Joint mobilization 300

Question 1

GH joint – resting position, closed pack position, capsular pattern of restriction

Answer 1

Closed packed position: maximal abduction and lateral rotation
Resting position: 55* of abduction and 30* horizontal adduction
Capsular Pattern: lateral rotation, abduction, medial rotation

Question 2

GH flexion, roll/glide

Answer 2

anterior roll
posterior glide

NOTE FLEXION IS ALSO INFERIOR GLIDE

Question 3

GH extension, roll/glide

Answer 3

posterior roll
anterior glide

Question 4

GH internal rotation, roll/glide

Answer 4

anterior roll
posterior glide

Question 5

GH external rotation, r/g

Answer 5

posterior roll
anterior glide

Question 6

GH horizontal adduction, r/g

Answer 6

anterior roll
posterior glide

Question 7

GH horizontal abduction, r/g

Answer 7

posterior roll
anterior glide

Question 8

GH abduction, r/g

Answer 8

superior roll
inferior glide

Question 9

GH adduction, r/g

Answer 9

inferior roll (?)
superior glide (?)

Question 10

GH miscellaneous pathologies (including shoudler complex misc pathologies)

Answer 10

Winging scapula (paralysis of serratus ant and long thoracic nerve)
Adhesive capsulitis
Subscapular bursitis
Impingement syndrome
Supraspinatus and bicipital tendonitis
Post immobilization

Question 11

ST joint resting position, closed pack position, capsular pattern of restriction

Answer 11

N/A

Question 12

ST joint movements

Answer 12

Protraction/Retraction,
Elevation/Depression,
Upward Rotation of glenoid fossa/Downward rotation of glenoid fossa
(GFK 2018).

Question 13

scapulohumeral rhythm ratio

Answer 13

2:1 ratio
humerus 2x for scapula 1x

0-30 no scap movement

at 30 scap begins rotating superiorly

@ 60 scap 120 humerus

Question 14

humeral distraction (traction)

Answer 14

pull straight down

traction = sustained pull
distraction = not sustained for long

Question 15

traction vs distraction

Answer 15

traction = sustained pull
distraction = not sustained for long

RMT generally do distraction, not traction

traction can be done with external force (machine) w/ physio

Question 16

humeral distraction in other directions

Answer 16

can be straight down

can be laterally

Question 17

inferior glide GH

Answer 17

abduction flexion

Question 18

posteiror glide

Answer 18

internal rotation
flexion

horizontal adduction

Question 19

anterior glide

Answer 19

extension
external rotation

horizontal abduction

AND to decrease pain (?)

Question 20

note distraction signficance

Answer 20

always a little distraciton between Joint mobiization

distraction:
a less intense version of joint mob glide

Question 21

note during a glide/mobilization

Answer 21

don’t release tension in capsule all the way to neutral

always keep a bit of tension while doing frequency of glides/oscillation

Question 22

Humeroulnar/humeroradial flexion, r/g

Answer 22

anterior (distal) roll
anterior glide

Question 23

humeroulnar/humeroradial extension, r/g

Answer 23

posterior (proximal) roll
posterior glide

Question 24

proximal radioulnar pronation, r/g

Answer 24

.

Question 25

proximal radioulnar supination, r/g

Answer 25

.

Question 26

humeroulnar resting position, closed pack, capsular pattern of restriction

Answer 26

Close packed: extension with supination
Resting position: 70* flexion and 10* supination
Capsular pattern: flexion, extension

Question 27

HU joint pivot

Answer 27

The HU joint, particularly the trochlea can pivot (rotate) 5 degrees which are accessory (necessary) movements for FX/EXT.

Question 28

flexion, radial gap

Answer 28

To increase flexion @the HU joint > radial gap allows the radial part of the trochlea to pivot 5 degrees so full flexion can occur.

Question 29

extension, ulnar gap

Answer 29

To increase extension @the HU joint>ulnar gap allows the trochlea to pivot 5 degrees so extension can occur.

