Marking Points - Mobilising

Question 1

How many reps and sets for each exercise?

Answer 1

3 x 10-15 reps

multiple times a day

Question 2

How would 1st law be applied in mobilising?

Answer 2

Items at rest remain at rest.

Use momentum to make exercise easier - so to continue the exercise through range - no stopping or starting

Question 3

How would 2nd law be applied in mobilising?

Answer 3

Items moving slower require greater force - i.e. the law of acceleration.

Get the patient to move quickly through the range to make the movement easier or adding weight to long lever to increase momentum

Question 4

How would 3rd law be applied in mobilising?

Answer 4

Every action has an equal and opposite reaction.

Reducing friction will make the exercise easier.

Question 5

How is Hooke’s law applied in mobilising?

Answer 5

Taking joint structures - e.g. capsule and ligaments - through the elastic range past yeild point into plastic range

Question 6

What might be the causes of joint stiffness?

Answer 6

Immobilisation, soft tissue injury, pain limiting movement, connective tissue tightness

Question 7

what are the physiological changes to the collagen matrix during stiffness?

Answer 7

Decreased movement of the joint –> decreased fibre glide –> additional cross link formation–> decreased extensibility –> remodelling to new length –> decreasedROM

Question 8

what are the physiological changes to the articular cartilage during stiffness?

Answer 8

loss of matrix, proteoglycans and water.
Flaking of the articular cartilage surface.
Loss of cartilage thickness.

Reversible if less than 12 weeks of immobilisation.

Question 9

what are the physiological changes to the synovial fluid during stiffness?

Answer 9

decreased amount of synovial fluid, increased viscosity –> decreased movement of synovial fluid –> decreased nutrition of surface layers of cartilage

Question 10

what are the physiological changes to the ligaments during stiffness?

Answer 10

stress deprivation means the matrix is laid down in random manner –> reduction in tensile strength –> decreased ability to withstand load

Question 11

what are the physiological changes to the boneduring stiffness?

Answer 11

increased resorption of cancellous and compact bone after 8 weeks –> decreased bone mineral density –> decreased ability withstand stress –> increased fracture risk

Question 12

What is Hooke’s laws?

Answer 12

“The strain is proportional to the stress producing it, unless the elastic limit is exceeded, when permanent deformation will occur”.

Question 13

what occurs in the ‘toe’ region?

Answer 13

crimped fibres straighten out - little stress produces a large deformation

Question 14

what occurs during the ‘elastic’ region?

Answer 14

alignment of fibres which become longer and thinner - strain is put on cross links.
water is displaced - causing ‘creep’ phenomenon

removal of stress - return to original tissue length

Question 15

what occurs in the ‘plastic’ region?

Answer 15

microfailure of the tissue - causes breaking of the individual collagen fibres and cross links

leads to plastic deformation and overall increase in length

Question 16

What is the benefit of a sustained static stretch?

Answer 16

Takes movement beyond available range to get change in soft tissue length.

Must be sustained for at least 15 seconds with patient relaxed

• prior to exercise *
• Contraindicated in new injuries, elderly and corticosteroids *

Question 17

what is the physiological effect of accessory movement?

Answer 17

acts primarily on capsule and ligaments

increase length of collagen by causing micro failure in the plastic range

Question 18

what is the expected physiological response to treatment?

Answer 18

increased range of movement.

slight inflammation and healing by fibrosis and discomfort due to micro trauma

Question 19

How can mobilising exercises potentially relieve pain?

Answer 19

Pt likely to be experiencing pain from nociceptors - travel down C fibres (inflammation) - enters spinal cord via Lamina 2 and synapses with WDR in lamina 5 via interneurone.

During mobilising, we are activating Adelta fibres via proprioceptors and touch/pressure receptors - enter the spinal cord via lamina 5 to the WDR.

The WDR preferentially transmit non-noxious stimuli, and therefore inhibit transmission of noxious stimuli

By activating Ad fibres, we reduce signals from C fibres and therefore reduce pain experienced by pt.

Question 20

what are the 6 therapeutic principles which increase engagement?

Answer 20

• use of targets to get end of range
• motivation through voice
• competition with self
• variety and individuality (using interests)
• instruction and demo
• explanation of benefits

Question 21

what are the key practical considerations for mobilisations?

Answer 21

• appropriate undress
• optimal starting position
• supporting pt to ensure safety
• use pillows effectively for comfort

Question 22

how to appropriately progress a mobilising program?

Answer 22

• go further into plastic range - move target further away
• increase amplitude of movement - i.e. increase weight, acceleration
• push for 30s at end of range