Foundational Theory

Question 1

What are osteokinematic movements?

Answer 1

the gross, big movements of bones that occur at joints

Question 2

What are examples of osteokinematic movements?

Answer 2

flexion, extension, abduction, etc…

Question 3

What are arthrokinematic movements?

Answer 3

smaller movements that occur within joints, enabling the greater movements that occur at the joints

Question 4

What are some examples of arthrokinematic movements?

Answer 4

roll, glide, spin

Question 5

What does passive accessory mobilization/manipulation refer to?

Answer 5

externally imposed, small amplitude passive motion intended to produce gliding or traction at a joint

Question 6

What does passive physiological mobilization/manipulation refer to?

Answer 6

pROM

Question 7

What does “loose pack” or “resting position” refer to?

Answer 7

the position where the periarticular tissues/joint capsule is the most lax and there is the most space between the articular surfaces

Question 8

The most comfortable position for a patient with joint pain is usually…

Answer 8

resting/loose pack

Question 9

What is “actual resting position”?

Answer 9

whatever the most comfortable position is for the patient, with the least amount of soft tissue tension - unique to the patient

Question 10

What is the treatment plane?

Answer 10

the plane you are mobilizing within, which is parallel to the articulating surfaces (look at the concave plan and imagine it flattened)

Question 11

If a concave surface moves on a stable convex surface, roll and slide must occur…

Answer 11

in the same direction as the osteokinematic movement

Question 12

If a convex surface moves on a stable concave surface, roll and slide must occur…

Answer 12

in the opposite direction of the osteokinematic movement

Question 13

What occurs in ‘spinning’?

Answer 13

one point of one surface remains in contact with the articulating surface while rotating in relation to it

Question 14

In rolling, one point comes into contact with another point _____ from the original contact point on both surfaces

Answer 14

equidistant

Question 15

In glide/slide, the point of contact stays the same on which articulating surface?

Answer 15

the moving surface

Question 16

Restricted ROM is most often associated with a decrease in which arthrokinematic movement?

Answer 16

gliding

Question 17

Differentiate sellar vs. ovoid joints

Answer 17

sellar - one surface is concave in one direction and convex in the direction perpendicular to it

ovoid - one surface is completely concave, the other completely convex

Question 18

What is ‘excursion’?

Answer 18

the amount of movement available in the joint capsule

Question 19

Which grades of excursion present a corrective opportunity for joint mobilization?

Answer 19

grade 1 or grade 2

Question 20

You would never try to mobilize/increase mobility in joints with which grades of excursion?

Answer 20

grade 0, or 4, 5, 6

Question 21

Articulating surfaces are maximally congruent in what position?

Answer 21

closed-pack

Question 22

The position a joint will assume in the case of synovial effusion is…

Answer 22

resting position

Question 23

What does ‘capsular pattern of restriction’ refer to?

Answer 23

the predictable pattern of restriction that occurs in a synovial joint when pathological conditions exist, affecting the whole joint capsule. this is listed from most restricted to least

Question 24

To position the joint to prepare for a mobilization, what should you do?

Answer 24

move the joint to the point of restriction, then back off by approximately 10 degrees before performing it

OR for some you may start from resting position

Question 25

Joint play assessment should be done in what position?

Answer 25

resting

Question 26

List the absolute contraindications of joint mobilizations.

