Passive Accessory Movements

Question 1

What are contraindications to passive accessory movements (name 6)

Answer 1

Osteoporosis
Antincoagulants within last 6/52
Long term steroid use
Hypermobility
Inflammatory arthritis
Malignancy (local)
Recent radiotherapy (local)
TB
Ligamentous rupture (local)
Disc prolapse with nerve compression
Cauda Equina lesion
Central stenosis / cord pressure
Congenital bone deformities
Vascular disorders
Spondylolithesis
Patient unable to give consent
Bone disease
Neurological involvement

Question 2

What are possible precautions for passive accessory movements

Answer 2

osteoarthritis (acute)
pregnancy
children
total joint replacement
severe scoliosis
poor general health
down’s syndrome

Question 3

What are the passive accessory movements possible at the ankle

Answer 3

AP glide (including DF) of the talocrural joint
PA glide (including PF) of the talocrural joint
Transverse glide medial (include eversion) subtalar joint
Transverse glide lateral (include inversion) subtalar joint

Question 4

What possible passive physiological mobilisations are there at the ankle

Answer 4

Plantar flexion and dorsiflexion talocrural
Inversion and eversion subtalar

Question 5

What possible passive accessory movements are there at the knee

Answer 5

AP glide (includes flexion) tibiofemoral joint
PA glide (include extension) tibiofemoral joint

Transverse glide medially and laterally of patellar
Longitudinal caudad and cephalad of the patellar

Question 6

What passive physiological mobilisations are possible at the knee

Answer 6

Flexion and extension

Question 7

What passive accessory movements are possible at the hip

Answer 7

Longitudinal caudad

Question 8

What possible passive physiological mobilisations are possible at the hip

Answer 8

Medial rotation

Question 8

What should passive movements be done until and how

Answer 8

Gentle till mention of pain

Question 9

What are examples of normal end-feel and what do they mean

Answer 9

Soft = soft tissue aposition
Hard = bony block, e.g. elbow
Elastic = stretching capsule and ligaments

Question 9

What is the key difference between physiological movements and accessory movements

Answer 9

Physiological movements can be consciously performed by the person or patient, accessory can’t be performed consciously

Question 10

What are physiological movements

Answer 10

Either active or passive movements that can be consciously done, generally major movements

Question 11

What do physiotherapist use physiological movements for

Answer 11

Looking at ROM
End-feel
Assessing symptoms

Question 12

What are the maitland grades

Answer 12

Grade I - IV

Grade I: small movement performed at start of range

Grade II: large movement performed within resistance- free range

Grade III: large amplitude movement into resistance range may block with body part

Grade IV: small amplitude movement into resistance or up to limit of range

Question 13

What are maitland grades used for in physiological movements

Answer 13

Grades III - IV are used stretch soft tissue and adhesions
It also creates synovial sweep aiding lubrication

Grade I and II
Help to relieve pain
Pain gait theory and descending inhibition

Question 14

Describe pain gate theory

Answer 14

A-delta fibres transmit sharp pain quickly
This goes to the dorsal horn
A-beta fibres transmit non-painful sensations from mechanoreceptors in skin and other soft tissues
C fibres transmit dull pain more slowly
These are processed in the same area so other sensors reduce pain if non painful receptors going through

Question 15

Describe descending inhibition

Answer 15

reduces pain by “closing” gates directly
This secretes opioids
Mechanical non-pain sensation / meditation

Question 16

What are accessory mobilisations

Answer 16

During physiological movements, small movements occur between joint surfaces to maintain congruence
Can’t be controlled
3 main types
- Roll : rolling parallel to joint surface
- Slide: moves parallel to joint surface (occurs with roll)
- Spin: perpendicular to joint surface e.g. locking knee mechanism

Question 17

what determines whether roll and slide are independent

Answer 17

If surface is convex or concave
If convex rolls posteriorly and slides anteriorly
If concave roll and glide are same motion

Question 18

What can passive accessory movements be used for

Answer 18

Assessment of:
ROM
End-feel
Symptoms

Question 19

What are the aims of treatment with passive accessory movements

Answer 19

Relieve pain (between grades I and II)
Increase or restore ROM (grades III and IV)

Question 20

What are the names of passive accessory movements when treating

Answer 20

glide, rotation and rolls = passive physiological
can also compress and distract

Question 21

What are the different glides and rotations

Answer 21

PA
AP
Medial glide
Lateral Glide
Cauda glide
Cephalad glide (towards head)

medial rotation
lateral rotation

Question 22

Which accessory movement should you use?

Answer 22

Most comparable accessory movement
for pain

For movement
Accessory movement involved in physiological movement wanting to improve

Question 23

Should you use accessory or physiological

Answer 23

For pain:
Accessory

For increasing movement:
Combination of accessory and physiological mobilisations

Question 24

What are the key principles of carrying out accessory movement

Answer 24

Should be relaxed and comfortable
Grip not too tight and should make use of mechanical advantage of levers
Stabilise above joint
Assess patient symptoms and range before, during and after

Question 25

How would you conduct talocrural glides

Answer 25

PA glide (increases plantar flexion)
Prone lying with foot over plinth
1 hand over dorsum lightly distracts foot
Other hand over posterior aspect of talus and calcaneus
Calcaneus anteriorly to glide talus anteriorly

AP glide (increase dorsiflexion)
Supine with heel end of plinth
Palm over talus distal to ankle joint
Stabilise over shin
Foot maintained in resting and grade I distraction downward
Glide moves posteriorly

Question 26

How are subtalar glides conducted

Answer 26

Patient side lying or prone
leg supported on table or with towel
Align shoulder and arm parallel with bottom of foot
Talus stabilized with procimal hand and distal on side of calcaneus medially to perform medial glide
To mobilise fingers wrap round plantar surface, some distraction in caudal direction
calcaneus moved medially or laterally

Question 27

How would you carry out tibiofemoral passive accessory movements

Answer 27

PA tibiofemoral glide
Increases knee extension
Patient positioned in crook lying or prone
In prone
knee in resting or as close to end range
small pad or towel under patella
Distal tibia in one hand and proximal hand on proximal tibia
force directed laterally / medially over tibial plateau

AP tibiofemoral glide
Increases knee flexion
patient in supine with knee slightly flex with prop under femur
Hand stabilising hand props distal femur
mobilising hand over proximal tibia below tibial tuberosity
Mobilisation perpendicular to line of tibia

Question 28

How would patella glides be carried out

Answer 28

Medial / lateral glides used for knee rotation
Supine with knee slightly flexed
Therapist uses both hands to press inferior and superior of medial patella and force in lateral direction. Vice versa for lateral glide

Superior and inferior glides aid extension and flexion, similar concept to lateral and medial

Question 29

How would you carry out longitudinal caudad

Answer 29

Knee flex and leg raised
scoop hand round base of leg
distract leg