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Clinical Practice 2 > Week 1: Joint mobs > Flashcards

Week 1: Joint mobs Flashcards

1
Q

Injury to a joint or structures surrounding a joint will often lead to:

A

Pain
Loss of motion (tightening/ inflammation)
Excessive motion (streched JC)

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2
Q

Loss of motion at a joint could be due to several reasons

A 
Pain and muscle guarding
Joint hypomobility
Joint effusion (swelling)
Contractures (scarring) or adhesion in joint capsule or supporting structures
Combination
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3
Q

Objectives of manual therapy

A

Pain modulation
Address tissue extensibility
Address muscle guarding
Peripheral effects (improve circulation, fluid/waste uptake, improve healing, etc.)
Improve tolerance for other interventions

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4
Q

Guarding is when active is

A

Guarding is when active is more than passive*

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5
Q

How to measure effectivness of manual therapy

A

test and re-test: measure then intervention and re-test did it get better, worse, or the same

use observable pattern

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6
Q

joint capsule is made of _ tissue and forms a _ around the joint. It can vary in _ according to _ placed on it. Vital to the _ of synovial joint

A

Dense fibrous connective tissue

Forms sleeve around the joint

Varies in thickness according to stresses placed on it

Vital to function of synovial joints

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7
Q

3 Roles of joint capsules

A

Seals joint space
Provides stability by limiting movements
Provides active stability via its proprioceptive nerve endings

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8
Q

During AROM translation/glide direction is influenced by the

A

capsuloligamentous complex

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9
Q

Passive restraints act to

A

restrict movements but also to reverse articular movements at the end range of motion

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10
Q

Tight capsular structure will cause

A

early and excessive accessory motion in the opposite direction of the tightness

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11
Q

perform assesment in ___ position of the joint and assess _ and _ of joint mvm

A

perform assessment in RESTING POSITION of the joint assessing the QUALITY AND QUANTITY of joint mvm

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12
Q

Open packed

zygopophyseal (spine facet) joint

A

midway between flexion and extension

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13
Q

open packed

temporomandibular

A

mouth slightly open

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14
Q

open packed

glenohumeral

A

55 degrees abd/30 degrees horizontal add/slight ER

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15
Q

Open packed

acromoclavicular

A

arm resting by side

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16
Q

open packed

sternoclavicular

A

arm resting by side

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17
Q

open packed

ulnohumeral

A

70 degrees flexion/10 degrees supination

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18
Q

Open packed

radiohumeral

A

Full extension/ full supination

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19
Q

Open packed

proximal radioulnar

A

70 degrees flexion/ 35 degrees supination

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20
Q

open packed

distal radioulnar

A

10 degrees supination

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21
Q

open packed

radiocarpal joint

A

slight flexion and ulnar deviation

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22
Q

Open packed

carpometacarpal

A

midway between abd/add and flex/ext

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23
Q

open packed

metacarpophalangeal

A

slight flexion

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24
Q

open packed

interphalangeal

A

slight flexion

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25
Q

open packed hip

A

30 degrees flexion/30 degress abd/ 0-5 degrees ER

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26
Q

open packed

tibiofemoral

A

25 degrees flexion

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27
Q

open packed

patellofemoral

A

full extension

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28
Q

open packed

talocrural

A

10 degrees plantar flexion/midway between extremes of inversion and eversion

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29
Q

open packed

subtalar

A

midway between extremes of OROM

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30
Q

open packed midtarsal

A

midway between extremes of ROM

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31
Q

open packed

metatarsophalngeal

A

neutral

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32
Q

open packed

interphalangeal

A

slight flexion

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33
Q

what do you asses with joint assessment

A

gross quantity of mvm
end feel
provocation

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34
Q

gross quantity of mvm levels

A

hypomobile
normal
hypermobil

35
Q

end feel possibilities

A

firm
hard
empty

36
Q

what does provocation mean

A

painful painless

37
Q

Current classification scale, more commonly used toda

A

hypomobile
normal
hypermobike

38
Q

define hypomobile

A

Motion stops short of anatomical limit at pathological point of limitation

Pain, spasm, adhesions, inflammation

39
Q

define hypermobile

A

Joint moves beyond its anatomical limit because of laxity of surrounding structures

