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4 classic patterns of inert tissue

1. ROM full and no Px indicating no lesion of inert tissues
2. Px and limitation of movement in every direction - indicates entire joint is affected suggesting arthritis or capsulitis
3. Px and limitation or excessive movement in some directions, but not in others - ligament sprain or local capsular adhesion, movements that stretch, pinch or move affect structure, causing the pain, could be indicative of an internal derangement
4. Limited movement that is Pain free - end feel is usually abnormal, bone to bone type, symptomless arthritis d/t osteophytes


How do you find contractile tissues

Assessed with resisted isometric testing


how you assess Inert tissue issues



4 classic patterns may be seen with contractile and nervous tissue

1. Mvmt that is strong and pain free - no lesion of contractile/nervous tissue
2. Mvmt is strong and painful - local lesion of muscle or tendon; could be 1 degree or 2 degree muscle strain, avulsion # (partial); tendinosis, tendinitis, paratendonitis
3. Movement is weak and painful - severe leision around that joint such as #
4. Movement is weak and pain free indicative of complete rupture of a muscle (3 degree)


Grade of mobilization Grade I

Small amplitude rhythmic oscillations that are performed at the beginning range of joint play, short of tissue resistance

Rate of oscillation (fast) 5x sec
Stage of healing Acute


Grade II of Mobilization

Larger amplitude rhythmic oscillations that do not reach issue resistance
Rate of Oscillation (slow)
Stage of healing - sub acute


Grade III of mobilization

large amplitude rhythmic oscillations that rae applied through the first barrier of tissue resistance

Rate of oscillation (slow) 3x/sec
Stage of healing: chronic


Grade IV of mobilization

Small amplitude rhythmic oscillations performed at the limit of available motion and into tissue resistance but short of anatomical limit
Rate of oscillation (fast) 5x/sec
Stage of healing Chronic


All grades of joint mobilization are performed ------to the treatment plane (joint surface)



Joint play refers to

the movement or play available when the joint is in some degree of loose pack and can be assessed


Joint mobilization 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 the modality used to assess, treat and maintain articular health


Joint restrictions compromise/limit...

movement! Because the neuro-musculoskeltal framework of our bodies includes specific articulations, which provide the necessary flexibility for mobility.


What is the classification of the structure of the joint

Fibrous, cartilaginous and synovial.


What is the functional classification of the joint

diathroses, synarthrosis, amphiarthrosis


What are the sub-types of synovial joints (6 types)

Ball and socket


What does synovial joint posses?

a joint capsule, articular cartilage synovial membrane and fluid as well as innervation essential to posture and movement.
Joint mobilization has positive physiological effect on these components.


Planer Axis and example

Biaxial, back and forth and side to side movement

Naviculocuneiform joint


Hinge joint axis and example

Monaxial, flexion-extention
Humeroulnar joint


Pivot joint axis and example

Monaxial, rotation
Rdioulnar joint


Condyloid joint axis, example

Biaxial, flexion-extension, abduction-adduction

Radiocarpal joint


Saddle joint axis and example

Multi/triaxial, flexion-extension, abduction-adduction, rotation

Carpometacarpal jt (between the trapezium and thum)


Ball and socket joint axis and example

Multi/triaxial; flexion-extension abduction-adduction, rotation

Glenohumeral and aceabulofemoral joint


Osteokinematic movement is

the gross or physiological movement of a joint (angular, special and rotational)


Arthrokinematic movement are

the movements occurring between articulating the surfaces themselves


The gross or physiological movement of a joint

Osteokinematic movement


The movement occurring between articulating the surfaces themselves



What are Accessory or component movements?

the particular arthrokinematic movement, (like roll, glide/slide and spin etc) that occur as one bone moves on another within the joint


What is Roll?

an accessory/component movement analogous to a wheel rolling on a surface; it always travels in the same direction as the angular/physiological movement of the bone itself.


Roll example

Knee flexion an angular movement, moves in a posterior direction, like wise roll is posterior in knee flexion


What is Glide or slide

Component/accessory movement where bone's articulating surface slips on the other, similar to the way a puck slides on ice.


The direction of slide is

either the same or opposite of the physiological/osteokinematic movement, depending on the articulation surface's concave or convex nature


What is spin

is an accessory/component movement where the bone turns around mechanical axis while maintaining a constant contact at a particular point on the reciprocating bone.


