Topic 1 - Introduction & Mobilization Theory Flashcards
Manual therapy techniques used to modulate pain and treat joint impairments that limit ROM by addressing the altered mechanics of the joint.
Joint Mobilizations
T/F - Mobilization is the same as manipulation.
False - Mobilization is NOT the same as manipulation.
A term that refers to when the patient can voluntarily contract a muscle to stop the movement.
Mobilization
A term that refers to when the patient cannot stop the movement.
Manipulation
A ____________ is applied with speed and thrust, and is often used by chiropractors and physiotherapists.
Manipulation
Synovial joints rely on the ______ of the joint capsule and surrounding structures and the potential _____ between the bones for optimal movement.
Laxity
Space
Label the following image (letters A-E) displayed below.
A) Fibrous Layer
B) Synovial Layer
C) Intra-Articular Disk
D) Joint Cavity
E) Articular Cartilage
Voluntary motions the patient performs by moving a joint.
Osteokinematic Movements
______________ terms describe the movement (or swing) of a bone in space.
Osteokinematic
Involuntary movements within the joint and surrounding tissues that are necessary for normal ROM.
Arthrokinematic Movements
T/F - Arthrokinematic movements allow for osteokinematic movements to happen.
True
What are the 5 types of arthrokinematic movements?
1) Roll
2) Slide
3) Spin
4) Compression
5) Distraction
_______________ movements are necessary for pain-free, unrestricted, voluntary movements to occur.
Arthrokinematic
A type of arthrokinematic movement that occurs between joint surfaces when a new point on the moving surface contacts a new point on the stationary surface.
Roll
T/F - In a normal joint, roll occurs without slide or spin.
False - In a normal joint, roll occurs WITH slide or spin.
T/F - Roll results in the movement (swing) of a bone.
True
____ always occurs in the direction that the bone is moving, regardless of whether the moving surface is convex or concave.
Roll
A type of arthrokinematic movement that occurs when the same point on the moving surface contacts new points on the stationary surface.
Slide
A relationship in which the direction of slide depends on whether the moving surface of the joint is concave or convex.
Concave-Convex Rule
Slide occurs in the same direction as the roll if the moving surface is _______.
Concave
Slide occurs in the opposite direction of the roll if the moving surface is ______.
Convex
A type of arthrokinematic movement that occurs when the same point on a moving surface contacts the same point on the stationary surface.
Spin
____ involves the rotation of a segment about a stationary axis.
Spin
A type of arthrokinematic movement that occurs when there is a decrease in space between the two articulating joint surfaces.
Compression
___________ normally occurs during weight bearing and can occur when muscles contract, providing stability to the joint.
Compression
Normal ___________ encourages movement of synovial fluid, which helps maintain cartilage health.
Compression
T/F - Abnormally high compression can lead to deterioration of articular cartilage.
True
A longitudinal pull or a pull along the long axis of the bone.
Traction
Traction is often called ____-____ traction.
Long-Axis Traction
A force applied perpendicular to the treatment plane involving a separation or pulling apart of the articular surfaces.
Distraction
Distraction and/or glides are applied to the joint surfaces to decrease ____ or restore normal ________________.
Pain
Arthrokinematics
Distractions can be applied on their own or in combination with a _____. When possible, it should be a grade __ distraction.
Glide
Grade I
Distractions and glides are applied using _________ or ___________ techniques.
Sustained
Oscillatory
T/F - Glide and slide are both arthrokinematic movements.
False - Glide and slide are NOT both arthrokinematic movements.
_____ is when you mobilize a bone in a direction that is parallel to the treatment plane.
Glide
A plane that lies parallel to the concave surface of a joint.
Treatment Plane
T/F - There are four grades of sustained mobilization.
False - There are THREE grades of sustained mobilization.
Match the following grades of sustained mobilization techniques with their appropriate description.
1) Grade I
2) Grade II
3) Grade III
A) Small-amplitude distraction, no stress on the joint capsule
B) Distraction or glide is applied with an amplitude large enough to place stretch on the capsule and periarticular structures
C) Distraction or glide is applied, tightens the tissue around the joint
1) Grade I – A) Small-amplitude distraction, no stress on the joint capsule
2) Grade II – C) Distraction or glide is applied, tightens the tissue around the joint
3) Grade III – B) Distraction or glide is applied with an amplitude large enough to place stretch on the capsule and periarticular structures
T/F - There are 4 grades of oscillatory mobilization.
True
Match the following grades of oscillatory mobilization techniques with their appropriate description.