40
Q

Manual therapy techniques involving movement of articulating surfaces with intention of:

A 
Regaining normal ROM
Improving joint capsule extensibility
Regaining normal distribution of forces and stresses on a joint
Reducing pain
Lubricating joint surfaces
Providing nutrition to joint structures
41
Q

joint mobs are most effective when

A

combined with a comprehensice treatment plan

42
Q

absolute contraindications (8)

A 
CANCER in the area
active inflammation 
active infections
joint fusions (ankylosis)
fractures 
untrained practioner
neuro degeneration 
disease affecting bone integrety 
arterial insufficieny
43
Q

relative (yellow flags) contraindications

A 
exessive pain/ swelling in the area
arthroplasty 
hypermobility
metabolic bone disease 
pregnancy 
spondylolisthesis (vert split)
44
Q

joint mkobs help biomechanixs how

A

Motion improvement
Positional improvement
Increase joint capsule extensibility

45
Q

joint mobs nutritional effects

A

Synovial fluid movement

Improve nutrient exchange

46
Q

joint mobs neurophysiological

A

Stimulates mechanoreceptors to inhibit pain impulses

gate control and descending pain pathway

47
Q

gate control theory

A

Gate control theory

Slow pain signals are getting to the brain faster so that the pain signals are unable to get into the brain

48
Q

brain

Descending pathway inhibition theory

A

(primarily related to grade V mobilizations/manipulations)

Grade 5 manips: stimulate the periaqueductal gray area for pain modulation

49
Q

stress strain curve

A

Toe- taking up the slack
Yield: stretch but come back to normal
Plastic region: good amount of stress to make a permanent stretch

50
Q

joint play mvm

A

compression
traction/distraction
gliding

51
Q

compression joint mobs

A

approximation of joint surfaces; force perpendicular to joint plane
Improves stability

52
Q

traction/ distraction joint mob

A

separation of joint surfaces; force perpendicular to the joint plane
Pulling away from the joint surface perpendicular
People who have rubbing love distraction

53
Q

gliding

A

force direction parallel to joint surface

54
Q

how many grades are there for distraction

A

3

55
Q

Distraction

grade I

A

piccolo (loosen)
Very small amplitude of traction force

Minimal stress on the joint capsule

Reduces compression forces on articular surfaces

Pain reduction

Commonly used with gliding mobilizations

56
Q

Distraction

Grade II

A

slack (take up the slack, “tightening”) in elastic
phase

Slack in joint capsule and surrounding tissues is taken up

Can help to determine the sensitivity of the joint

Used to alleviate pain, assess joint play, and/or reduce muscle guarding

57
Q

Distraction

Grade III

A

stretch

Designed to stretch joint capsule and soft tissues surrounding the joint to increase mobility

Used to assess end feel or increase movement

58
Q

how many grades for oscillation grades

A

5

59
Q

Oscillation

Grade I

A

Small amplitude technique performed at beginning of available ROM (first 25%)

Primary goal:
reduce pain and muscle guarding
improve joint lubrication/nutrition

60
Q

Oscillation

Grade II

A

Large amplitude technique performed in middle of available ROM (middle 50%; 25-75%)

Primary goal:
reduce pain and muscle guarding
improve joint lubrication/nutrition

61
Q

oscillations

Grades I and II summery and theory

A

Pain relief and muscle guarding

No direct mechanical effect on restrictions

Influences mechanical nociception

Often used before and after grade III and IV mobilizations

Theory:
Reduces pain by improving joint lubrication and circulation to tissues related to the joint

Rhythmic oscillations possibly activate articular and skin mechanoreceptors which play role in pain reduction

62
Q

oscillations

Grade III

A

Large amplitude technique performed at end of available ROM (last 50%; 50-100%)

Primary goal:
stretching joint capsule and associated structures (ligaments, muscles attaching in the area)

63
Q

Oscillations

Grade IV

A

Small amplitude technique performed at end of available ROM (last 25%; 75-100%)
Hovering at end range w/ small mvm

Primary goal:
stretching joint capsule and associated structures (ligaments, muscles attaching in the area)
ONLY ON HYPOMOBILE that is not hypermobile correction
Assess the mvm at all times to make sure they are not normal and assess what grade do they need that day