Question 30

humeroradial closed pack, resting position, capsular pattern of restriction

Answer 30

Close packed: 90* flexion, forearm supinated to 5*
Resting position: full extension and full supination
Capsular pattern: flexion, extension

Question 31

** JM 300 – first lecture (theory) **

Answer 31

.

Question 32

end feels

Answer 32

soft (soft tissue approximation)

firm (stretch from muscle, capsule, ligament)

hard (bone on bone)

Question 33

abnormal soft/hard end feel – and empty end feel

Answer 33

(abnormal)

Soft - wrong timing during movement or abnormal for that joint (e.g. edema or synovitis

Firm or Hard
- bony grating or bony block
- wrong timing during movement or abnormal for that joint (e.g. increased mm tonus, loose bodies, mm or fascial shortening, OA)

Empty - pain prevents sense of end feel (e.g. acute joint inflammation, bursitis, abscess, fracture, psychogenic factor)

Question 34

Joint play meaning

Answer 34

refers to the movement or “play” available when the joint is in some degree of loose- pack and can be assessed.

Question 35

joint mobilization define

Answer 35

“is a passive modality that moves a joint through its accessory movements (normally not under voluntary control), to restore pain-free physiological movement. Joint mobilization is a passive movement of the articular surfaces performed by a therapist to decrease pain and/or increase joint mobility. (Mulligan). “

Question 36

recall: classification of joints (Structural classification)

Answer 36

Synovial: This is the most common and freely moveable articulation. Joint mobilizations are primarily concerned with synovial joints.

Cartilaginous: Examples include the manubriosternal joint and the pubic symphysis

Fibrous: Examples include the sutures of the skull and syndesmoses between certain long bones

Question 37

recall: classification of joints (Functional classification)

Answer 37

Synarthrosis: an essentially immobile joint (e.g. sutures of the skull and rib 1 of Sternocostal joint)

Amphiarthrosis: a joint with limited movement (e.g. intervertebral joints and pubic symphysis)

Diarthrosis: a freely mobile joint (e.g. Glenohumeral joint and radiocarpal)

Question 38

6 subtypes of synovial joints

Answer 38

planar

hinge

pivot

condyloid

saddle (Biaxial/Triaxial (GFK 2018))

ball and socket

Question 39

who established joint mobilization?

Joint mobilization definition

Answer 39

Mennell, Cyriax, Kaltenborn, Maitland, Mulligan, Paris & Grimsby

Definition:
“… an externally imposed small amplitude passive motion that is intended to produce gliding or traction at a joint”

“… a specific technique in which the articular capsule is passively stretched …”

Question 40

Why do RMTs use JM?

Answer 40

Used as an assessment tool.

also
To help restore PAIN-FREE ROM by:

“Modulating pain and treating joint dysfunctions that limit range of motion by specifically addressing the altered mechanics of the joint. “

“Specifically address restricted capsular tissue by replicating normal joint mechanics while minimizing abnormal compressive stresses on the articular cartilage of the joint. “

Question 41

4 types of JM (Maitland)

Answer 41

1) Passive Accessory Mobilizations - intended to produce glide or traction

2) Passive Physiological Mobilizations – PROM

3) Muscle Energy - passive joint movement induced by active contraction of the patient’s own muscles

4) Mobilization with Movement - passive joint movements that occur simultaneously with AROM

Question 42

which type of JM will JM300 focus on?

Answer 42

1) Passive Accessory Mobilizations - intended to produce glide or traction

Question 43

osteokinematic vs arthrokinematic

Answer 43

Osteokinematic: Refers to the movement of the parts of the body in the anatomical planes. These terms are flexion, extension, abduction, adduction, internal rotation, external rotation. They are the gross movements that you can see/visible.

Arthrokinematic: The unobservable (invisible) articular accessory/component movements between adjacent joint surfaces (e.g. roll, spin, and glide). They can not occur independently or voluntarily and if restricted, can limit physiological movement. They are necessary for normal ROM.

Question 44

accessory/component movements

Answer 44

***“Roll: movement analogous to a wheel rolling on a surface and always travels in the same direction as the physiological movement of the bone itself. E.g. The tibia moves posterior in knee flexion and the roll is also in a posterior direction.”

