pjm Flashcards
what is the main rationale for PJM
to modulate pain and joint LOM by correcting altered joint mechanics
what are the usual causes for altered joint mechanics
pain and MG
jt effusion
capsular adhesions
ligament adhesions
aberrant joint motion
diff PJM stretching from normal stretching
PJM addresses capsular tissue restriction by replicating loss arthrokinematics
stretching only stretches muscle and not joint capsule
exp mobilization or manip
passive manual therapy at varying speeds and ampli
using physiologic and accessory motions
discus self-mob or automob
self-stretching that uses joint traction or glide to stretch capsule
dicuss MWM
sustained accessory mob and active movement
able to to passive end range over pressure s pain
when is MWM applicable
no contra for manual therapy
(+) local MSK pathology
localized loss of movement or pain c function
(-) pain during and after appli
example of MWM
belt on post ankle while PT applies anterior glide to talus while pt dflexes ankle
discuss thrust
high velocity short ampli
done and end of pathologic limit
only once
thrust is intended to ______
alter pos rela
snap adhesions
stim joint receptors
discuss muscle energy
appli of active isometric contraction = desired accessory motion
isometrically contract hams to pull pelvis backward in SI joint dysfunction
what are physiologic movements
voluntary - osteokinematics
elbow flex/ext
what are accesorry movements
involuntary and has 2 kinds
component - accompanies active motion but not under volu control; shoulder abd and clavicle tilts up
joint play - arthro; necessary for nomal jt function
what is swing
angular rot of a lever c roll, slide or spin
elbow flexion
what is roll
same direction as the movement of lever
elbow flexion - ant roll
discuss glide/slide/translation
convex moving - opposite direction of roll; shoulder abd - sup roll and inf glide
concave moving - same direction of roll; elbow flexion - ant roll and glide
discuss spin
rolling + gliding
usually shoulder flex/ext, hip flex/ext, radiohum pron/supin
shoulder flexion - posterior spin
compare joint-glide stretching and passive angular stretching in terms of intensity
joint-glide stretching - modulates intensity based on pathology
passive angular stretching - cant be modulated
compare joint-glide stretching and passive angular stretching in terms of effect on joint
joint-glide stretching - replicated normal arthro and does not compress
passive angular stretching - causes compress and may inc pain
compare joint-glide stretching and passive angular stretching in terms of effect on pt
joint-glide stretching - stretch tight capsule
passive angular stretching - stretch tight muscle
discuss compression
dec jt space - during WB or for stab
during rolling, compression on angulating side
compare normal and high load compression
normal - helps move synovial fluid and for stab
high - articular cartilage damage; OA
discuss traction
sep of jt surfaces
what is long-axis traction
longitudinal pull along long axis of bone
what is distraction
pulling perpendicular to the treatment plane or concave side
effects of joint motion
stims bnio activity - move synovial fluid - nutri to articular structures
maintains extensib and tensile strength of articular and peri structures (cartilage and ligaments)
sensory for proprio feedback
effects of immob on jt
immob - fibrofatty prolif w/in 2-3 days - intra artic adhesions - contractures and ligament weakening
kaya jt mob as early as possible
indications for PJM
pain, MG and spasm
reverse joint hypomob
positional faults or sublux
progressive limitation
functional immob
how does PJM dec pain
neurophysiologic - GCT from oscillations
mechanical - stims movement of synovial fluid
limitations of PJM
cannot change disease process - RA or OA
only alleviate symptoms
contraindications of PJM
hypermob
joint effusion
inflammation
conditions requiring special precautions for PJM
gr 3/4
malignancy
bone disease
unhealed fx
excessive pain
hypermob
total jt replacements
new or weak connective tissue
RA or systemic diseases
elderly
usual evaluation findings that would warrant the use of PJM
capsular pattern
firm capsular end feel
dec joint play
adhered or contracted ligament
sublux or disloc
grade 1 oscillatory technique
Small-amplitude rhythmic oscillations; beginning of range
grade 2 oscillatory technique
Large-amplitude rhythmic oscillations; within the range not reaching the limit; 2-3 per second
grade 3 oscillatory technique
Large-amplitude rhythmic oscillations; up to the limit of available motion
grade 4 oscillatory technique
Small-amplitude rhythmic oscillations; at the limit of available motion,
grade 5 oscillatory technique
Small-amplitude, high velocity thrust
oscillatory grade for inhib pain and improve nutri
grade 1 and 2
oscillatory grade for stretch
grade 3 and 4
oscillatory grade for snap adhesion, reposition of disloc
grade 5
grade 1 sustained translatory technique
Small amplitude distraction; no stress
grade 2 sustained translatory technique
Enough distraction or glide to tighten tissues - taking up slack
grade 3 sustained translatory technique
large enough to place a stretch on jt. capsule and surrounding periarticular structures
use of grade 1 sustained translatory technique
pain relief or gliding motions
use of grade 2 sustained translatory technique
for initial tx
inhib pain and maintain jt play when ROM not allowed
use of grade 3 sustained translatory technique
stretch jt structures and inc jt play
speed, rhythm and duration of oscillations
gr 1 and 4 - rapid
gr 2 and 3 - 2-3 cycles per second
grade 5 - once only
gr 1-4 - 1-2 mins total
speed, rhythm and duration of sustained translatory JP
gr 1 - 7-10 secs and 1-2 sec resr
gr 2-3 - stretch for 6 sec then repeat c slow intermittent stretch for 3-4 secs
total 1-2 mins
discuss pos and stab for PJM
OPP and relax pt’s muscles
always stab proximal to mob distal - guard belt ot BW
discuss direction of force
distraction - perpendicular to treatment plane
gliding - parallel to treatment plane
discuss initiation and progression
start c sustained gr 2 distraction - ask pt to note changes w/in 24 hrs
no pain proceed or inc; yes pain dec to gr 1
good response next grade if not dec grade
what can be done prior or during PJM
warm tissue around or muscle relaxation techniques
gr 1-2 oscillitatory to inhibit MG
if gr 3-4 gliding only use gr 1 distraction
beging gliding in painless directions
move through available ROM then apply stretch
incorporate MWM