1) Grade I
2) Grade II
3) Grade III
4) Grade IV
A) Small-amplitude, performed into the tissue limit
B) Large-amplitude, performed into the tissue limit
C) Small-amplitude, performed at the beginning of the range
D) Large-amplitude, performed within the range, not up to the limit
1) Grade I – C) Small-amplitude, performed at the beginning of the range
2) Grade II – D) Large-amplitude, performed within the range, not up to the limit
3) Grade III – B) Large-amplitude, performed into the tissue limit
4) Grade IV – A) Small-amplitude, performed into the tissue limit
Sustained mobilizations are held for approximately ___ seconds, with 3-5 seconds of ____ and repeated for a total of __ to __ minutes.
10 seconds
Rest
1-3 minutes
Small-amplitude oscillatory mobilizations are applied like __________.
Vibrations
Large-amplitude oscillatory mobilizations are applied __ to __ times per second.
2-3 times per second
T/F - Both small- and large-amplitude oscillations are applied for approximately 1 minute.
True
There should be __ to __ seconds of rest for oscillatory mobilizations and they can be repeated for a total __ to __ minutes.
3-5 seconds
1-3 minutes
A __________________ effect of mobilization is that small-amplitude oscillatory and distraction movements may stimulate the mechanoreceptors that inhibit the transmission of pain signals.
Neurophysiological
A __________ effect of mobilization is that small-amplitude distraction and gliding movements facilitate synovial fluid motion, which encourages nutrition to avascular structures.
Mechanical
______ grade mobilization, either sustained or oscillatory, will distend the joint capsule and peri-articular joint structures. This will effect _____ of ______.
Higher
Range of Motion
T/F - Mobilization with movement cannot realign bony segments.
False - Mobilization with movement CAN realign bony segments.
Grade I distraction should be used prior to ______ when possible.
Glides
Grade ___ distraction should be used as an initial assessment to determine joint sensitivity and available movement
Grade II Distraction
Grade I and II oscillatory mobilizations are used to decrease ____ and increase nutrition.
Pain
Grade ___ and ___ sustained mobilizations are used to decrease pain.
Grade I and II Sustained
Grade II oscillatory and sustained mobilizations are used to ________ ROM.
Maintain
Grade ____ sustained along with grade ____ and ___ oscillatory mobilizations are used to increase ROM.
Grade III Sustained
Grade III and IV Oscillatory
Pain, muscle guarding and spasm can be treated with low grade ___________ mobilizations.
Oscillatory
Reversible joint ____________ can be treated with ‘progressively vigorous’ mobilizations.
Hypomobility
Positional faults or ____________ can be corrected with higher grade mobilizations, especially with movement.
Subluxations
T/F - Mobilizations can maintain ROM and possibly stop progression of conditions that limit ROM.
False - Mobilizations can maintain ROM and possibly SLOW progression of conditions that limit ROM.
T/F - Mobilization can help maintain ROM and offset degenerative or restrictive effects from a cast or being on bed rest.
True
Joint mobilizations cannot alter disease or ____________ processes, such as rheumatoid arthritis.
Inflammatory
Inappropriately applied joint mobilizations can create or exacerbate _____________, traumatize joints or joint surfaces and initiate _____ or muscle guarding.
Hypermobility
Spasm
The following are ________ contraindications for all joint mobilizations:
- Any undiagnosed lesion
- Joint ankylosis
Absolute
The following are ________ contraindications for high grade joint mobilizations only:
- Hypermobility, ligamentous rupture, instability
- Joint effusion
- Inflammation
- Malignancy
- Osteoporosis
- Osteomyelitis
- Recent fracture
- Herniated discs with nerve compression
Absolute
The following are ________ contraindications for all joint mobilizations:
- Be careful and if in doubt, don’t mobilize
- Osteoarthritis
- Unhealed fractures
- Hypermobility
- Total joint replacements
- Conditions that weaken connective tissue (e.g. RA, advanced diabetes)
- Pregnancy (especially lumbar spine and pelvis)
- Internal derangement
Relative
Apply low-grade joint mobilization (sustained grade I/II or grade I/II oscillations) given that the client’s treatment plan indicates a need to maintain joint ROM and/or decrease joint pain.
Technique Standard 11
CMTO Technique Standard ___ is described as follows:
- Joint is in a loose-pack position
- Joint is taken to the elastic barrier but not beyond, within the client’s pain tolerance
- Assess the joint for pain prior to treatment using a gentle, controlled traction
- Treat the client within their agreed upon pain tolerance
- Perform a gentle traction where possible before doing any gliding movements
- Joint mobilization is not used or is modified if a contraindication to this technique exists
Technique Standard 11
Apply high-grade joint mobilization (sustained grade II or grade III/IV oscillations) given that the client’s treatment plan indicates a need to increase inert tissue elongation through joint mobilization.
