Joint Mobilization

Question 1

What is Maitland Grade 1?What is the purpose?

Answer 1

-small amplitude and fast (6-12 per second)
- at the beginning of range BEFORE R1
-do not stretch the tissue
-PURPOSE: to decrease pain and irritability

Question 2

what is Maitland grade 2? what is the purpose?

Answer 2

-large amplitude and slow (3-6 per second)
-starts at the beginning of ROM and ends within available ROM up to R1 (first resistance)
-do not stretch the tissue
-PURPOSE: to decrease pain and irritability

Question 3

what is Maitland grade 3? what is the purpose?

Answer 3

-large amplitude and slow (3-6 per second)
-starts at midrange and moves into stiffness from R1 to R2
-stretch the tissue
-PURPOSE: to stretch the joint capsule or passive tissues to increase ROM/ mobility

Question 4

what is Maitland grade 4? what is the purpose?

Answer 4

-small amplitude and fast (6-12 per second)
-moves into stiffness that is primarily focused at R2
-stretch the tissue
-PURPOSE: to stretch the joint and passive tissue to increase ROM/mobility

Question 5

which Maitland grades do NOT STRETCH the joint or passive tissues?

Answer 5

grade 1-2

Question 6

Describe slack with regard to Maitland’s grades of motion

Answer 6

In grade 1, the tissue is still loose. In grade 2, the slack is being taken up, In grade 3 and 4, the tissue is being stretched.

Question 7

What are the passive joint movements by kaltenborn? When are they indicated?

Answer 7

-compression as a provocation technique
-traction
-gliding
Passive joint movements are indicated for relief of pain or muscle guarding and restoration of normal joint mobility in the presence of stiffness.

Question 8

what are contraindications to passive joint movement?

Answer 8

-hypermobility and instability
-recent fractures, ligament sprains, RA, osteoporosis
-active disease processes
-inflammation, swelling, warmth, muscle guarding

Question 9

what are the benefits of passive movement (type 1 receptors)?

Answer 9

Type 1 receptors are postural receptors.
-They fire with small oscillatory movement and inhibit pain and muscle guarding
- they are found in the joint capsule and are small and myelinated
-low threshold and slow adapting
-they promote body awareness

Question 10

what happens when type 1 receptors degenerate

Answer 10

Since type 1 receptors promote body awareness, degeneration will decrease coordination

Question 11

what are the benefits of passive movement (type 2 receptors)?

Answer 11

Type 2 are dynamic receptors. -Small oscillatory movements fire type 2 which inhibit pain and muscle guarding.
- found in the joint capsule and articular fat. Medium sized and myelinated.
-low threshold and fast adapting
-where are we going in space

Question 12

what are the benefits of passive movement (type 3 receptors?)

Answer 12

-Type 3 receptors are inhibitive receptors.
-end range thrusts fire type 3 receptors leading to inhibition of muscle guarding
- found in ligament and are large and myelinated
-high threshold and slow adapting
-firing will lead to reflex inhibition of surrounding muscles.

Question 13

what are the benefits of passive movement (type 4 receptors)?

Answer 13

Type 4 receptors are nociceptive receptors.
- found in most joint structures and are unmyelinated fibers and free nerve endings
- have a high threshold

Question 14

what movements fire Type 1 and Type 2 receptors?

Answer 14

small oscillatory movements
both will inhibit pain and muscle guarding

Question 15

what movement will fire type 3 receptors?

Answer 15

dynamic movements and end range thrusts will fire type 3 receptors which leads to inhibition of muscle guarding

Question 16

what is a soft end feel?

Answer 16

soft tissue approximation or tissue stretch

Question 17

what is a firm end feel?

Answer 17

capsular or ligamentous

Question 18

what is a hard end feel?

Answer 18

bone or cartilage

Question 19

what are the Kaltenborn quantity grades of movement?

Answer 19

0= anklosed (does not move)
1-2= hypomobile (only mobilize if they have tight tissues)
3= normal
4-5= hypermobile
6= unstable

Question 20

You should not mobilize patients that are graded ______ .

Answer 20

patients that are 4-5 (hypermobile) or 6 (unstable) should not be mobilized.

Question 21

There are 3 grades of motion according to Kaltenborn. What is grade 1?What is the purpose?

Answer 21

You are unweighting the tissue, just enough to nullify compressive forces. It should be used ONLY in traction to relieve pain and muscle guarding and to move joint fluid.

Question 22

There are 3 grades of motion according to Kaltenborn. What is grade 2?What is the purpose?

Answer 22

The slack is being taken up. The surrounding joint tissues are being tightened. Used in traction to relieve pain, assess joint play and reactivity (gliding as well)

Question 23

There are 3 grades of motion according to Kaltenborn. What is grade 3?What is the purpose?

Answer 23

Actual deformation “stretch” occurs. Moving beyond first stop into resistance. Used in traction and gliding to increase mobility.

Question 24

What grade of mobilization should a joint mob begin and end with? why?

Answer 24

grade 1 and grade 2 because they facilitate relaxation and pain relief.

Question 25

all mobilization should be performed in the _____ position

Answer 25

loose pack

Question 26

what does it mean when there is a limitation during mobility testing when the concave surface is moving?

Answer 26

the restriction is likely due to a contracture of the trailing portion of the capsule

Question 27

what does it mean when there is a limitation during mobility testing when the convex surface is moving?

Answer 27

restriction is likely due to an inability of the convex moving surface to move into the contracted position of the capsule. Could be due to adhesions in the capsule.