mobilization vs manipulation Flashcards
are mobilization and manipulation active or passive
Passive joint movement
What is mobilization
Passive joint movement to increase range or motion or decrease pain
What is manipulation
Passive joint motion to increase joint mobility and reduce pain
what is the main differences beween mobilization and manipulation?
Mobilization - varies speed and depth and can be resisted and it only goes to the elastic barrier, Manipulation is fast thrust that patient cant resist, going into the paraphysiological space
can mobilization of manipulation be controled by the patient?
mobilization , a patient can stop the movement
which one goes further?
manipulation goes to the pariphysiological space
what part of vertebrae plays major role in controling passive joint movement?
fascet joints, they resist torsion.
orientatio nof cervical fascets
45-parallel
direction of thorasic fascets
60 - 2o
direction of lumbar facets
90 - 90
what are the broad effects of mobilization?
Neurophysiological, Nutritional, mechanical,
Nutritional mobilization?
synovial fluid nurishing
mechanical mobilization
losens adhesions
neurophysiological mobilization?
stimulate proprioception inhibit nociception
goal of mobilization?
stimulate neurophysiological, nutritional and mechanical effects.
what are the 5 motions of mobilization?
roll, spin, slide, glide, distract/traction and compression
Rationale for mobilization
can break tissue adhesions, stretch tissue to help cause permanent changes in the plastic range
what is the type of movement for mobilization?
slow, small amplitude oscillations/traction
what is the roll and glide for convex on concave
glide occurs opposite that of roll so bone end stays in one place while rotating.
what is the roll and glide for concave on convex?
glide occurs in same diretion as roll, so bone sort of rolls around end
when saying convex on concave, what one is stationary?
the second one is stationary.
what joint mobilizations do not follow the convex-concave rule?
none, they all follow rule
what direction is joint restriction in convex on concave movement?
mobilization is in the same direction as restriction - slide tword tight capsule
what direction is joint restriction in the concave on convex
direction of restriction is opposite that of the direction its sliding/rolling
what are the rules?
Everyone relaxed with a stabalizing hand,
what must operator concider
direction of movement, velocity, and amplitude.
how many movements and joints are done at once?
only one at a time.
what bone is stabalized during manipulation?
the proximal one.
how should joint be positioned?
loose packed, open position, lax
How many maitland grades of oscillations?
five grades of oscilations.
what is grade 5 miatland?
small amp, high velocity thrust beyond end range - to decrease stiffnese.
what would grade II be used for?
to manage pain and spasm - mid range movement
what maitland grade levels go past tissue resistance, stretch?
three through 5
What type of movement is maitland?
oscillations
what grade maitland does cavitation and joint lube
grade 5
what should be treated first, pain or tightnes?
Pain should be treated first
how many oscilations per treatment? Maitland
2-3 oscilation 3-6 sets for 20-60 seconds
is tightness or pain treated more often?
Pain is treated daily while tighness is 3-4 times a week
what are small amplitude oscilations used for?
stimulate mechanoreceptors and limit pain perception
what does kaltenbord do?
combine traction with mobilization
what is kaltenborn used for?
decrease pain or reduce joint hypomobility
How many kaltenborn grades of traction?
three grades
Kaltenborn grade one?
loosen - pain relieve by reducing compression
Kaltenborn grade II?
tighten - eliminate play, to determine joint sensitivity
Kaltenborn grade III?
stretch - increase mobility
what kalten born grades are in available joint play
Kaltenborn I and II are in joint play, II goes into tissue resistantce and stretch.
How is kaltenborn applied, directionally
Traction is perpendindicular while gliding is parallel to treatment plane
how long do kaltenborn for pain or tightness?
pain: 1-2 minutes, tightness for 20-60 seconds
what kaltenborn do you used first to limit painful reaction?
grade I traction, then alternate with grade II.
what sort of things are contraindicated for mobilization?
malignancy, fractures or bone disease, inflammation that is acute, acute arthritis, vertebral artery disease, cauda equina lesions, nerve root involve, congenital abnormalities. Seroid use.
principles of gait analysis
feet upwards, patient should walk at normal speed. Follow up with other procedures.
what is gaits purpose?
to get from A to B efficiently while maintining equilibrium and bareing bodies weight.
what can effect gait pattern?
speed of gait
walking slowly
spread feet, less swing, shorter step, side to side body
walking fast
close feet, large swing, ling step, body foreward
what are the two main phases of gait?
stance 60% and swing at 40%
what are the 5 parts of stance phase?
Heel strike, foot flat, midstance, push off, heel off, and toe off
what are the 3 parts of swing phase?
acceleration, mid-swing and deceleration
how long is the gait cycle?
from the time the foot touches the grount till it touches it again
what is mid stance?
when body passes directly over the reference leg.
push off is made of what movements?
Heel off: where heel leaves the ground and Toe off: where only the toe is left in contact with ground
when does swing phase begin?
as soon as toe leaves ground
what happens to pelvis on side of swing leg>
Pelvis drops 5 degrees
how far does pelvis rotate?
it rotates 4 degress forward on side of swing leg
which way does pelvis shift laterally during walking?
Pelvis shifts laterally tword side of stance leg.
how far apart are the feet during walking?
2-4 inches between big toes
referred pain
percieved at site adjacent or distand from site of orgin
radiating pain
pain moves from original area outwarts to another part of body
radicular pain
pain along dermatomal distribution due to inflammation etc of nerve root
radiculopathy
spinal nerve root irritiation along distribution of a that leads to pain, numbness or muscle weakenss, muscle atrophy.
what can help diffierentiat the difference between musculoskeletal and visceral pain?
location, how patiet points to pain was there an injury, how did it start
how would a patient point to pain that may indicate visceral?
broad flat hand over large area rather than pointing with a finger.
is referred pain visceral or somatic?
either,
is musculoskeletal or visceral pain more likely to have identifiable mechanism?
musculoskeltal is more likely to have an identifiable mechanism.
what would and insidious onset of pain indicate>
degenerative or chronic
what would a sudden onset of pain indicate?
infectious
what ususally releaves musculoskeletal pain?
rest, specific positions, heat, cold massage etc.
what ususally aggrivates visceral pain?
related to stressing involved organ.
if pain was poorly localized, dull and assiociated with nausa and anxiety, what type would you expect it to be?
visceral pain, patology
what type of pain ususally has autonomic components?
somatic pain.
what could indicate injured muscle
pain with isometric contraction, contraction without movement
what could indicate injured ligament, muscel or tendon
pain with passibe stretch
pain with direct pressure?
muscle strain, trigger point
what would indicate ligamentous injury
pain with distraction
pain with compression?
cartilagenous injury
Painless crepitis indicates
degenerative joint disease or defomity
Painful drepitus
Degenerative joint disease
tenter areas with referred pain
trigger points
what is pain at rest along meridian at alarm point
deficient chi
tentderness along merician at alarm during palp
excessive chi
pain on either side of spinous process
joint dysfuncion
musculoskeletal diagnosis depends on what 4 things?
anatomy knowledge, history, observation and exam.
howwould you avoid overlooking anything ?
sequential approach to patient evaluation
what should you avoid doing while taking patient history
leading patient
why is asking age pertient
because speciifice diseases or impingments
what are the pertinent questions
age, occupation, hobbies, complaints mechanism of injury, predisposing factors, onset, timing, provokers, relievers., exact location
why does entire joint complex need examination with trauma?
injury to one side can lead to injury to another.
what sometimes makes chronic inflammation better?
activity