64
Q

summery of grade III and IV fxn

A

Primarily stretching techniques

Mechanical and neurophysiological effect

May activate inhibitory joint and muscle spindle receptors to aid in reducing restriction of movement

65
Q

Oscillations

Grade V

A

High velocity thrust of small amplitude at end of available range but within its anatomical range

Movement that exceeds the resistance barrier

Commonly referred to as high velocity thrust technique or joint manipulation

Primary goal:
decrease pain and muscle guarding

66
Q

Oscillations Grade V summery

A

Similar to grade IV in terms ofamplitude and position in joint range, but difference in velocity

Applied to barrier or point of joint restriction

Involves application of fast impulse (quick thrust) of small amplitude (short distance)

Joint briefly forced beyond restricted ROM

67
Q

joint mobs types

A

Distractions
Oscillation mobilizations
Sustained hold mobilizations
Manipulations

68
Q

target impairments for oscillation mobs and manips

A

guarding, pain, joint hypomobility

Address extensibility

Must consider stress-strain curve of
collagen tissue when considering efficacy of joint mobilization for improved joint mobility

69
Q

sustained hold mobs target impairments

A

joint mobility, pain

Pain:
beginning range to mid range

Joint mobility:
end range
Address tissue extensibility directly to allow motion (when enough force applied for enough time according to stress-strain curve for collagen)

70
Q

joint mobs technique

A 
Resting position used for: 
Assessment
Acute stage
During grade I and II oscillations
Can be used during grades III and IV if this is the only position patient can tolerate

When attempting to improve ROM (grades III and IV) should place joint at
end ROM if tolerable

One half of joint should be stabilized,
while other half is mobilized

71
Q

technique for mobs the therapist positions should be

A

Both stabilizing and mobilizing hands should be as
close as possible to the joint line

Clinician’s hands should make
maximum contact with patient’s body

72
Q

in what direction do you apply a joint mobs

A

Based on convex concave rule and which part of joint is being mobilized and which is being stabilized

73
Q

goal time and ocillations per second

A

1-3/seconds
Typically:
1-5 sets for 15-60 seconds each

74
Q

goal sustained hold times

A

Typically:
1-5 sets for 5-30 seconds each
More commonly used to treat ROM

75
Q

tips for PTs applying mobs

A

Allow gravity to
assist when possible

Your body and the mobilizing part should act as
one unit as much as possible

Body
mechanics!!!

When possible your forearm should align with the
intended direction of your force

Reassess afterwards

Stop for the day when a large improvement has been
obtained or when improvement ceases

76
Q

How do I know what direction to push for joint glides?

A

ARTHROKINEMATICS
CONVEX/CONCAVE RULE
CONCAVE/CONVEX RULE

77
Q

Grade I and II mobilizations direction is

A

Direction less important as
not stretching the joint capsule
Trying to stimulate the gate control theory

Perform grade I and II in direction which
initially caused their pain if tolerated

Often done in 
open pack (resting) position
78
Q

direction of Grade III and IV

A

Determine what motion you want to improve and the direction of the osteokinematics (ie hip extension)

Determine what joint you are going to mobilize (ie hip joint)

Determine which part of the joint you are going to mobilize which part is going to be stationary (ie femur=mobilizing, acetabulum=stationary)

Determine if bone mobilizing is convex or concave (femur=convex)

Convex on concave=mobilize opposite direction as osteokinematics; if concave on convex=mobilize in same direction as osteokinematics

If tolerated should mobilize at the end range (where restriction likely is)

79
Q

most often therapist mobilize

A

distal part of the joint and stabilize the proximal portion

80
Q

Mulligan’s Mobilization with Movement (MWMs) type

A

combined sustained joint mobilization applied by therapist while patient performs active movement to end range

81
Q

mulligans golden rule

A

Golden rule of MWMs should be painless,

if pain occurs either need to change direction of force, correct pressure, or not use MWMs

82
Q

MWM’s theory

A

bony positional faults contribute to painful joint restrictions

83
Q

MWM’s guidelines

A

Should be
pain free when performing

Apply
10 times before reassessing joint motion

Overpressure
should be applied at end range of AROM

Clinical Practice 2 (3 decks)

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