone
How do we list vertebrae?
name the upper vertebra relative to the lower one of the motion segment
How do we make a static listing?
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”
How do we make dynamic listings?
based on motion palpation and dynamic xrays
determine the direction the joint will not move in, add the term restricted
eg: right rotation restricted
What is manipulation?
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
What is mobilization?
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
How are the cervical facet joints oriented?
45 deg transverse, parallel to frontal
How are the thoracic facet joints oriented?
60 deg transverse, 20 degrees frontal
How are the lumbar facet joints oriented?
90 deg transverse, 90 deg frontal
What are three effects of mobilization?
neurophysiological, nutritional and mechanical
What are five motions used for mobilization?
roll, spin, slide/glide, distraction/traction, compression
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.
gliding occurs in the opposite direction
mobilization occurs in the same direction
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.
gliding in the same direction,
mobilization occurs in the opposite direction
What are three general rules for mobilization techniques?
the patient must be relaxed
the operator must be relaxed
one hand will usually stabilize while the other hand performs the movement
What are three things that the operator must consider when doing mobilization techniques?
direction of movement
velocity of movement (slow stretch for large capsules, faster oscillation for minor degree restrictions)
amplitude of movement
In mobilization, which bone is stabilized, the proximal or distal one?
proximal bone
What is a Maitland Grade 1 oscillation? What is it used for?
small-amplitude movement at the beginning of ROM
used to manage pain and spasm
What is Maitland Grade 2 oscillation? What is it used for?
large-amplitude movement between beginning and mid ROM
used to manage pain and spasm
What is Maitland Grade 3 oscillation? What is it used for?
large-amplitude movement reaching limit of available ROM
used to increase ROM and decrease stiffness
What is Maitland Grade 4 oscillation? What is it used for?
small amplitude movement at end of available ROM
used to increase ROM and decrease stiffness
What is Maitland Grade 5 oscillation? What is it used for?
small amplitude, high-velocity thrust beyond end ROM
used to increase ROM, decrease pain and decrease stiffness
What are some (4) physiological effects of Grade 1-3 oscillations?
neurophysiological effect (muscle tone, axoplasmic flow) stimulate mechanoreceptors vascular effect mechanical effect (collagen, joint lubrication, neuromeningeal tissue)
What are some physiological effects of Grade 4 mobilization?
same as grade 1-3, with greater
mechanical mobilizing effect
enhanced joint lubrication
What are some physiological effects of Grade 5 mobilization?
as per Grades 1-4, with greater: mobilizing effect, neurophysiological effect, cavitation, enhanced joint lubrication
For Maitland oscillations, what is the recommended oscillations/second and # of sets of oscillations?
2-3 oscillations per second
3-6 sets of oscillations
What is the recommended Maitland treatment for tightness (hypomobility) of a joint? Is this the same for Kaltenborn techniques?
20-60 seconds of oscillations
Grades 3-4
3-4 times per week
same for Kaltenborn technique
What is the recommended Maitland treatment for pain?
Is this the same for the kaltenborn technique?
1-2 minutes of oscillations
Grades 1-2
treated daily
same for kaltenborn technique
What should be treated first, pain or hypomobility?
pain
What is the Kaltenborn technique? What is it used for?
combines traction and mobilization, applied in a perpendicular plane.
used to decrease pain or increase joint hypomobility
What is Grade 1 Kaltenborn traction? What does it do?
LOOSEN: neutralizes pressure in the joint without actual surface separation.
produces pain relief by reducing compressive forces
What is Grade 2 Kaltenborn traction? What is it used for?
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
What is Grade 3 Kaltenborn traction? What is it used for?
STRETCH: involves stretching of soft tissue surrounding a joint past tissue resistance
used to increase mobility
In the Kaltenborn technique, traction in applied _____ and gliding is applied ______ to the treatment plane (parallel/perpendicular).
traction is applied perpendicular
gliding is applied parallel
How might one use the kaltenborn technique?
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
What are some contraindications to mobilization and manipulation?
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
