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PT 670 Jnt Mob Ex/Tx

Would you perform joint mobilization on a hyper-mobile joint? NO
What is joint mobilization? A manual therapy technique comprising a continuum of skilled passive movements to the joints and related soft tissues or both, that are applied at varying speeds and amplitudes, including a small amplitude, high velocity therapeutic movement
What is joint play? The assessment of accessory motions at a joint
Define thrust Grade V: High velocity, low amplitude therapeutic movement within or at the end range of motion
What is a non-thrust manipulation? Grades 1-iV manipulations that do not involve thrust
What are osteokinematics? Physiological movements that take place at a joint The position of one bone in relationship to the other bone
What causes movemetn of a joint? muscle or gravity
What are arthrokinematics? Movement between two articulating surfaces without reference to any external force being applied to the joint
What is an accessory motion? Movement occurring between two joint surfaces that are produced by forces applied by the examiner
Types of arthrokinematic and accessory motions. 1, glide 2. roll 3. spin 4. compression 5. distraction
What is a glide? Specific point on one surface comes into contact with a series of points on another surface
Does glide occur alone? If, not what other movement might occur with glide? roll and gliding
What is a roll? A series of points on one articulating surface come into contact with a series of points on another surface
What is spinning? Occurs when one bone rotates around a stationary longitudinal mechanical axis (same point of moving surface creates an arc as it spins)
What is compression? 1. decrease in space between two joints 2. increases stability 3. normal reaction of a joint when a muscle contracts
What is a distraction? Two surfaces are pulled apart Used in combo with joint mobilization to increase stretch of capsule
Concave on convex rule Gliding is in the same direction as the bone movement Restriction and bony motion in the same direction Knee flexion restriction: posterior glide is restricted
Convex on concave Gliding is in the opposite direction Restriction and bony motion in the opposite direction G-H joint decreased abd: decreased inferior glide restricted
Which convex/concave rule applies to the knee? Tibia is concave, femur is convex (concave on convex)
What is the treatment plane for the knee joint? Tibia
What direction does distraction? glide occur? oscillations? distraction- perpendicular glide- parallel oscillations- parallel
What is the zero possition? arthrokinematic or anatomical position starting point for goniometry, NOT mobilization
What is the resting position? loose-packed, joint capsule and periarticular structures are most relaxed, joint surfaces least congruent, joint play is the most in this position
What is actual resting position? as close to resting as possible
What is the close-packed position? Joint capsule and periarticular tissues are most taut Joint surfaces are most congruent Contraindicated to perform joint play in this position
Kaltenborn Grade I a slow, small amplitude movement that does not take the joint capsule to the limit of the available joint motion; do not go to 1st tissue stop; unweighting joint Structures affected: pain fibers
Kalt Grade II a slow larger amplitude movement that takes the joint capsule to the limit of the available joint motion and into tissue resistance; up to the 1st tissue stop Structures affected: pain fibers and capsule
Kalt Grade III Grade III: a slow even larger amplitude movement that takes the joint through the limit of available joint motion and into tissue resistance; through the 1st tissue stop Structures affected: capsule and periarticular structures
Maitland's Grade I a slow, small amplitude of oscillatory movements that does not take the joint capsule to the limit of available joint motion; not up to the 1st tissue stop; beginning of range Structures aff.: pain receptors; little or no stress to the capsule/ligaments
Mait. Grade II a slow lrge amplitude of oscillatory movements that doesn't take the jnt capsule to the limit of the avail joint motion; not up to 1st tiss stop; 1st ½ of range Structures aff.: pain recep and jnt capsule and periarticular structures (no ch in length)
Mait Grade III slow, lrg amplitude of oscill movemnts takes the jnt up to + slightly thru the limit of avail jnt mot'n and into tiss resist; up to 1st tiss stop and down into ½ elastic rnge Structures aff: jnt capsule and periartic structures; progress glide to grde IV
Mait Grade IV slow, small amplitude of oscillatory movements performed thru the limit of avail jnt motion and into the tissue resistance; up to and slightly thru the 1st tiss stop; never comes back to elastic range Structures aff: jnt capsule and periartic structures
