Mobs and spinal worksheet Flashcards by natalie brown

techniques where by the pt is taught to apply joint mobilization techniques to restricted joints using proper gliding techniques.

Self-mobilization

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

Movements the pt can do voluntarily.

ex: flex, abd, rotation,

Physiological movement

How well did you know this?

Not at all

Perfectly

When motions of the bone are described (flex, ext, abd, etc..)

Osteokinemetics

How well did you know this?

Not at all

Perfectly

movements in the joints and surrounding tissues that are necessary for normal ROM but that cannot be actively performed by the pt.

Accessory movements

How well did you know this?

Not at all

Perfectly

These are motions that accompany active motions but are not under voluntary control. This term is often used synomously with acessory movement.

component motions

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

small amplitude rythmic oscillation are perform at the beginning of the range. The are usally rapid like manuel vibrations.

Oscillation grade I

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What grades of oscillations are primarily used as a stretching maneuver.

Oscillations Grade III and IV

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

enough destraction or glide is applied to tighten the tissues around the jt. (“taking up the slack”)

sustained jt play grade II

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

a perment or transient limitation of movment or shortening of the muslcle or other soft tissues

contracture

How well did you know this?

Not at all

Perfectly

how do jt mobs differ from other forms of passive or self stretching?

they specifically address restricted capsular tissue

How well did you know this?

Not at all

Perfectly

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”

How well did you know this?

Not at all

Perfectly

The joint end feel is characterized by a yeilding compression. This end-feel results from muscular tissue compression during jt flexion.

soft-tissue approximation

How well did you know this?

Not at all

Perfectly

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) ## Footnote 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)_ ## Footnote 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) ## Footnote 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) ## Footnote 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) ## Footnote 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) ## Footnote 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?

1. HR increase more than 20 to 30 BPM 2. HR decrease below resting HR 3. systolic BP increase mor than 20- 30 4. systolic BP decreased more than 10 5. oxygen sat drops below prescribed 6. pt becomes SOB or RR increase to level not tolerated 7. 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)_ ## Footnote 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)_ ## Footnote 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)_ ## Footnote 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)_ ## Footnote 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) ## Footnote 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)_ ## Footnote 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)_ ## Footnote 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)_ ## Footnote 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)_ ## Footnote 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)_ ## Footnote 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)_ ## Footnote 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)_ ## Footnote 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