Module 4: Joint Mobility

Question 1

What is a joint?

Answer 1

The location where two or more bones meet to allow movement.

Question 2

What structures can compose a joint?

Answer 2

Bones, cartilage, joint capsules, synovial membranes & fluid, ligaments, menisci, bursa, labrum

Question 3

What are the three types of joints found in human body? Give an example of each.

Answer 3

Synarthrosis – fibrous: immovable; sutures
Amphiarthrosis – cartilaginous: slight movement; intervertebral discs
Diarthrosis – synovial: freely movable; knee

Question 4

Name 3 types of synovial joints and give one example of each.

Answer 4

Ball and socket - hip
Condyloid (ellipsoid) – radiocarpal
Hinge - elbow
Pivot – proximal radioulnar
Plane (gliding) – intertarsal
Saddle – CMC of thumb

Question 5

Name and describe the 3 planes of movement in the human body.

Answer 5

Frontal (coronal) – divides the body into front and back
Sagittal – divides the body into right and left
Transverse – divides the body into top and bottom

Question 6

Name the 3 axes of movement and place them according to the plane of movement. What joint motion occurs in each?

Answer 6

1) Frontal plane (coronal)| divides the body into front / back| with a Sagittal axis (anteroposterior)| for Abduction / Adduction| and movements like Jumping jacks
2) Sagittal plane| divides the body into Left / right| with a Frontal axis (transverse)| and Flexion / Extension| for movements like Squats
3) Transverse plane (horizontal)| divides the body into Top / Bottom| with a Vertical axis (longitudinal)| and movements like Rotation Russian twists

Question 7

What is a uniaxial joint? Give an example.

Answer 7

A joint that allows movement in one plane. Example: Elbow (hinge joint).

Question 8

What is biaxial joint? Give an example.

Answer 8

A joint that allows movement in two planes. Example: Wrist (condyloid joint).

Question 9

What is a multiaxial joint? Give an example.

Answer 9

A joint that allows movement in multiple planes. Example: Shoulder (ball and socket joint).

Question 10

What are accessory movements of a joint? Give 3 examples.

Answer 10

Movements that occur within a joint that allow the physiological movement of the joint.

Spin – radial head spins in the proximal radioulnar joint
Roll – femur condyles of the knee roll backwards on the tibia
Glide – femur condyles of the knee glide forward on the tibia

Question 11

Define the movement of glide. Describe one joint in the body where this accessory movement occurs.

Answer 11

Translatory movement, where one fixed point glides over another at a joint surface.
Anteroposterior or mediolateral direction.
Femoral condyles gliding forward in the knee joint during flexion/extension.

Question 12

Define the movement of spin. Describe one joint in the body where this accessory movement occurs.

Answer 12

Rotational movement, one surface rotates around another fixed surface.
Proximal radioulnar joint in supination/pronation

Question 13

Define the movement of roll. Describe one joint in the body where this accessory movement occurs.

Answer 13

One joint surface roll over another.
Femoral condyles roll over the tibia in the knee joint in flexion/extension

Question 14

Define closed packed position of a joint.

Answer 14

The joint surfaces are most congruent and stable; the joint surfaces fit together tightly; the ligaments and capsule are taut.

Question 15

Define loose-packed position of a joint.

Answer 15

The position where the joint surfaces are less congruent, less stable, allowing for more movement, the joint surfaces are least aligned, the ligaments and capsule to be loose.

Question 16

When measuring ROM, what is the difference between full ROM, inner ROM and outer ROM?

Answer 16

Full ROM: The complete range of motion from start to end.
Inner ROM: The range during muscle contraction, focusing on stability and strength.
Outer ROM: The range during muscle extension, focusing on flexibility and stretch.

Question 17

Give 4 factors that contribute to normal ROM. Describe how they facilitate ROM.

Answer 17

Bony Shape and Integrity: structure and alignment in a joint.
Cartilage: hyaline cartilage cushions and smooths joint surfaces.
Joint Capsule: provides stability while allowing movement.
Ligamentous Tissue: connect bones and limit excessive movement.

Question 18

How do muscles facilitate ROM?

Answer 18

Muscles support ROM by stretching across joints but have limits. For example, the hamstrings cross the hip and knee. When the hip is bent, knee extension is limited because the hamstrings are stretched. When the hip is straight, more knee extension is possible

Question 19

Joints can be hypomobile and hypermobile. What is the difference?

Answer 19

Hypomobility: Restricted joint movement.
Hypermobility: Excessive joint movement.

Question 20

What might cause decreased joint ROM?

