Wk 2- Intro to Joint Mobilizations

Question 1

Mobilization Description

Answer 1

-Skilled, passive movement
-Low Velocity
-Does not go beyond end range
-Can be graded I-III (Kaltenborn) or I-IV (Maitland)

Question 2

Manipulation Description

Answer 2

-Low amplitude
-High velocity
-Thrust
-Intentionally moves joint beyond end range (Grade V mobilization)

Question 3

Grades of Motion (Maitland)

Answer 3

I-IV are all oscillatory with either:
-small amplitude (6-12/s)
-large amplitude (3-6/s)
-before or after “first stop” and before “final stop”

V is a high velocity, low amplitude thrust (HVLAT):
-moves beyond “final stop”

Question 4

Maitland Mobilization Grading Scale

Answer 4

I= small amplitude (6-12/s), before R1 and back to resting
II= larger amplitude (3-6/s), right up to R1 and NOT back to resting
III= between R1 and R2 and NOT back to resting
IV= right up to R2 and NOT back to resting

Question 5

Angular Joint Mobilization/Nordic/Kalltenborn Grading Scale

Answer 5

I= right up to R1, just enough to nullify compressive forces (only applied to traction mob)

II= just before R1 midway to R2, tissue slack is being taken up, surrounding joint tissues are being tightened, assess tissue and subject response

III= between R1 and R2, actual tissue deformation occurs

Question 6

Kalltenborn Joint Movement Types

Answer 6

1. Compression
2. Traction
3. Translatoric (Gliding)

Question 7

Kalltenborn Joint Quality vs Quantity

Answer 7

Quality:
Soft- soft tissue approx./muscle stretch
Firm- Capsular or ligamentous
Hard- Bone or cartilage

Quantity-
0=ankylosed, 1-2=hypomobile, 3=normal, 4-5=hypermobile, 6=unstable

Question 8

Indications for Passive Joint Motion

Answer 8

1. Relief of pain and muscle guarding
2. Restriction of normal joint mobility in presence of stiffness

Question 9

Neurophysiologic Benefits to Passive Joint Mobilization

Answer 9

-small oscillatory movements fire Type I (postural) and Type II (Dynamic) to inhibit pain and muscle guarding
-end range dynamic movements fire type III (Inhibitive) leading to inhibition of muscle guarding

Question 10

Contraindication to use of passive motion

Answer 10

1. hypermobility or instability (recent fx, RA, ligament sprain, osteoporosis)
2. any active disease process (flu, infection, malignancies)
3. conditions of acuity, substantial inflammation, reactivity (based on hx, swelling, warmth, or muscle guarding)

Question 11

Use of accessory motion in assessment and tx per Kalltenborn

Answer 11

1. Compression: provocation assessment only
2. Traction: Grade I (relieve pain and muscle guarding and move joint fluid), Grade II (relieve pain and assess joint play/reactivity), Grade III (increase mobility)
3. Gliding: Grade II (assess joint play and reactivity), Grade III (improve mobility)

Question 12

Principles for Maitland mobilizations

Answer 12

-Grade I and II to reduce pain
-Grade III and IV to increase mobility
-begin and end all mobilization sessions with Grade I and II to facilitate relaxation and reduce pain
-initial mobilization techniques should be performed in loose pack positions