Joint Mobilization (Exam 4) Flashcards
(34 cards)
Joint Mobilization
Selective stretching of specific tissue around a joint without damaging adjacent tissue
Stretching a capsular structure (cartilage structure) in physiological planes
Remodel connective tissue, bathe joint in synovial fluid and nourish joint structure
Restores accessory motions (arthrokinematic) by gliding one joint surface on another, stretching peri-articular structures in the desired direction
Trying to make space and work on ligamentous
only done with tightness or stiffness
When passive = active it is usually a joint structure included, good to do on true contractors and to reduce pain and stiffness
*Great to do on adhesive capsulitis
Contraindications:
*NOT on someone who has loose joints or is unstable
*NOT on joint replacement or fx that are not healed
Acute inflammatory
Septic arthritis - infection and could spread
Bone disease - no compression
Bacterial infection
Malingnancy - don’t want it to spread
Biomechanics
OSTEOKINEMATICS: Movements produced by 2 adjacent bones (flexion, extension, abduction etc) Motions we can see and observe
Motions that we are familiar with that occur in the cardinal planes - flex, ext, ab/adduction, int/ext rotation etc.
Described by the direction the bone is moving
ARTHROKINEMATICS: (accessory) essential movements that occur in joints as a result of physiologic (osteokinematic) motion but which CANNOT BE PRODUCED BY Mm ACTION
The motions that occur in the joint during movement (Spinning, rolling, gliding, sliding) are necessary or impingement, compression, inflammation, stiffness and pain will occur.
What is going on at the joint that we can’t see, not Mm doing it but the forces working around the axis
Occurs at joint surface to keep from pinching structures - not a specific muscle that will make shoulder roll. If not allowed to move at surface we will get stiffness and pain
Every joint in the body has arthrokinematic movements
Concave - convex relationship
Describes the glide of the articular surface (arthrokinematic / accessory motion) of the moving segment relative to its osteokinematic direction of movement.
CONVEX ON CONCAVE RULE:
Convex moving on Concave: Glide is to the OPPOSITE DIRECTION of movement. In other words, the joint surface moves in the opposite direction that the bone shaft is moving.
Ex: Glenohumeral Joint - head of the humerus is convex and the glenoid fossa is concave. As the humeral shaft elevates, the head of the humerus slides and spins down. As the humerus shaft (extends) comes back down the humeral head glides and spins up.
(convex on concave = run the opposite way)
shoulder working on flexion going up so mobilize humerus down
CONCAVE ON CONVEX RULE:
Concave moving on convex: Glide is in the SAME DIRECTION as movement of the bone shaft.
Ex: The IP joints in the digits. As the PIPJ is flexed the middle phalanx bone surface and shaft move volubly. As it extends the bone surface and shaft move dorsally.
(concave on convex = like a wrench moves a hex)
IP of hand is a hinge joint = concave on convex = stiff and can’t flex = mobilize down
Joint Positions
Resting position =
position in which joint capsule and ligaments are most relaxed
evaluation and tx position utilized with hypomobile jts
Loose-packed position (open-packed)
articulating surfaces are maximally separated
joint will exhibit greatest amount of joint play
joint capsule and lig are at max laxity
joint structures are not stressed
surfaces not compressed
position used for both traction and joint mobilization
Closed-packed position =
joint surfaces are in maximal contact to each other
joint capsule and ligaments are tightened
joint structures are stressed
joint surfaces are approximated and compressed
General Rule:
extremes of joint motion are closed-packed
midrange positions are loose-packed
Importance of arthrokinematic motion
essential to normal joint motion
loss of accessory motion can be clinically detected with joint assessment and at times might be the only pathology causing the pain or problem
restoration of accessory/arthrokinematic movement must accompany and usually proceeds restoration of movement in restricted joints.
pay attention to end feel
Roll
A series of points on one articulating surface come into contact with a series of points on another surface (moves in all diff directions)
*rocking chair analogy; ball rolling on ground Ex: femoral condyles rolling on tibial plateau roll occurs in direction of movement occurs on incongruent (unequal) surfaces usually occurs in combination with sliding or spinning
Spin
Occurs when one bone rotates around a stationary longitudinal mechanical axis
*same point on the moving surface creates an arc of a circle as the bone spins *Ex: radial head at the humeroradial joint during pronation/supination shoulder flex/ext and hip flex/ext spin does not occur by itself during normal joint motion
Slide/Glide
Specific point on one surface comes into contact with a series of points on another surface
Surfaces are congruent
When a passive mobilization technique is applied to produce a slide in the joint - referred to as a GLIDE
Combined rolling - sliding in a joint
Safest and most common type of distraction oscillation
Ex: fingers = proximal phalanx head on distal surface can glide - proximal surface held still and distal surface gliding on top of it
Compression and Distraction
Compression =
decrease in space btwn 2 joint surfaces
adds stability to joint
normal reaction of a joint to muscle contraction
Distraction =
2 surfaces are pulled apart
often used in combination with joint mobs to increase stretch of capsule
Assessment of Joint Play: What are we looking at?
