9/16 - Peripheral Joint Mobilization

Question 1

what are 2 main goals of joint mobilization

Answer 1

modulate pain
treat joint impairments limiting ROM

Question 2

how does joint mobilization treat joint impairments limiting ROM

Answer 2

replicate normal joint mechanics while minimizing abnormal compressive stresses on articular cartilage

Question 3

what do you need to know in order to determine if joint mobilization is indicated

Answer 3

knowledge of anatomy, arthrokinematics, and pathology of neuromuscular system

Question 4

what is a joint mobilization/manipulation

Answer 4

skilled, passive manual therapy techniques applied at joint and related soft tissues at varying speeds and amplitudes

Question 5

osteokinematic

Answer 5

“motion you see”
movements of bones in space
- flex, ext, ABD

Question 6

arthrokinematic

Answer 6

“motion you feel”
accessory motion b/w adjacent joint surfaces
- roll
- glide
- spin
occurs w all A/PROM

Question 7

how do you assess osteo vs arthrokinematics

Answer 7

osteo - typical AROM/PROM assessment
arthro - joint play

Question 8

what is joint play

Answer 8

passive movement
- can’t be achieved by active ms contraction

Question 9

what is a component movement

Answer 9

involuntary obligatory joint motion
- occurs w active motion

ex: scapular upward rotation (component) w shoulder flexion (active)

Question 10

arthrokinematic motion: roll

Answer 10

new points on one surface come in contact w new points on another surface

Question 11

what are other words for a glide

Answer 11

slide
translation

Question 12

what arthrokinematic motion is the majority of joint play assessments

Answer 12

glide

Question 13

arthrokinematic motion: glide

Answer 13

translatory motion
one point on one surface contacts new points on another surface

Question 14

arthrokinematic motion: spin

Answer 14

rotation around a single point of contact
- CW or CCW direction

Question 15

describe osteo and arthro motion when concave moves on convex

Answer 15

osteo and arthro move in the same direction

ex: tibia on femur, flexion means a posterior roll and posterior slide

Question 16

describe osteo and arthro motion when convex moves on concave

Answer 16

osteo and arthro move in opposite directions

ex: humerus on glenoid, when flex or ABD arm - humerus glides inferiorly and rolls superiorly

Question 17

obligate translation

Answer 17

restricted capsular mobility will cause translation AWAY from tightness

Question 18

what are some reasons you could have limited shoulder flexion

Answer 18

limited inferior glide
- capsule tightness
tight muscles / ms length
pain / anticipated pain
- empty end feel or pt stops you
- more indicative of pain/guarding

Question 19

where is the treatment plane

Answer 19

perp to axis
parallel to joint surface

Question 20

traction

Answer 20

separation of joint surfaces perp to treatment plane

Question 21

what can traction do and how does it accomplish this

Answer 21

help w pain and mobility
- applies load to entirety of joint capsule

Question 22

gliding (in terms of treatment plane)

Answer 22

joint surfaces displaced parallel to treatment plane

Question 23

if no gliding is occurring what does this likely indicate

Answer 23

issue w capsule

Question 24

overall grades for traction

Answer 24

grade 1 - unweighting
grade 2 - taking up slack
grade 3 - capsule & ligaments stretched

Question 25

describe grade 1 traction

Answer 25

unweighting/loosening - not pulling hard enough to feel end point - won't feel anything stopping motion

Question 26

when is grade 1 traction typically indicated

Answer 26

helpful to dec pain good for people w high reactivity

Question 27

describe grade 2 traction

Answer 27

taking up the slack as you separate - the first time you feel some tissue resistance - feel some tension

Question 28

describe grade 3 traction

Answer 28

capsule and ligaments stretched - get to end of available motion

Question 29

how do you assess joint mobility

Answer 29

it is difficult - poor intra/intertester reliability quantity graded in mm quality graded by "end feel" comparison to uninvolved side - assess that side first

Question 30

why are soft hands important when doing a joint mobility assessment

Answer 30

if you grab to hard, can make patient guard

Question 31

describe handling technique in a joint mobility assessment

Answer 31

soft hands hands close to joint line (most proximal) palpate joint line to inc sensitivity to motion

Question 32

why is it important for a patient to be relaxed for a joint mobility assessment

Answer 32

guarding or tightening muscles can limit motion - can feel like a false end range how relaxed pt is correlates to PT handling techniques and how supported pt feels

Question 33

what are things of note when assessing the quality of joint mobility

Answer 33

onset of resistance/ms guarding end feel - normal? pain provocation - reactivity?

