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CP 2 > Joint Mobalizations > Flashcards

Joint Mobalizations Flashcards

1
Q

What 3 things does injury to a joint or structure surrounding a joint often lead to?

A
  1. Pain
  2. Loss of motion
  3. Excessive motion
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2
Q

Why does a loss of motion happen at a joint?

A

Because of:

  1. Pain and muscle guarding
  2. Joint hypomobility
  3. Joint effusion
  4. Contractures or adhesion in joint capsule or supporting structures.
  5. Combination of things
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3
Q

What are the main objectives for manual therapy?

A
  1. Pain modulation
  2. Address tissue extensibility
  3. Address muscle guarding
  4. Peripheral effects - improve circulation, fluid/waste uptake, improve healing
  5. Improve tolerance for other interventions.
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4
Q

How should the effectiveness of manual therapy be assessed?

A

By test re-test!

*want to utilize observable patterns of response.
Ask “Is it better? Worse? or the same?”

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5
Q

Describe a joint capsule.

A
  • Dense fibrous connective tissue that forms a sleeve around the joint.
  • It varies in thickness according to the stresses placed on it.
  • Is vital to function of synovial joints.
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6
Q

What are the roles of joint capsules?

A
  1. Seal joint space
  2. Provides stability by limiting movements
  3. Provides active stability via its proprioceptive nerve ending.
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7
Q

What influences the AROM translation/glide direction in a joint capsule?

A

The capsuloligamentous complex.

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8
Q

What do passive restraints do for the joint capsule?

A

Act to restrict movements but also to reverse articular movements at the end ROM.

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9
Q

What will happen if a capsular structure is tight?

A

Will cause early and excessive accessory motion in the opposite direction of the tightness.

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10
Q

What position do you perform the assessment of joint mobility?

A

In the resting (open-pack) position of the joint.

  • Want to assess quality and quantity of joint movement.
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11
Q

What are the things you are accessing for with joint mobility?

A
  1. Gross quantity of movement:
    - Hypomobility
    - Normal
    - Hypermobility
  2. End-feel (quality of movement)
    - Firm
    - Hard
    - Empty
  3. Provocation
    - Painful
    - Painless
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12
Q

What do you ask the patient when assessing the joint and it causes pain?

A

“Is this your pain that brought you here?”

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13
Q

Describe hypomobile.

A

When the motion stops short of anatomical limit at pathological point of limitation.
- Can be due to: pain, spasm, adhesions, inflammation

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14
Q

Describe hypermobile.

A

Joint moves beyond its anatomical limit because of laxity of surrounding structures.

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15
Q

What are the interventions used for manual therapy techniques aimed at accomplishing when addressing joint mobility?

A
  1. Regaining normal ROM
  2. Improving joint capsule extensibility
  3. Regaining normal distribution of forces and stresses on a joint
  4. Reducing pain
  5. Lubricating joint surfaces
  6. Providing nutrition to joint structures.
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16
Q

How are interventions of manual therapy for joint mobilization most effective?

A

When combines with comprehensive treatment plan.

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17
Q

What are the ABSOLUTE contraindications for joint mob intervention?

A
  1. Malignancy in area of treatment
  2. Active inflammation and/or infectious joint
  3. Ankylosis (fusion) of joint
  4. Fracture at the joint
  5. Practitioner lack of ability
  6. Neurological deterioration
  7. Disease which affects integrity of ligaments
  8. Arterial insufficiency
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18
Q

What are the RELATIVE contraindications for joint mob intervention?

A
  1. Excessive pain or swelling in the area
  2. Arthroplasty
  3. Hypermobility
  4. Metabolic bone disease
  5. Pregnancy
  6. Spondylolisthesis
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19
Q

What are biomechanical mechanisms proposed for joint mobilizations?

A
  1. Motion improvement
  2. Positional improvement
  3. Increase joint capsule extensibility
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20
Q

What are nutritional mechanisms proposed for joint mobilizations?

A
  1. Synovial fluid movement

2. Improve nutrient exchange

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21
Q

What are neurophysiological mechanisms proposed for joint mobilizations?

A

Stimulates mechanoreceptors to inhibit pain impulses.

  • Gate control theory
  • Descending pathway inhibition theory
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22
Q

Describe compression in terms of joint play movement.

A

Approximation of joint surfaces; force perpendicular to joint plane.
- Improves stability

23
Q

Describe traction/distraction in terms of joint play movement.

A

Separation of joint surfaces; force perpendicular to the joint plane.

24
Q

Describe gliding in terms of joint play movement.

A

When the force direction is parallel to joint surface.

25
Q

What is the name of Kaltenborns first distraction grade? What characterizes this grade?

A

Grade 1 - piccolo (loosen)

  • Very small amplitude of traction force
  • Minimal stress on the joint capsule
  • Reduces compression forces on articular surfaces
  • Pain reduction
  • Commonly used with gliding mobilizations
26
Q

What is the name of Kaltenborns second distraction grade? What characterizes this grade?

A

Grade 2 - slack (take up the slack, “tightening”)

  • Slack in joint capsule and surrounding tissues is taken up
  • Can help to determine the sensitivity of the joint
  • Used to alleviate pain, assess joint play. and/or reduce muscle guarding.
27
Q

What is the name of Kaltenborns third distraction grade? What characterizes this grade?

A

Grade 3 - stretch

  • Designed to stretch joint capsule and soft tissues surrounding the joint to increase mobility
  • Used to assess end feel or increase movement
28
Q

Describe what you would do for grade 1 of Maitland joint mobilization oscillations.

A

Small amplitude technique performed at the beginning of available ROM (first 25%).

29
Q

What is the primary goal of Maitland’s grade 1 joint mobilization oscillations?

