Mobilisation Flashcards
What are contraindications to joint mobilisations?
- Fractures
- Gross instability
- Metastases or other bone disease
- Joint infections / inflammation
- Spondylolisthesis
- Osteoporosis
- Serious spinal pathology (eg CES)
- Neurological disease or problems
- Complex Regional Pain Syndrome (CRPS)
What are the precautions of mobilisations?
- Pregnancy
- Severe pain
- History of trauma
- Rheumatoid Arthritis and other rheumatological conditions
What are the aims of mobilisation?
- Reduce pain
- Increase range of movement
- Improve function
- Improve compliance to other treatments
What is the concave-convex rule?
- When the concave bone moves; it moves in the same direction as the joint glide.
- When a convex bone moves, the glide is in the opposite direction to the bone movement.
What is some evidence for mobilisations?
- No evidence of negative effect.
- No evidence it increases patients reliance on passive treatment.
- Spinal mobilisations =similar/better outcomes compared to NSAIDS with fewer side effects.
- Posteroanterior (PA) mobilisations can reduce spinal stiffness and pain.
- Some evidence spinal mobilisations reduce pain and increase function in acute LBP, neck pain & persistent LBP.
- Spinal mobilisation can cause a normalisation of muscle function (but unclear whether this is associated with symptom reduction + the underlying mechanisms of action).
- Has short term effects on pain + joint mobility in patients with knee OA and following ankle inversion injuries.
What is some evidence against mobilisation?
- No difference has been demonstrated between manual therapy and other interventions for persistent LBP.
- Mobilisations had a minimal effect in reducing pain and no effect in reducing disability in patient with persistent LBP.
- Passive treatment which some clinician feel increases patient reliance on services (though there is no evidence to this effect).
- Some evidence that minor or major adverse effects can occur after manual therapy.
What is one of the largest predictors of mobilisation efficiency?
Patient expectations of treatment effectiveness is one of the largest predictors of outcome for both conservative and surgical management.
When is mobilisation most effective?
When used to modulate pain in conjunction with other modalities (e.g.: rehabilitation exercises and cognitive behavioural therapy).
What is grade 1 mobilisation?
Small amplitude movement at the beginning of the available range of movement
What is grade 2 mobilisation?
Large amplitude movement at within the available range of movement
What is grade 3 mobilisation?
Large amplitude movement that moves into stiffness or muscle spasm
What is grade 4 mobilisation?
Small amplitude movement stretching into stiffness or muscle spasm
What are the lower grades (1+ 2) of mobilisation used to do?
Used to reduce pain & irritability (use VAS + SIN scores)
What are the higher grades (3 + 4) of mobilisation used to do?
Used to stretch the joint capsule and passive tissues which support and stabilise the joint so increase range of movement
What are the different directions of mobilisation?
- Anterior-posterior (AP)
- Posterior-anterior (PA)
(E.g.: Femoral PA = Tibial AP) - Caudad (a direction towards the tail or lower body part)
- Cephalad (points towards the head or upper body part)
- Distractions
What is used to document mobilisation?
- Joint / bone / spinal level
- Grades (1-4, (or I, II, III, IV))
- Duration / number of mobilisations (2 minutes, 5 minutes, 30 x 5 etc)
- Direction (AP, PA, caudad, cephalad, distraction)
- Spinal (arrow to indicate movement)
E.g.: G3 AP mobilisation on tibia, 5 mins // inc DF Knee to wall 8cm (prev 6cm)
What are accessory mobilisations?
A mobilisation which the patient can not do themselves.
What are caudad mobilisations?
A mobilisation directed towards the feet.
What are Maitland grade 3-4 mobilisations?
A mobilisation designed to increase range of movement.
What are transverse mobilisations?
A mobilisation from a medial-lateral or lateral-medial direction.
What are Maitland grade 1-2 mobilisations?
A mobilisation designed to reduce pain.
What are cephalad mobilisations?
A mobilisation directed towards the head.
What are physiological mobilisations?
A mobilisation which follows normal movement patterns that the patient could perform themselves.
What are AP mobilisations?
A mobilisation from an anterior to posterior direction.
What are PA mobilisations?
A mobilisation from a postero-anterior direction.
True or false…
Mobilisations increase patient reliance on passive treatments.
False
True or false…
There is evidence that mobilisations can reduce pain and improve function in patients with acute lower back and neck pain.
True
True or false…
The neurophysiological model suggests that through central and peripheral mechanisms, a reduction in cytokine and substance P levels alongside associated hypoalgesia and changes in muscle activity are responsible for the positive effects of mobilisations.
True
