P6 - Pain Management of the Shoulder

Question 1

What are the two types of movements in a joint?

Answer 1

1) Physiological movements (osteokinematic) from muscle contractions, and
2) Accessory movements between articulating joint surfaces.

Question 2

What are examples of physiological movements?

Answer 2

Flexion, Extension, Abduction, Adduction, Internal Rotation, External Rotation.

Question 3

What are examples of accessory movements in a joint?

Answer 3

Spin, Roll, Glide, Distraction, Compression.

Question 4

What is the importance of accessory movements in joint function?

Answer 4

They are essential for full-range physiological movement. Without normal accessory motion, normal physiologic movements will not occur.

Question 5

What can cause loss of movement following joint injury?

Answer 5

Loss of movement may result from contracture of inert connective tissue (e.g., ligaments, joint capsule) or resistance of contractile tissues (e.g., muscles, tendons, fascia).

Question 6

Can accessory movements occur independently from physiological movements?

Answer 6

No, accessory movements accompany physiological movements and cannot occur independently.

Question 7

Why is it important for the joint to move freely during rehabilitation?

Answer 7

A muscle cannot be fully rehabilitated if the joint is not free to move, and vice versa.

Question 8

What is the purpose of Maitland Grades?

Answer 8

Maitland Grades are used to classify the intensity of mobilization techniques in manual therapy for joint pain and stiffness.

Question 9

Describe Maitland Grade I mobilization.

Answer 9

Small amplitude rhythmic oscillation in the early range of movement, typically used for pain modulation.

Question 10

Describe Maitland Grade II mobilization.

Answer 10

Large amplitude rhythmic oscillation in the mid-range of movement, used for pain relief.

Question 11

Describe Maitland Grade III mobilization.

Answer 11

Large amplitude rhythmic oscillation to the point of limitation in the range of movement, aimed at increasing mobility.

Question 12

Describe Maitland Grade IV mobilization.

Answer 12

Small amplitude rhythmic oscillation at the end of the available range of movement, typically used to improve joint stiffness.

Question 13

Describe Maitland Grade V mobilization (Thrust Manipulation).

Answer 13

A small amplitude, quick thrust at the end of the available range of movement, often used for stiff joints.

Question 14

What are some contraindications to manual therapy?

Answer 14

Osteoporosis, fractures, inflammatory conditions (RA/AS), DVT, neurological instability, hypermobility, pregnancy, clotting disorders, malignancy, lack of consent.

Question 15

List some precautions when applying manual therapy.

Answer 15

Fragile skin, incompletely healed scars, calcified soft tissue, skin grafts, inflamed tissue, osteoporosis, joint instability, pregnancy.

Question 16

What is the goal of manual therapy in rehabilitation?

Answer 16

To increase ROM, reduce pain, prevent contractures, maintain soft tissue integrity, increase venous circulation, improve synovial fluid production, and enhance kinaesthetic awareness.

Question 17

How does manual therapy help reduce pain?

Answer 17

Manual therapy initiates neurophysiological responses in the peripheral and central nervous systems, modulating pain through the Pain Gate mechanism.

Question 18

How can you explain manual therapy’s pain modulation to a patient?

Answer 18

It is like taking ibuprofen for temporary pain relief; manual therapy provides short-term relief, allowing the patient to incorporate exercise for long-term benefits.