Joint mobilization treatment movement

parallel to the treatment plane (glide/slide)
Perpendicular to the treatment plane (traction or compression)


Mechanical axis is

perpendicular o the treatment plane, which is a plane super imposed over the concave articulating surface of a joint


Traction is

the application of a force to draw or pull articulating surfaces apart.


Compression is

the application of a manual force to approximate or press articular surfaces together


What is the benefit of moving the joints

circulates synovial fluid and aids in the health of the intra-articular structures, while it maintains the pliability of the capsule and peri-articular structures as well


Close pack position

is the position of a joint when its articular surfaces are most closely approximated, or congruent and involves a rotational component, where the joint capsule and peri-articular ligaments are tightened so that the joint is fixed or locked.


Can you perform joint movement when joint surfaces are maximally congruent and no movement is possible in close pack position?

No, it is contraindicated. It would damage both intra and extra-articular structures


Loose pack position

is any position of a joint other than closed pack, where there is laxity in some part of the joint capsule.


What does laxity of loose pack position allow?

Arthrokinematic movment


What position does the synovial joint naturally assumes when injury causes maximal synovial effusion (filling of the joint capsule)

Resting position


what do you do when you find restriction in loose pack position is identified?

The therapist backs off 10 degrees and then performs a corrective mobilization


Resting position

is the maximum loose pack position and is ideal for joint play assessment and early treatment.


The particular movements from close to loose-pack are characteristic to

a specific joint moving from relative compression to distraction as a natural consequence of movment


Capsular pattern of restriction

when joint impairment affects the entire joint, the capsule of each joint undergoes a characteristic pattern of restriction in passive range of motion - specific for each joint


Concave-convex Rule

If a concave surface moves on a convex surface, glide/slide occur in the same direction as roll. Conversely, if a convex surface moves on a concave surface, glide/slide occur in opposite direction direction to roll.


Indication for joint mobilization

is to restore pain free ROM
- post immobilization due to sprains, strains, fractures, tendonitis, bursitis, etc.
- To resolve the sequence of fibrosis and relative capsular fibrosis (aka capsular/ligamentous tightening and adherence) and intra-articular damage.
-pain control
-to decrease reflex muscle guarding and restore muscle balance
-improving joint nutrition, eliminating meniscoid impingement


Contraindications of joint mobilization

- neoplasm or any non-diagnosed lesions
-bacterial infection
-recent fracture
-acture/active inflammatory and infective arthritis, i.e.rheumatoid arthritis
-joint ankylosis
-joint is in closed pack position
-active use of corticosteroids
-joint hyper mobility


Precaustions of joint mobilization

These would require omission or modification of treatment
- Joint effusion or inflammation where excess swelling would not allow any movement to occur
-Chronic or non-active inflammatory arthritis/Rheumatoid arthritis
-Diseases affecting the bones structural integrity of connective tissue
-Degenerative joint disease, osteoarthritis, where mobilization may adversely affect bone spur
-Local intra-articular injection (corticosteroids)
-Hormone induced joint hyper extensibility, i.e. relaxin's effect on joints of the pelvis (late stage of pregnancy)
-Guest has an adverse response to joint mobilization or where the treatment is too painful


Joint mobilization procedure

Give a pain scale
Perform joint play/assessment with the joint in loose-pack position
-One bone is stabilized
-one bone is mobilized
-one movement is performed
-one joint is mobilized at a time


What you should not do during joint mobilization manipulation?

Do not lever a joint or allow roll to occur during the manipulation


Joint play 3 stages

1st stage: elastic stage (release the tension, it goes back to the original position)
2nd stage: plastic stage (release the tension, it stays to the new length)
3rd stage: failure or breaking point


Grades of application of joint play

Grade I (for acute) stops at normal position
Grade II (for subacute) stops at the tissue resistance
Grade III (for chronic) goes beyond tissue resistance


Joint mobilization grade I-V

Grade I (acute)
Grade II (subacute)
Grade III (Corrective chromic)
Grade IV (Chronic)
Grade V (Thrust, Chiro only)


Why do we oscilliation

To decrease/modify pain
To warm up the joint


Corrective vs Non corrective

Non corrective Grade I and II - is to modify or decrease pain
Corrective Grade III and IV to improve ROM or physiological change