Mobs and spinal worksheet Flashcards
techniques where by the pt is taught to apply joint mobilization techniques to restricted joints using proper gliding techniques.
Self-mobilization
The concurrent application of sustained accessory mobilization applied by a therapist and an active physiolgical movement to end range applied by the pt
Mobilization with movement (MWM)
Movements the pt can do voluntarily.
ex: flex, abd, rotation,
Physiological movement
When motions of the bone are described (flex, ext, abd, etc..)
Osteokinemetics
movements in the joints and surrounding tissues that are necessary for normal ROM but that cannot be actively performed by the pt.
Accessory movements
These are motions that accompany active motions but are not under voluntary control. This term is often used synomously with acessory movement.
component motions
the motion that occurs between the joint surfaces and also the distance ability or give in the joint capsule which allows for bones to move.
joint play
Refers to high velocity short amplituded techniques. It is performed at the end of the pathological limit of the joint and is intented to alter positiional relationships, snap adhesions, or stimulate joint receptors.
Thrust
A procedure used to restore full ROM by breaking adhesions around the joint while the pt is anestheized.
The technique may be a rapid thrust or a passive stretch using physiological or accessory movements.
Manipulation under anethesia
- this technique requires the therapists to provide stabalization on the segment on which the distal aspect of the muscle attaches. A command for an isometric contraction is given that causes accessory movement of the joint.
- an active contraction of deep muscles that attach near the joint and whos line of pull can cause the desired accessory motion.
muscle energy techniques
(hold relax)
small amplitude rythmic oscillation are perform at the beginning of the range. The are usally rapid like manuel vibrations.
Oscillation grade I
Large amplitude rythmic oscillations are performed within the range, not reaching the limit. The are usually performed for at 2 to 3 per second for 1 to 2 minutes.
Oscillation grade II
Large amplitude rythmic oscillations are performed up to the limit of the available motion and are stressed into the tissue resistance.
they are usually performed for 2 to 3 secs for 1 to 2 mins
Oscillation Grade III
Small amplited rythmic oscillations are performed at the limit of the available motion and stressed into the tissue resistance.
They are usually rapid oscillations like manuel vibrations.
Oscillation grade IV
What joints are used for treating joints limited by pain or muscle guarding and help move synovial fluid to improve nutrition to the cartilage.
Oscillations grade I and II
What grades of oscillations are primarily used as a stretching maneuver.
Oscillations Grade III and IV
Vary the speed of oscillation for different effects
such as _________ and __________ to inhibit pain or
__________to relax muscle guarding.
Low amplitude
High speeds
; slow speeds
small amplitude distraction is applied when no stress is placed on the capsule. It equalizes (or elephants or perhaps anything that starts with an E) coehesive forces, muscle tension ,and atmospheric pressure acting on the joints.
Sustained joint play grade I
enough destraction or glide is applied to tighten the tissues around the jt. (“taking up the slack”)
sustained jt play grade II
a distraction or glide is applied with an amplitude large enough to place stretch on the jt capsule and surrounding perriarticular structures.
sustained jt play grade III
a perment or transient limitation of movment or shortening of the muslcle or other soft tissues
contracture
how do jt mobs differ from other forms of passive or self stretching?
they specifically address restricted capsular tissue
A joint end feel that is sudden, hard , and non-yeilding sensation felt at the end of Motion. generally not painfull.
Ex: elbow ext
Bone to Bone end feel or “Firm”
The joint end feel is characterized by a yeilding compression. This end-feel results from muscular tissue compression during jt flexion.
soft-tissue approximation
this end-feel is most the most common normal end feel and is characterized as elastic resistance or rising tension.
hard or tissue stretch end feel
this abnormal end feels major component is pain accompanied by a sudden halt of movment that prevents full ROM
muscle spasms
this abnomal end feel is characterized by full motion being limited by a soft or springy sensation occaionally accompanied by pain.
springy black or internal derangement
this end feel is characterized by by motion being very limited by significant pain without without muscle spasm. clinically this is not characterized by any mechanical block or restriction
empty end feel
this end feel is charcterized by jt hypermobility with no resistance typically felt at the end ROM.
loose end feel
abnormal end feel that is analogous to a normal stretch, but the elastic resistance is encountered before the normal ROM
capsular end feel
what are the contras for jt mobs with in the SPINE?
bone disease, CNS disorder, spondylolisthesis, prego, arthritis (acute inflammatory and infectious), malignancy
B
Cn
S
P
A
M
what are the extreme preccautions for jt mobs?
jt hypermobility, osteoporosis, RA, neurologic symtoms
H
O
R
N
what are the precautions for jt mobs?
hypermobilty, elderly, replacment total jt, malignant, excessive pain, system connective tissue disease, bone disease, unhealed fracture, new/weak connective tissue
H
E
R
M
E
S
B
U
N
adaptive shortening of the muscle-tendon unit and other soft tissue that cross or surround a jt resulting in significant resistance to passive or active stretch and limitation of ROM, which may compromise functional abilities.
contractures
Posture refers to ……
alignment of body parts whether upright, sitting, or recumbent.
