pjm

Question 1

what is the main rationale for PJM

Answer 1

to modulate pain and joint LOM by correcting altered joint mechanics

Question 2

what are the usual causes for altered joint mechanics

Answer 2

pain and MG
jt effusion
capsular adhesions
ligament adhesions
aberrant joint motion

Question 3

diff PJM stretching from normal stretching

Answer 3

PJM addresses capsular tissue restriction by replicating loss arthrokinematics

stretching only stretches muscle and not joint capsule

Question 4

exp mobilization or manip

Answer 4

passive manual therapy at varying speeds and ampli

using physiologic and accessory motions

Question 5

discus self-mob or automob

Answer 5

self-stretching that uses joint traction or glide to stretch capsule

Question 6

dicuss MWM

Answer 6

sustained accessory mob and active movement

able to to passive end range over pressure s pain

Question 7

when is MWM applicable

Answer 7

no contra for manual therapy

(+) local MSK pathology

localized loss of movement or pain c function

(-) pain during and after appli

Question 8

example of MWM

Answer 8

belt on post ankle while PT applies anterior glide to talus while pt dflexes ankle

Question 9

discuss thrust

Answer 9

high velocity short ampli

done and end of pathologic limit

only once

Question 10

thrust is intended to ______

Answer 10

alter pos rela
snap adhesions
stim joint receptors

Question 11

discuss muscle energy

Answer 11

appli of active isometric contraction = desired accessory motion

isometrically contract hams to pull pelvis backward in SI joint dysfunction

Question 12

what are physiologic movements

Answer 12

voluntary - osteokinematics

elbow flex/ext

Question 13

what are accesorry movements

Answer 13

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

Question 14

what is swing

Answer 14

angular rot of a lever c roll, slide or spin

elbow flexion

Question 15

what is roll

Answer 15

same direction as the movement of lever

elbow flexion - ant roll

Question 16

discuss glide/slide/translation

Answer 16

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

Question 17

discuss spin

Answer 17

rolling + gliding

usually shoulder flex/ext, hip flex/ext, radiohum pron/supin

shoulder flexion - posterior spin

Question 18

compare joint-glide stretching and passive angular stretching in terms of intensity

Answer 18

joint-glide stretching - modulates intensity based on pathology

passive angular stretching - cant be modulated

Question 19

compare joint-glide stretching and passive angular stretching in terms of effect on joint

Answer 19

joint-glide stretching - replicated normal arthro and does not compress

passive angular stretching - causes compress and may inc pain

Question 19

compare joint-glide stretching and passive angular stretching in terms of effect on pt

Answer 19

joint-glide stretching - stretch tight capsule

passive angular stretching - stretch tight muscle

Question 20

discuss compression

Answer 20

dec jt space - during WB or for stab

during rolling, compression on angulating side

Question 20

compare normal and high load compression

Answer 20

normal - helps move synovial fluid and for stab

high - articular cartilage damage; OA

Question 20

discuss traction

Answer 20

sep of jt surfaces

Question 21

what is long-axis traction

Answer 21

longitudinal pull along long axis of bone

Question 22

what is distraction

Answer 22

pulling perpendicular to the treatment plane or concave side

Question 23

effects of joint motion

Answer 23

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

Question 24

effects of immob on jt

Answer 24

immob - fibrofatty prolif w/in 2-3 days - intra artic adhesions - contractures and ligament weakening kaya jt mob as early as possible

Question 25

indications for PJM

Answer 25

pain, MG and spasm reverse joint hypomob positional faults or sublux progressive limitation functional immob

Question 26

how does PJM dec pain

Answer 26

neurophysiologic - GCT from oscillations mechanical - stims movement of synovial fluid

Question 27

limitations of PJM

Answer 27

cannot change disease process - RA or OA only alleviate symptoms

Question 28

contraindications of PJM

Answer 28

hypermob joint effusion inflammation

Question 29

conditions requiring special precautions for PJM

Answer 29

gr 3/4 malignancy bone disease unhealed fx excessive pain hypermob total jt replacements new or weak connective tissue RA or systemic diseases elderly

Question 30

usual evaluation findings that would warrant the use of PJM

Answer 30

capsular pattern firm capsular end feel dec joint play adhered or contracted ligament sublux or disloc

Question 31

grade 1 oscillatory technique

Answer 31

Small-amplitude rhythmic oscillations; beginning of range

Question 32

grade 2 oscillatory technique

Answer 32

Large-amplitude rhythmic oscillations; within the range not reaching the limit; 2-3 per second

Question 33

grade 3 oscillatory technique

Answer 33

Large-amplitude rhythmic oscillations; up to the limit of available motion

Question 34

grade 4 oscillatory technique

Answer 34

Small-amplitude rhythmic oscillations; at the limit of available motion,

Question 35

grade 5 oscillatory technique

Answer 35

Small-amplitude, high velocity thrust

Question 36

oscillatory grade for inhib pain and improve nutri

Answer 36

grade 1 and 2

Question 37

oscillatory grade for stretch

Answer 37

grade 3 and 4

Question 38

oscillatory grade for snap adhesion, reposition of disloc

Answer 38

grade 5

Question 39

grade 1 sustained translatory technique

Answer 39

Small amplitude distraction; no stress

Question 40

grade 2 sustained translatory technique

Answer 40

Enough distraction or glide to tighten tissues - taking up slack

Question 41

grade 3 sustained translatory technique

Answer 41

large enough to place a stretch on jt. capsule and surrounding periarticular structures

Question 42

use of grade 1 sustained translatory technique

Answer 42

pain relief or gliding motions

Question 43

use of grade 2 sustained translatory technique

Answer 43

for initial tx inhib pain and maintain jt play when ROM not allowed

Question 44

use of grade 3 sustained translatory technique

Answer 44

stretch jt structures and inc jt play

Question 45

speed, rhythm and duration of oscillations

Answer 45

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

Question 46

speed, rhythm and duration of sustained translatory JP

Answer 46

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

Question 47

discuss pos and stab for PJM

Answer 47

OPP and relax pt's muscles always stab proximal to mob distal - guard belt ot BW

Question 48

discuss direction of force

Answer 48

distraction - perpendicular to treatment plane gliding - parallel to treatment plane

Question 49

discuss initiation and progression

Answer 49

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

Question 50

what can be done prior or during PJM

Answer 50

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