Technique Standard 12
CMTO Technique Standard ___ is described as follows:
- Tissues around the joint are warmed and stretched prior to joint mobilization
- Directions of mobilization are correct for that specific capsular pattern
- Joint is in a loose-pack position
- Joint is taken to the end of its physiological ROM, and then slightly beyond the physiological ROM, within the client’s comfort level
- Accessory movement and physiological movements may be improved
- High velocity low amplitude thrust techniques are not used to the spine
- Assess the joint for pain prior to treatment using a gentle, controlled traction
- Treat within the client’s agreed upon pain tolerance
- Take special precaution, based on your assessment, with any client who is prone
Technique Standard 12
Prepare surrounding ______ prior to higher-grade mobilizations and make sure the patient is ___________, stable and the body segment being mobilized is supported.
Tissue
Comfortable
Make sure your hand contact and any other means of _____________ is comfortable and when possible, your _____ must be as close to the joint as possible.
Stabilization
Hands
Initial mobilization is applied in the _______ position and assess the joint movement with a grade ___ distraction prior to the mobilization.
Resting Position
Grade II Distraction
When possible, apply a grade ___ distraction prior to any glide mobilization. Your ____ and the mobilizing segment should be moving as one.
Grade I Distraction
Body
T/F - Mobilize one joint, in two directions, at one time.
False - Mobilize one joint, in ONE DIRECTION, at one time.
Never mobilize through ____ or in the __________ position.
Pain
Close-Pack Position
When progressing a mobilization, always start with the joint in the resting or __________ position.
Loose-Pack Position
T/F - Mobilizing in the resting position is the safest from which to start, but not the most effective position in which to treat.
True
To progress treatment, position the joint at or near the end of the available and _________ ROM prior to mobilizing. This will place the restricting tissue in its most _________ position where the stretch force can be more specific and effected
Pain Free ROM
Tensioned
Grade III and IV mobilizations can cause post-treatment ________, but not pain.
Soreness
T/F - Treatment was too aggressive if the patient experiences pain, soreness lasting more than 24 hours, worsening symptoms, swelling or spasm.
True
T/F - Between treatments, the patient should not perform ROM into any newly gained range and self-mobilization should be avoided.
False - Between treatments, the patient SHOULD perform ROM into any newly gained range and self-mobilization should be APPLIED EVERY OTHER DAY.
These techniques use active contraction of muscles that attach near the joint to correct a joint misalignment. Contractions are applied at the “barrier” and progressed.
Muscle Energy Techniques (MET)
Usual precautions apply for MET, but also note any localized muscle pain or _______.
Strains
When it comes to MET application, contractions are _________ and gentle/submaximal. Contract for __ to ___ seconds and then wait for the muscle to completely _____ (usually about 3-5 seconds). Reposition to the next barrier or point of joint restriction and repeat __ to __ times.
Isometric
5-10 seconds
Relax
3-5 times
A type of stretching that uses the bone as a lever to stretch the capsule.
Passive-Angular Stretching
_______________ stretching may cause pain or damage the joint because:
- The use of a lever magnifies the force at the joint
- The force causes joint surface compression in the direction of the rolling bone
- Roll without slide does not replicate normal joint mechanics
Passive-Angular Stretching
The two most common sources of the “cracking” sound are _______ or scar tissue moving over a bony prominence and cavitation or _______________.
Tendons
Tribonucleation
T/F - Cavitation or tribonucleation can repeat.
False - Cavitation or tribonucleation CANNOT repeat.
T/F - The mechanism of a joint “cracking” is not fully understood.
True
When two joint surfaces are moved or pulled apart, they resist the movement until a critical point where they separate rapidly. This separation creates a vapour cavity which presents as a “crack.”
Tribonucleation
Patient files should reflect the application and _____________ must include:
- Patient postion
- Joint mobilized
- Grade applied
- Type (e.g. oscillatory or sustained)
- Direction of mobilization
- Parameters (e.g. duration, rest, total time)
Documentation
When communicating with patients, briefly explain the mobilization by keeping it simple and using _________ terms.
Layperson
When mobilizing a joint, let the patient know it should not cause ____ but if it does, they must let you know so you can stop or ______. Then ask if they have any questions and if it’s okay to proceed.
Pain
Modify
Traction, distraction or glides applied by the patient as part of home-care.
Self-Mobilization (Auto-Mobilization)
T/F - Self-mobilization is for everyone.
False - Self-mobilization is NOT for everyone.