“Glide/Slide: movement where one bone’s articulating surface slips on the other, similar to a puck sliding on the ice. The direction may be the same or opposite of the gross bone movement.”

“Spin: movement where the bone turns around a mechanical (vertical) axis while maintaining a constant contact at a particular point on the reciprocating bone.”

Roll/glide is main focus (?)

Question 45

mechanical axis?

Answer 45

Mechanical Axis: perpendicular to the treatment plane

Question 46

treatment plane?

Answer 46

Treatment Plane: plane superimposed over the concave surface of the joint

Question 47

distraction (/traction)

Answer 47

Distraction: application of force to pull articulating surfaces apart (type of traction)

Question 48

compression

Answer 48

Compression: manual force applied to approximate articular surfaces together

(opposite of distraction?)

Question 49

closed pack position

Answer 49

Close Packed Position: joint position when articular surfaces are most closely approximated; capsule and ligaments tightened. It is a CI for joint mobs.

Question 50

loose packed position (resting position?)

Answer 50

Loose Packed Position: laxity in some parts of the joint capsule; this allows for arthrokinematic movement and is the position for joint mobs.

Question 51

capsular pattern of restriction

Answer 51

Capsular Pattern of Restriction: characteristic pattern of ROM restriction for each joint; occurs when condition affects the whole joint.

Question 52

grades of glide/traction (Kaltenborn)

Answer 52

Grade I: small amplitude
Grade II: take up the slack in tissue
Grade III: stretch joint capsule

Note: grade I and II are non-corrective

Question 53

grades of oscillation (Maitland)

Answer 53

Grade I: small-amplitude rhythmic oscillations are performed at the beginning range of joint play

Grade II: Large-amplitude rhythmic oscillations are performed within the range, not reaching tissue resistance

Grade III: Large-amplitude rhythmic oscillations are performed up to the limit of the available motion and are stressed into the tissue resistance.

Grade IV: Small-amplitude rhythmic oscillations are performed at the limit of the available motion and stressed into the tissue resistance but short of anatomical limit

Grade V: Small-amplitude high-velocity thrust technique to the limits of available motion. It is beyond the RMT scope of practice.

Question 54

when to use each grade?

Answer 54

Grade I and II traction and/or grade I and II joint mob oscillations are used to modify/interrupt pain.

Grade III traction and/or grade III and IV joint mob oscillations are considered corrective. They use mechanical distention to promote capsular mobility.

For acute stage of healing, grade I is usually applied.

For subacute stage of healing, grade I and possibly grade II is applied

For chronic stage of healing, grades I to IV may be applied depending on the treatment goal.

all of the above applications are subject to patient presentation and comfort

Question 55

important points/steps

Answer 55

1) If there is limited or painful motion, assess which tissues are affected and the state of the pathology/stage of healing. Determine the joint mob goal: pain relief or joint nutrition or altering ROM.

2) Position the patient so that they are comfortable and joint being mobilized is well supported and in loose packed position.

3) One bone is stabilized (usually proximal bone) and one is mobilized (usually distal bone).

4) Apply a slight distraction before beginning the joint mobilization in the determined direction and grade (make sure the mobilizing bone is not being levered.)

5) If pain occurs, stop treatment and reassess.

Question 56

indications for JM

Answer 56

Main purpose is to restore pain free range of motion

-neurophysiological effects (decrease pain)

-increase synovial fluid motion thereby increasing joint nutrition

-reverse joint hypomobility

-correct positional faults

-slow down progressive mechanical restrictions from trauma or conditions

-increase functional mobility post-immobilization

-to decrease reflex muscle guarding and restore muscle balance

Question 57

CI’s for JM (& precautions)

Answer 57

-hypermobility

-joint effusion

-joint is in close packed position

-conditions needing precautions for stretching or movement (e.g. malignancy, bone disease, fracture, pain, hypermobility, total joint replacements, newly formed connective tissue, systemic connective tissue conditions, ACUTE ARTHRITIS, joint ankylosis)

-bacterial infection

-active use of corticosteroids

-elderly with weakened connective tissue and/or decreased circulation

Question 58

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Answer 58

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