MAit Grade V high velocity, smll amplitude nonoscill movement begins at limit of avail jnt motion and takes jnt into tissue resist; starts at 1st tiss stop and continues ; difficult to control Structures aff: jnt capsule and periartic structures; adhesions, pos faults
Nomenclature for grading for arthrokinetic mobility Normal, Hypomobile, Hypermobile
Grades of joint play/mobility (maitland) 0 no movement (ankylosed/fused) hypomobility 1 considerably decreased movement 2 slight decreased movement 3 normal 4 slight increased movement hypermobility 5 considerable increased movement 6 complete instability
Proper hand position Stable hand: pos. close to the joint line, with the ability to palpate the joint line (90% of the time this will be the proximal bone) Mobile hand: close to joint line, with forearm perpendicular to the bone (90% of the time this will be the distal bone)
Therapist position Close to the patient in order to Ensure resting position is maintained during the examination Minimize aberrant motions during testing and treatment
Purposes of joint mobility Determine if ↓ ROM is due to joint (capsule) or periarticular structures Determine mobility of joint (hypo vs. hyper) Determine end feel of accessory motion: bony or firm Determine if ligaments are compromised Establish baseline Determine progress
Impairments caused by joint immobilization and inflammation Joint capsule + soft tissues affected Decrease in water Increase in cross linkage Increase scar tiss formation Decreased strength of collagen Jnt mob thought to reverse these conseq by promo movement by helpin realign the fibers + decrease the crosslinks
phases of the stress-strain curve 1. elastic 2. plastic 3. failure/breaking point
elastic phase stretched tissue returns to the original state once the force is removed
plastic phase permanent elongation of stretched tissue occurs when the force is removed
failure/breaking point separation of elongated tissue occurs
How forceful should joint mobilization be? Joint mobilization should be forceful enough to bring the tissue to the plastic phase but not to the breaking point -exception would be if the goal was to break through adhesions
Factors affecting joint extensibility 1. amount of force 2. rapidly administered oscillations (increase extensibility and effectiveness of Tx of adhesions) 3. Number of Reps
Number of reps influences creep, what is ti? stretch into plastic phase for an increased time frame increases the amount of extensibility than one of short duration (Gr III, distraction techniques Gr II/III
Impairments of joints 1. positional faults:Minimal alteration of 1 joint surface in relation to another joint surface 2. decreased nutrition 3. pain 4. bony compression
ow does decreased nutrition influence a joint? Articular surfaces avascular: nutrition from synovial fluid Hypomobility causes decreased nutrition to joints and structures Motion is necessary for the diffusion of nutrients to occur Normal movement allows proper joint nutrition
How will jnt mob. help with pain? decreases pain by stimulating joint receptors that block pain impulses through the gate control mechanism by producing reflexive inhibition in periarticular structures
How else does jnt mob. decrease pain? Stimulating fast conducting large diameter proprioceptive nerve fibers that block transmission of the slow conducting small diameter pain fibers, decreasing transmission of pain to the brain
Bony compression at the joint can be caused by what? Meniscal, labral, and capsular entrapment
Treatment for Pain: Relaxation: Decreased joint nutrition: Joint compression: Decreased joint extensibility: Adhesions: Bony alignment: Pain: grade I and II Relaxation: grade I and II Decreased joint nutrition: grade I-IV Joint compression: grade V Decreased joint extensibility: grade III-IV Adhesions: grade III, IV and V Bony alignment: grade IV and V
Treatment with distraction Pain: grade I Increased joint compression: grade I-III Decreased tissue extensibility: grade II-III
Contraindications with joint mobilizations Unstable joint (hypermobility) Recent fracture Over open epiphyseal plates Considerable joint effusion Aggravate joint May make joint appear hypomobile Ankylosing/fused joints Aggravate joint Cause increased inflammation
why is diabetes a contraindication? Nutritional issues at skin surface May cause skin tearing Impaired nutrition to bone Osteoporosis Kidney dysfunction Vascular abnormalities Spine contraindication: vertebral artery test Bacterial infection in the area to be mobilized
What bony diseases are contraindications for joint mobilization? Osteoporosis Osteomyelitis TB Paget’s disease: proximal bone softening of cortical bone leading to possible fractures
two other contraindications for joint mobility Undiagnosed pain RA: exacerbated stages
Precautions to take when doing a joint mobilization Joint irritability or pain Protective muscle spasm/inability for the patient to relax Irritability of adjacent joint structures Chronic debilitating disease
Created by: 696592119