Answer 20

Disease, injury, pain, scarring, stiffness, contractures, spasticity, or flaccidity.

Question 21

What can be the problem if a joint has increased physiological ROM (hypermobile)?

Answer 21

Greater risk of hyperextension: This can damage connective tissues, ligaments, and joints.
Increased joint instability: This can lead to pain and a higher likelihood of injury.

Question 22

Name 4 factors that can decrease ROM. Describe how they can decrease ROM.

Answer 22

Immobilization: Leads to stiffness and loss of flexibility in joints and surrounding structures.
Injury: Causes physiological blocks that restrict movement.
Pain: Inhibits willingness to move during joint movement.
Muscle weakness: Reduces strength and limits effective movement.
Inflammation: Swelling restricts joint movement.

Question 23

Name 2 factors that can lead to a hypermobile joint. Describe how they contribute to hypermobility.

Answer 23

Congenital conditions: Affect connective tissues and increase joint laxity (e.g., Ehlers-Danlos syndrome leads to hypermobility due to collagen production abnormalities).
Acquired conditions: Result from repetitive stress or injury, which can stretch or damage ligaments and connective tissues over time.

Question 24

What is goniometry?

Answer 24

Measurement of joint angles to assess changes in ROM over time

Question 25

What is the definition of passive ROM? How would you perform this?

Answer 25

PROM is movement performed by an external force. It is performed by moving the joint without the patient’s active involvement.

Question 26

What is the definition of active ROM? How would you perform this?

Answer 26

AROM is movement actively performed by the patient without external assistance.

Question 27

What is the definition of end-feel?

Answer 27

The sensation felt at the end of a joint’s ROM during passive movement.

Question 28

Why is it important to feel for the end-feel?

Answer 28

To assess the condition of the joint and surrounding tissues.

Question 29

What are the indications for performing passive ROM?

Answer 29

When full AROM is not possible due to muscle weakness, neurological problem, pain, stiffness, surgery, or injury

Question 30

What are the indications for performing active ROM?

Answer 30

When full or near-full PROM is achieved but AROM is decreased, the focus should be on strengthening muscles, improving coordination and control, and promoting circulation. AROM is preferred whenever possible.

Question 31

Give 3 examples of situations in which you would perform passive ROM and not active ROM.

Answer 31

After surgery when the patient cannot move independently.
When assessing joint stiffness.
To prevent joint contractures in immobile patients.

Question 32

Provide 3 examples of when active ROM would be more indicated than passive ROM.

Answer 32

During rehabilitation for muscle strength.
To maintain joint flexibility after injury.
To assess muscle function.

Question 33

Name 2 contraindications for passive ROM.

Answer 33

Acute injury to joint, ligament, muscles
Early fractures

Question 34

What is the definition of stretch?

Answer 34

Taking a joint or muscle to the end of its available ROM and holding the position to lengthen the muscle or soft tissues.

Question 35

What is the difference between stretches and passive ROM?

Answer 35

Stretching lengthens muscle and/or soft tissue, improving flexibility and increasing tissue elasticity over time.
PROM maintains or restores full joint ROM by moving the joint through its available ROM.

Question 36

Name 3 physiological properties of the muscle tissue that need to be taken into consideration when performing a stretch.

Answer 36

Elasticity - Muscle’s ability to return to original length
Extensibility – Muscle’s ability to stretch
Contractility – Muscle’s ability to forcefully shorten

Question 37

List 3 indications for stretching.

Answer 37

Maintain or increase ROM
Prevent muscle tightness, injury or contractures
Increase circulation
Decrease muscle spasm
Increase tissue compliance/flexibility
Decrease pain

Question 38

List 3 contraindications for stretching.

Answer 38

Acute injury to joint, ligament, muscles
Early fractures
Joint hypermobility

Question 39

What are accessory movements?

Answer 39

Small, involuntary movements that occur within a joint that are not under voluntary control and allow the physiological movement of the joint.

Question 40

What is the difference between passive ROM and accessory movements?

Answer 40

PROM is the total movement available without muscle effort, while accessory movements are involuntary actions that support and enhance active movements within a joint.

Question 41

List 3 contraindications for performing accessory movements.

Answer 41

Acute inflammation
Pain
Surgery or Injury
Joint instability

Question 42

What is a manipulation?

Answer 42

High-velocity, low-amplitude movements applied to the joint past the available range to increase ROM

Question 43

What is the difference between accessory movements and manipulations?

Answer 43

Accessory movements are gentle and involuntary, focusing on normal joint function. Manipulations are fast, forceful movements (think chiropractor) aimed at addressing joint dysfunction and pain relief.