Question 34

joint mobility grades

Answer 34

0 - no movement, ankylosed 1 - mod, marked hypomobility 2 - slightly hypomobile 3 - normal 4 - slightly hypermobile 5 - mod, marked hypermobility 6 - unstable, dislocated, subluxed

Question 35

what joint mobility grade do you not mobilize

Answer 35

grade 0** shouldn't be mobilizing grades 4 or 5

Question 36

what joint mobility grades are mobilization indicated for

Answer 36

grades 1 and 2

Question 37

what joint mobility grade is no treatment needed at all for

Answer 37

grade 3

Question 38

what joint mobility grade is the treatment plan assessment for adjacent hypomobility, stabilization exercise, taping, bracing

Answer 38

grade 4 and 5

Question 39

what are indications for mobilization

Answer 39

pain, ms guarding & spasm reversible hypomobility positional fault / subluxation goal to achieve full unrestricted pain free ROM

Question 40

grade 6 treatment plan

Answer 40

bracing, splinting, casting, surgical stabilization

Question 41

how does joint mobilization help w pain, ms guarding and spasm

Answer 41

gentle techniques stimulate mechanoreceptors to inhibit transmission of nociceptive stimuli

Question 42

how does join mobilization reverse hypomobility

Answer 42

progressively vigorous techniques

Question 43

how can joint mobilization help w a positional fault / subluxation

Answer 43

relocate joint - seen w patella and shoulder

Question 44

what are 3 neurophysiological effects of mobilization

Answer 44

1. stim of mechanoreceptors 2. dec nociceptive stim of brainstem/SC 3. proprioceptive & kinesthetic awareness

Question 45

what are 3 mechanical effects of mobilization

Answer 45

1. inc blood supply and nutrients to area 2. stretch/elongate hypomobile structures such as capsular or ligamentous tissue 3. break adhesions

Question 46

contraindications to mobilization (8)

Answer 46

1. most acute cases 2. malignancy in area 3. infectious arthritis 4. metabolic bone dz 5. fusion / ankylosis 6. OM 7. fx 8. ligament rupture

Question 47

precautions for mobilization (7)

Answer 47

1. excessive pain/swelling 2. arthroplasty 3. pregnancy 4. hypermobility 5. spondylolisthesis 6. RA 7. vertebrobasilar insufficiency

Question 48

why is excessive pain/swelling a precaution for mobilization

Answer 48

can indicate something more serious is happening and should look further into it

Question 49

why is arthroplasty a precaution for mobilization

Answer 49

depending on surgery technique can change how you mobilize the joint

Question 50

grades of mobilization

Answer 50

I - small amplitude at beginning of range II - large amplitude w/i available range III - large amplitude reaching end range IV - small amplitude movement at end range V - high velocity thrust manipulation

Question 51

what are grades 1 and 2 for joint mobilization helpful for

Answer 51

for pain - stimulate mechanoreceptors not for inc motion bc not in end range

Question 52

what are grades 3 and 4 for joint mobilization helpful for

Answer 52

ROM and joint play - getting into end range - putting load onto tissues

Question 53

how do you pick what grade of joint mobilization to implement

Answer 53

what the goal is

Question 54

what is the role of pain in how you determine the grade of joint mobilization to implement

Answer 54

just bc have pain doesn't mean you can only do grades 1 or 2 - if have <5/10 pain, and person is hypomobile you can do grades 3 or 4 the pain is relatively low primary problem is hypomobility - addressing this will help relieve pain one thing to be uncomfortable, as long as they can tolerate it

Question 55

how do you stabilize for joint mobilization

Answer 55

stabilize one segment and be as close to joint line as possible

Question 56

what is the procedure for joint mobilization (7)

Answer 56

explain what you are going to do pt position and PT position joint position stabilization direction of force amt of force pt response

Question 57

what are mobilization treatment variables (6)

Answer 57

grade of technique rhythmic or sustained position of joint direction of movement sx guides selection of techniques always re-exam joint for change in ROM

Question 58

what position do you typically start joint mobilization in

Answer 58

open pack - there is equal slack in the joint

Question 59

after doing joint mobilization what is an important next step

Answer 59

to do something active to engage the muscle

Question 60

what are treatment considerations for grades I and II

Answer 60

neurophysiological effect to treat pain - neuromodulation on sensory innervation of joint mechanoreceptors & pain receptors neutralizes joint pressures

Question 61

what are treatment considerations for grades III and IV

Answer 61

mechanical effect to treat stiffness / hypomobility - inc mobility plastic deformation of capsule