A

Primary goal = reduce pain and muscle guarding, and improve joint lubrication/nutrition.

30
Q

Describe what you would do for grade 2 of Maitland joint mobilization oscillations.

A

Large amplitude technique performed in middle of available ROM (middle 50%; 25-75%)

31
Q

What is the primary goal of Maitland’s grade 2 joint mobilization oscillations?

A

Primary goal = reduce pain and muscle guarding, and improve joint lubrication/nutrition.

32
Q

Describe what you would do for grade 3 of Maitland joint mobilization oscillations.

A

Large amplitude technique performed at end of available ROM (last 50%; 50-100%)

33
Q

What is the primary goal of Maitland’s grade 3 joint mobilization oscillations?

A

Primary goal: stretching joint capsule and associated structures (ligaments, muscle attaching in the area)

34
Q

Describe what you would do for grade 4 of Maitland joint mobilization oscillations.

A

Small amplitude technique performed at end of available ROM (last 25%; 75-100%)

35
Q

What is the primary goal of Maitland’s grade 4 joint mobilization oscillations?

A

Primary goal = stretching joint capsule and associated structures (ligaments, muscle attaching in the area)

36
Q

What is the advantage of using grades 1 and 2 of Maitland’s Oscillations?

A

Reduces pain by improving joint lubrication and circulation to tissues related to the joint.

  • Rhythmic oscillations possibly activate articular and skin mechanoreceptors which play role in pain reduction.
37
Q

What is the advantage of using grades 3 and 4 of Maitland’s Oscillations?

A
  • Primarily stretching techniques.
  • Mechanical and neurophysiological effect.
  • May activate inhibitory joint and muscle spindle receptors to aid in reducing restriction of movement.
38
Q

Describe what you would do for grade 5 of Maitland joint mobilization oscillations.

A
  • High velocity thrust of small amplitude at end or available range but within its anatomical range.
  • Movement that exceeds the resistance barrier.
  • Commonly referred to as high velocity thrust technique or joint manipulation.
39
Q

What is the primary goal of Maitland’s grade 5 joint mobilization oscillations?

A

Primary goal = decrease pain and muscle guarding.

40
Q

What type of techniques are used for a grade 5 that are different from the other grades?

A
  • Similar to grade 4 in terms of amplitude and position in joint range, but difference in velocity.
  • Applied to barrier or point of joint restriction.
  • Involves application of fast impulse (quick thrust) of small amplitude (short distance)
  • Joint briefly forced beyond restricted ROM.
41
Q

What are the 4 different types of joint mobilizations?

A
  1. Distractions
  2. Oscillation and mobilization
  3. Sustained hold mobilizations
  4. Manipulations
42
Q

What type of impairments are targeted with oscillation mobilizations and manipulations?

A

Guarding, pain, and joint hypomobility.

  • Want to address extensibility
  • Must consider stress-strain curve of collagen tissue when considering efficacy of joint mobilization for improved joint mobility.
43
Q

What type of impairments are targeted with sustained hold mobilizations?

A

Joint mobility and pain.
- For pain: beginning range to mid range (25% beginning, 50% mid range)
- For joint mobility: end range
Address tissue extensibility directly to allow motion

44
Q

What technique do you use for joint position with sustained hold mobilizations?

A

Resting position used for:

  1. Assessment
  2. Acute stage
  3. During grade 1 and 2 oscillations
  4. Can be used during grades 3 and 4 if this is the only position patient can tolerate.
  • When attempting to improve ROM (grades 3/4) should place joint at end ROM if tolerable.
  • One half of joint should be stabilized, while other half is mobilized.
45
Q

What is the therapist position with sustained hold mobilizations?

A

Both stabilizing and mobilizing hands should be as close as possible to the joint line. Clinicians hands should make maximum contact with patient’s body.

46
Q

What is the direction of mobilization based on?

A

Based on convex concave rule and which part of joint is being mobilized and which is being stabilized.

47
Q

For oscillations, how long do you hold them? How many sets do you try and for how long?

A

Hold for 1-3/seconds. Typically do 1-5 sets for 15-60 seconds each.

48
Q

For sustained holds, how many sets do you try and for how long?

A

Typically do 1-5 sets for 5-30 seconds each.

More commonly used to treat ROM.

49
Q

What are some techniques used when applying joint mobilizations?

A
  1. Allow gravity to assist when possible
  2. Your body and the mobilizing part should act as one unit as much as possible.
  3. Use proper body mechanics.
  4. When possible your forearm should align with the intended direction of your face.
  5. Reassess afterwards
  6. Stop for the day when a large improvement has been obtained or when improvement ceases.
50
Q

What direction should you apply the joint glide for grade 1 and 2 mobilizations?

A

Perform in direction which initially caused their pain if tolerated.
Done in open pack position.

51
Q

What direction should you apply the joint glide for grade 3 and 4 mobilizations?

A

Follow the convex on concave rule so mobilize opposite direction of osteokinematics. Or follow concave on convex rule so mobilize in same direction of osteokinematics.
- apply mobilization at the end ROM if can tolerate.

52
Q

Describe Mulligan’s Mobilization with movement.

A

Combined sustained joint mobilization applied by therapist while patient performs active movement to end range.

Golden rule of MWMs should be painless, if pain occurs either need to change direction of force, correct pressure or not use MWMs.

53
Q

What is the theory for Mulligan’s Mobilization with Movement?

A

Bony positional faults contribute to painful joint restrictions.

54
Q

What are the guidlines for Mulligan’s Mobilization with Movement?

A
  1. Should be pain free when performing
  2. Apply 10 times before reassessing joint motion
  3. Overpressure should be applied at end range of AROM.

CP 2 (1 decks)

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