Mobility = is it normal, restrictive (hypomobile), or excessive (hypermobile)
End feel
Pain with motion
Structures Being Assessed
Capsular tightness
Joint surface
Congruency - greater contact more resistance to motion
Surface quality - rough vs smooth or loose bodies
Mobilization Techniques
Oscillations - to stimulate mechanoreceptors and inhibit nociceptors, pain relief, low grade I and II
Roll/tilt
Glide
Spin/rotation
Distraction
Traction Grading
*Just know = Grade I - not as much distraction
Grade III - doing a stretch and soft tissue
being stretched
Grade I (loosen)
*neutralizes pressure in joint without actual surface
seperation
*produce pain relief by reducing compressive forces
Grade II (tighten or take up slack)
*separates articulating surfaces, taking up slack or
eliminating play within joint capsule
*used initially to determine joint sensitivity
Grade III (stretch)
*involves stretching of soft tissue surrounding jt
*increase mobility in hypomobile jt
Effects of Joint Mobilization
Neurophysiological effects =
* stimulates mechanoreceptors to decrease pain
* affect muscle spasm and guarding - nociceptive
stimulation
* increase in awareness of position + motion b/c of
afferent nerve impulses
Nutritional effects =
* distraction or small gliding movements - cause synovial
fluid movement
* movement can improve nutrient exchange due to joint
swelling and immobilization
Mechanical effects =
* improve mobility of hypomobile joints (adhesions and
thickening CT from immobilization - loosens)
* maintains extensibility and tensile strength of articular
tissues
Cracking noise may sometimes occur
Indications for Mobilization
Grades I and II - primarily used for pain
* pain must be treated prior to stiffness
* painful conditions can be treated daily
* small amplitude oscillations stimulate mechanorecept
limits pain perception
Grades III and IV - primarily used to increase motion
* stiff or hypomobile joints should be treated 3-4 times
per week alternate with active motion exercises
Joint Mobilization Application
- All joint mobilizations follow the convex - concave rule
- Patient should be relaxed
- Explain purpose of tx and sensations to expect to pt
- Evaluate BEFORE & AFTER treatment
- STOP tx if it is too painful for the pt
- Use proper body mechanics
- Use gravity to assist the mobilization technique if possibl
- Begin & end tx with Grade I or II oscillations
Positioning & Stabilization
- Pt and extremity should be positioned so that the patient
can RELAX - Initial mobilization is performed in a loose-packed
position (in some cases, the position to use is the one in
which the joint is least painful) - Firmly & comfortably stabilize one joint segment, usually
the proximal bone
(hand, belt, assistant)
(prevents unwanted stress & makes the stretch force
more specific & effective)
Patient Response
- May cause soreness
- Perform joint mobilizations on alternate days to allow
soreness to decrease & tissue healing to occur - Pt should perform ROM techniques
- Pt joints & ROM should be reassessed after tx, & again
before the next tx - Pain is always the guide
First Rib Mobilization
- Like to do 2nd rib first
- But when first rib is elevated we need to mobilize it
- Supine - take head in contralateral rotation
place MP on transverse process of T1 which is
just lateral to width of C1
direct forearm to opposite hip start with I and II
oscillations and progress to III past the
pathophysiological limit have client take in a
deep breath and hold, then as they let breath
out you can give a little more pressure - First and second ribs are free floating so sometimes scalenes get shortened or tightened, need the rest of the therapy or it will go right back
Second Rib Mobilization
*Usually done in addition to first rib mob
Scapular Mobilization
The scapula must be able to move to allow humerus to elevate overhead
Mobilize scapula in protraction, retraction, elevation and depression
Medial border distraction
Joint Mob Elbow
Proximal - convex on concave
accessory motions are the opposite
Anterior glide of the radius to increase flex and supination
Posterior glide of the radius to improve ext and pronation
Ulnar distraction
Lateral and Medial glides can be performed for varus and valgus tissue
Joint Mob Shoulder - Glenohumeral Joint
Convex on concave
mobilize in the opposite direction
oscillate for pain reduction
hold for mechanical effects
Inferior glide to improve flexion and abduction
Posterior glide to improve internal rotation
DISTRACTION = to improve motion in ALL PLANES
AC and SC Joint Mob
ACJ: Pt supine
apply pressure down and out toward their hips (not
straight down toward mat, toward feet but at the
angle of the ACJ
SCJ: Pt side lying
stabilize shoulder girdle posteriorly with your body
and cradle the front with your arm and forearm
squat and lift up with your body to create a gentle
distraction at the SCJ
