Joint Manipulation

Question 1

definition of joint manipulation/mob

Answer 1

skilled passive movements to the joints and or related soft tissues that are applied at varying speeds and amplitudes

Question 2

thrust joint manipulation

Answer 2

high velocity, low amplitude therapeutic movements within or at end range of motion

Question 3

what grade is high velocity low amplitude mob?

Answer 3

5

Question 4

maitland’s theory

Answer 4

move a peripheral or vertebral segment to increase motion or decrease pain

Question 5

who identified graded passive movements

Answer 5

maitland

Question 6

kaltenborn’s theory

Answer 6

restore movement allowed by shape of surface (convex/concave)

Question 7

cyriax’s theory

Answer 7

stretch joint capsule
alter shape/reduce strain of disc

Question 8

evjenth’s theory

Answer 8

stretch muscles spanning joint

Question 9

mennell’s theory

Answer 9

restore joint play

Question 10

strain/counterstrain theory

Answer 10

decrease soft tissue strain to facilitate muscle relaxation

Question 11

myofascial release theory

Answer 11

decrease tension in soft tissue to increase segmental movement to decrease likelihood that dysfunction returns

Question 12

A ______ is something the patient complains of while a _______ is an objective finding

Answer 12

symptom, sign

Question 13

T or F: a joint sign is an objective finding

Answer 13

T: anything found within a joint, its structures or movements that is abnormal

Question 14

comparable sign

Answer 14

• reproduction of the patient’s complaint of pain through examination
• reproduces the pt’s symptoms

Question 15

asterisk sign

Answer 15

outstanding signs used for quick reassessment of a patient’s progress

Question 16

how many asterisk signs should you try to find

Answer 16

1-2

Question 17

for pain, what is the goal of treatment

Answer 17

reduce, centralize, and eliminate the pain

Question 18

for stiffness, what is the goal of treatment

Answer 18

reproduce the pain (with respect) moving further into range to reduce stiffness

Question 19

pain is often _______ while stiffness is localized

Answer 19

diffuse

Question 20

is pain or stiffness usually worse at night?

Answer 20

pain

Question 21

does stiffness usually cause limitations? what about pain?

Answer 21

stiffness no, pain yes

Question 22

in pain-dominant patients, pain is usually constant while in stiffness dominant it is ___________

Answer 22

intermittent

Question 23

T or F: stiffness is usually chronic

Answer 23

T

Question 24

pain is aggravated by ________ activity and is slow to reduce while stiffness is aggravated by ________ activity and only lasts a short time

Answer 24

mild, vigorous

Question 25

in pain dominant, pain is usually ______ than a 5/10 while in stiffness-dominant pain is usually _________ than a 5/10

Answer 25

greater, less

Question 26

T or F: pain dominant is often aggravated by repeated movements

Answer 26

T: but for stiffness dominant repeated movements often increase range

Question 27

_______ dominant has pain at rest, early, and mid-range whereas ________ dominant usually only has pain at end range

Answer 27

pain, stiffness

Question 28

T or F: stiffness dominant usually has spasms

Answer 28

F: but pain does!

Question 29

Your pt c/o constant 7/10 shoulder pain that gets worse at night. He is very guarded and doesn't want to move his shoulder. On objective exam you find he has pain at rest, early, and mid-range. He also has spasm and as you continue your exam his pain increases. Is this pt most likely pain or stiffness dominant?

Answer 29

pain **your exam on someone who is pain-dominant may not be as in depth

Question 30

Your pt c/o 5/10 shoulder pain only w/ overhead movements. On objective exam, you find he has limited abduction, flexion, and ER. No spasms are found. As you continue your exam and moving his shoulder around his range slightly increases. Is this pt most likely pain or stiffness dominant?

Answer 30

stiffness

Question 31

what grades of mobs do you use for pain? what about stiffness?