Answer 26

``` recent fracture neoplasm acute inflammatory disease (like RA) joint sepsis bacterial infection acute pain response ```

Question 27

What are the non-corrective grades of sustained glide and of corrective oscillations?

Answer 27

sustained glide: 1 + 2 oscillations: 1 + 2

Question 28

What are the corrective grades of sustained glide and corrective oscillations?

Answer 28

sustained glide: 3 oscillations: 3 + 4

Question 29

End feel: firm, leathery, with a slight creep, may describe...

Answer 29

a capsular end feel

Question 30

End feel: firm, with no give/creep, may describe...

Answer 30

ligamentous end feel

Question 31

A bony end feel may suggest...

Answer 31

hypertrophic bone changes IF accompanied by restricted movement

Question 32

End feel: rubbery, less abrupt than capsular, may describe...

Answer 32

muscular end feel

Question 33

"Pronounced, springy rebound - accompanies noncapsular restriction from a mechanical block, such as a loose body or displaced meniscus" may describe which end feel?

Answer 33

internal derangement

Question 34

What would the end feel be like in the case of adhesions and scarring?

Answer 34

sudden sharp arrest in one direction

Question 35

What end feel is described? "similar to normal but with pain and mm guarding, stiffness in early range that increases until end is reached"

Answer 35

soft capsular

Question 36

In the case of a pannus, what would the end feel be like?

Answer 36

soft, crunchy squelch which may be due to synovial infold or trapped fat pad

Question 37

Hypomobility without pain suggests...

Answer 37

chronic adhesion or contracture

Question 38

Normal mobility with pain suggests...

Answer 38

mild sprain without capsular fiber disruption

Question 39

Normal mobility with pain can be treated with...

Answer 39

gentle mobilization to decrease pain and promote normal alignment of fibres in healing process

Question 40

Hypermobility with pain suggests...

Answer 40

partial sprain of capsular tissue

Question 41

Hypermobility without pain suggests...

Answer 41

complete sprain of capsular tissue

Question 42

Hypermobility with pain can be treated with...

Answer 42

gentle mobilization to decrease pain and promote normal alignment of newly forming collagen

Question 43

Pain that increases with distraction and decreases with compression suggests...

Answer 43

ligamentous or other capsular structures' involvement rather than the articulating surfaces

Question 44

What identifies the elastic phase?

Answer 44

tissue will return to original configuration when force is removed

Question 45

What occurs in the plastic phase?

Answer 45

permanent elongation of tissue even once force is removed

Question 46

What does the 'necking point' refer to?

Answer 46

a decrease in load is accompanied by an increase in deformation, suggests that breaking point is about to be reached

Question 47

What is the failure or breaking point in the stress-strain curve?

Answer 47

where separation of elongated tissue occurs

Question 48

____ speed oscillations may relax mm guarding

Answer 48

slow

Question 49

Oscillatory techniques are recommended for ______

Answer 49

pain management or high tonicity

Question 50

What is the function of oscillations in a prolonged stretch?

Answer 50

to reduce the amount of discomfort and facilitate maximal relaxation

Question 51

What are the pathological conditions that would affect the whole joint?

Answer 51

effusion, capsular fibrosis, and pseudo-fibrosis (or relative capsular fibrosis)

Question 52

Movement that is perpendicular to the treatment plane would mean you are doing a...

Answer 52

distraction

Question 53

Movement that is parallel to the treatment plane would mean you are doing a...

Answer 53

glide

Question 54

What are the absolute contraindications?

Answer 54

``` recent fracture metabolic bone disease acute inflammatory disease neoplasms ankylosing of joint joint sepsis/bacterial infection acute pain response to mobilization hesitancy/no consent ```

Question 55

What is the capsular pattern of restriction for the glenohumeral joint?

Answer 55

ER > abd > IR

Question 56

Describe the resting position for the shoulder joint

Answer 56

55-70 degrees of abduction + 30 degrees horizontal adduction

Question 57

What would closed pack position be for the shoulder joint?

Answer 57

maximal horizontal abduction + external rotation

Question 58

Describe an Excursion Grade 1

Answer 58

Considerable limitation

Question 59

Describe an Excursion Grade 0

Answer 59

Absolutely no movement between articular surfaces

Question 60

Describe an Excursion Grade 2

Answer 60

Slight limitation

Question 61

Describe an Excursion Grade 3

Answer 61

Normal!

Question 62

Which excursion grade is used for 'normal' mobility?

Answer 62

3

Question 63

Describe a joint with an excursion grade of 6?

Answer 63

unstable joint, stabilization exercises likely unsuccessful, most likely a surgical case

Question 64

There are _ grades of excursion, _ kaltenborn grades, and _ maitland grades.

Answer 64

6, 3, 4

Question 65

Small or large: describe the amplitude of oscillations for each of the Maitland grades

Answer 65

1 - small 2 - large 3 - large 4 - small

Question 66

Which Maitland grade would this be: "small amplitude movement at the beginning of the available ROM"

Answer 66

grade 1

Question 67

Which Maitland grade would this be: "small amplitude within/at tissue resistance"

Answer 67

grade 4