Impairments in the joints, muscles or connective tissues may cause a person to demonstrate …?
a faulty posture or the faulty posture may lead to impairments in the mentioned structures. Poor posture can also lead to discomfort and pain.
fyi
Objective 7: Describe clinical conditions resulting from trauma or pathology, and related surgical procedures affecting the cervical and thoracic regions.
Objective 8: Describe different approaches to treating patients with soft tissue, bony and post surgical conditions.
Objective 11: Examine arthrokinematics of the cervical and thoracic regions (See Table 14.1)
fyi
posture characterized by an exaggerated posterior curvature of the thoracic spine. also called humpback or round back
Kyphotic
posture characterized by an increase in the lumbosacral angle, causing increased lumbar lordosis, anterior tilt and hip flexion.
Lordotic posture
Muscle control in the cervical spine (K & C):
- Mandible elevator group
- Suprahyoid and infrahyoid group
- Rectus Capitis anterior and lateralis, longus colli and longus capitis
- Multifidus
“_______________ of the cervical spine by the longus colli muscle is necessary to prevent excessive lordosis from contraction of the upper trapezius as it functions with the shoulder girdle muscles in lifting and pulling activities.” pg 423 K & C
Stabilization
Effects on Impaired Postural Support from Trunk Muscles
weakening of muscles that are habitually kept in a stretched position beyond their physiological resting length.
Stretch weakness:
Effects on Impaired Postural Support from Trunk Muscles
weakening of muscles that are habitually kept in a contracted position. They are strong until lengthened.
Tight weakness:
posture that deviates from normal alignment but has no structural limitation.
Postural fault
faulty posture in which adaptive shortening of soft tissures and muscle weakness has occurred.
Postural dysfunction:
What are some Common Faulty Postures that Affect the Cervical and Thoracic Regions
rounded back with forward head and flat back and neck posture pg 427 k & c
What postures relieve postural stress in the cervical and upper thoracic regions?
Review Stress Management/ Relaxation Techniques (K & C)
Are these techniques appropriate for a patient in the acute stage?
No, due to inflammation, joint swelling, or disc derangements. If the pt is recovering form a pathologic condition in the spine caution him or her that these techniques should not increase sypmtoms (other than stretching) especially radicular symptoms.
Review Stress Management/ Relaxation Techniques (K & C)
What other dysfunction(s) may cause you to utilize caution if implementing these techniques?
caution should be used with flexion on pts with a medical diagnosis of herniated disc so that symptoms should not peripheralize.
pg 427kc
involves an irreversible lateral curvature with fixed rotation of the vertebrae. rotation of the vertebral bodies is toward the convexity of the curve.
Structural scoliosis: pg 427kc
a reversible and can be changed with forward or side bending and with positional changes, such as lying supine, realignment of the pelvis by correction of a leg-length discrepancy, or with muscle contractions.
Nonstructural scoliosis: pg 427kc
kc pg428 potential impairments
**Typically in scoliosis patients, mobility impairments are found in the structures on the ____________ side of the curve.
And impaired muscle performance due to stretched and weak muscles can be found on the \_________``\___ side of the curve. **
concave
convex
It is important to assist the patient in improving proprioception and control of the muscles that control posture through:
- Verbal reinforcement (feedback and education)
- Visual reinforcement
- Tactile reinforcement
See Management Guidelines – Impaired Posture (Box 14.1)
If the POC is to
develop an awareness and control of spinal posture.
what would the intervention be?
Kinestheitc training;
cervical and scapular motions, pelvic tilts, conrol of neutral spine. Utiilize procedures to develp and reinforce control of posture when sitting, standing, walking, and performing targeted fuctional activities.