Answer 31

grade 1-2 grade 3-4

Question 32

goal of mobs for pain

Answer 32

stay short of resistance to reduce pain

Question 33

goal of mobs for stiffness

Answer 33

go into/through barriers to produce pain in order to increase range

Question 34

for ________ dominant you use most free movements for manual treatment and exercise while for _______ dominant use most restricted movements for treatment

Answer 34

pain stiffness

Question 35

pain is likely an ______ condition, while stiffness is likely a ______ condition

Answer 35

inflammatory, mechanical

Question 36

3 signs of irritable patient/pain

Answer 36

1 - easily provoked, 10 mins or less of activity 2 - constant or severe intermittent pain 3 - takes 10 mins or more to settle pain back to baseline

Question 37

treatment for irritable pain

Answer 37

- grade 1 or 2 mobs for brief and few bouts - PROM, AAROM, AROM - light resistance exercise with fewer reps to be repeated throughout the day

Question 38

treatment for non-irritable pain

Answer 38

- grade 3-4 mobs for longer and more bouts - ROM also into barrier and end range - higher resistance and reps

Question 39

R1

Answer 39

onset of resistance

Question 40

R2

Answer 40

resistance limit

Question 41

P1

Answer 41

onset of pain

Question 42

P2

Answer 42

pain limit

Question 43

S1

Answer 43

onset of spasm

Question 44

S2

Answer 44

spasm limit

Question 45

A (on movement diagram)

Answer 45

beginning of movement

Question 46

B (on movement diagram)

Answer 46

end of normal ROM

Question 47

L (on movement diagram)

Answer 47

abnormal limit to a ROM

Question 48

passive physiological

Answer 48

typical PROM

Question 49

passive physiological intervertebral movements

Answer 49

used to assess movements at individual spinal levels

Question 50

passive accessory intervertebral motions (PIVMS)

Answer 50

movements available in a joint performed passively by the therapist

Question 51

TJM

Answer 51

thrust joint manipulation grade 5

Question 52

3 motions occurring when you do mobs

Answer 52

1 - osteokinematics 2 - arthrokinematics 3 - compression and distraction

Question 53

bone motion (flexion, abduction, rotation) is what kind of kinematics

Answer 53

osteokinematics

Question 54

osteokinematics are described from anatomical __________

Answer 54

neutral

Question 55

rolls and glides are what kind of kinematics? these are also known as accessory motions

Answer 55

arthrokinematics

Question 56

how many grades of movement are there

Answer 56

5

Question 57

grade 1

Answer 57

small amplitude, short of resistance

Question 58

grade2

Answer 58

large amplitude, short of resistance

Question 59

grade 3

Answer 59

large amplitude to 50% of R1-R2

Question 60

grade 4

Answer 60

small amplitude to 50% of R1-R2

Question 61

grade 5

Answer 61

small amplitude, high velocity thrust at end of available range

Question 62

type 1 and 2 mechanoreceptors

Answer 62

in joint capsules low threshold, excited with oscillations

Question 63

type 3 mechanoreceptors

Answer 63

in joint capsules, extracapsular ligs excited by stretching

Question 64

type 4 mechanoreceptors

Answer 64

in capsules, ligaments, fat pads, and blood vessels - pain receptors

Question 65

what type of mechanoreceptrs do you NOT want to excite

Answer 65

type 4

Question 66

what are some contraindications of joint mobs

Answer 66

- vertebral artery insufficiency - acute RA - instability - unhealed fracture - cauda equina - acute inflammation - psychological or undiagnosed pain - pain that doesn't relate to movement - bone disease - joint effusion - malignancy

Question 67

precautions for joint manipulation

Answer 67

- excessive pain - total joint replacement - fusion - neuro deficit - osteoporosis - spondylolishesis - pregnancy - acute trauma - foraminal encroachment - steroids or anticoagulants

Question 68

you should stabilize ________ and mobilize ________

Answer 68

proximally, distally