See Management Guidelines – Impaired Posture (Box 14.1)
If the POC is to
educate the pt about the relationship between faulty posture and symptoms.
what would the intervention be?
practice positions and movements to experience control of symptoms with various postures
See Management Guidelines – Impaired Posture (Box 14.1)
If the POC is to
Increase mobility in restricting muscles, joints, fascia
what would the intervention be?
manual stretching and joint mobilization/manipulation; teach self-stretching
See Management Guidelines – Impaired Posture (Box 14.1)
If the POC is to
develop neuromuscular control, strength, and endurance in postural and extremity muscles
what would the intervention be?
stabiliztion exercises; progress repetitions and challenge with extremity motions; progress to dynamic trunk stregthening exercises
See Management Guidelines – Impaired Posture (Box 14.1)
If the POC is to
teach safe body mechanics
what would the intervention be?
functional exercises to prepare for safe mechanics (squatting, lunges, reaching pushinpulling, lifting and truning loads with stable spine)
See Management Guidelines – Impaired Posture (Box 14.1)
If the POC is to
ergonomic assessment of home, work, recreational environments
what would the intervention be?
adapt work, home , recreational environment
See Management Guidelines – Impaired Posture (Box 14.1)
If the POC is to
stess management/ relaxaion
what would the intervention be?
relaxation exercises and postural stress relief
See Management Guidelines – Impaired Posture (Box 14.1)
If the POC is to
identify safe aerobic activities.
what would the intervention be?
implement and progress an aerobic exercise program
See Management Guidelines – Impaired Posture (Box 14.1)
If the POC is to
promote healthy exercise habits for self-maintenance.
what would the intervention be?
integration of a fitness program , regular exercise, and safe body mechanics into daily life
List ways in which you may progress the difficulty of cervical stabilization exercises.
with upper extremity loading.
The extemity motions are used to stimulate muscular endurance as well as strengthen the stabilizing muculature tin the spine. “Global muscles”
You are working to increase cardiopulmonary endurance with a patient with chronic spinal stenosis in the cervical region.
What types of activities would you avoid with this patient and why?
avoid going into extension
What signs and symptoms may alert you that a patient is having an abnormal response to the exercises you are implementing?
- HR increase more than 20 to 30 BPM
- HR decrease below resting HR
- systolic BP increase mor than 20- 30
- systolic BP decreased more than 10
- oxygen sat drops below prescribed
- pt becomes SOB or RR increase to level not tolerated
- EKG changes
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
suboccipital region:
self-stretch with capital nodding. pt apply a gentle stretch afainst the occiput with the lateral border of the hand
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
levator scapulae:
self stretch with scapular depression and cervical flexion and rotation to the opposite side
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
scalenes
self stretch with axial extension, side bend neck opposite and then rotate neck toward side of restriction
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
pectoralis major and anterior thorax
self stretch with corner stretches while lying supine on a foam roll placed longitudinally under the spine
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
latissimus dorsi
self stretch lying supine on a foam roll, reach arms overhead
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
lumbar and hip extensors
self stretch lying supine , bring knees to chest or quadruped position move buut back over feet
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
lumbar flexors
self stretch with prone press-ups or standing back bends
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
hip flexors
self stretch lying supine in thomas position or standing in modified fencers squat
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
TFL
self stretch either supine, side lying, or standing; extend, laterally rotate, then adduct the hip.
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
Iliotibial band foam roll
stretch side lie on a foam roll placed perpendicular to the thigh, gently roll the thigh back and forth with body weight appplying the stretch force
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
pyriformis
self stretch lying supine or sitting and bringing the flexed knee toward the opposite shoulder.
flex adduct and internally rotate the hip
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
hamstings
self stretch with a straight leg maneuver either lying supine or long sitting
Review Stretching Techniques for Common Mobility Impairments (Box 14.2, pg 432 K & C)
gastrocsoleus
self stretch in a forward stride position with the heel of the back leg maintained on the floor, or stand on an incline board or or edge of a step
Your patient has not demonstrated any ROM gains over a 3 week period. Therapeutic stretching without an increase in ROM demonstrates which property of muscle?
Two Most Common Surgeries in the Cervical Spine
- Laminectomy
- Fusions
what is involved in the Max Protection following Surgical Procedure:
- Pt education
- Wound management and pain control
- Bed moility
- Bracing
- Exercises
- Contraindications: Must avoid shower or getting incision wet until completely closes. Be aware of surgeon’s guidelines regarding limitations.
what is involved in the Mod/Min Protection following Surgical Procedure:
- Scar tissue mobilization
- Progressive stretching and joint mobs
- Muscle performance
- Gait training
- Contraindications: Continue to follow surgeon’s guidelines to promote healing.
- Joint manipulations at level of fusion
- McKenzie exercises are contraindicated in pts that have had laminectomy*
*Review Table 15.2 (K & C) – Summary of Interventions for Spinal and Related Pathologies*
the pain that results from mechanical stress when a person maintains a faulty posture for a prolong periord of time.
postura pain syndrome
