Lec Flashcards by Jonathan Famy

Passive, skilled manual therapeutic techniques applied at varying speeds and amplitudes use if physiologic and accessory motions

Mobilization/Manipulation

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Self stretching techniques that specifically use joint traction or glides that direct the stretch force to the joint capsule

Self-mobilization / Automobilization

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Concurrent application of sustained accessory mobilization and an active physiologic movement to end range to be able to do passive end-of-range over pressure or stretching without pain as a barrier

Brian Mulligan

Manipulation with movement (MWM)

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MWM applicable when (4)

No CI for manual therapy
(+) local musculoskeletal pathology on eval.
(+) localized loss of movement and/or pain associated with function
(-) pain during and immediately after treatment

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High velocity, short amplitude motion such that the patient cannot prevent the motion

Performed at end of pathologic limit

Thrust

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(True/False) thrust is done multiple times

False

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Thrust is intended to (3)

Alter positional relationships

Snap adhesions

Stimulate joint receptors

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Medical procedure

Manipulation under anesthesia

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Active isometric contraction of deep muscles that are attached near the joint and whose line or pull can cause the desired accessory motion

Stabilization is at distal attachment of the muscle

Muscle energy

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Types of physiologic movements (2)

Voluntary

Osteokinematics

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Types of accessory movements (5)

Involuntary

Component motions

Joint play

Compression

Traction

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Motions that accompany active motion but are not under voluntary control

Component motions

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Motions that occur between the joint surfaces as well as the ‘give’ in the joint capsule allowing the bones to move

Joint play

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Joint play is necessary for

Normal joint functioning

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Can be demonstrated passively but not done actively

Joint play

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Roll, slide, compression, distraction, spin

Joint play

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Joint shapes (2)

Ovoid

Sellar (saddle)

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For these to occur, sufficient capsule laxity or joint play is needed

Roll, slide, combined roll-sliding, spin

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Surfaces incongruent

Roll

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Surfaces congruent

Slide

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Surfaces more congruent more sliding

Roll-slide

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Rotation of a segment about a stationary mechanical axis

Spin

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New points to new point resulting in swing. ( angular motion of bone )

Roll

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Same points to new points

Slide

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Same point creates arc of a circle

Spin

Always in the same direction as the angulating bone, concave or convex

Roll

Opposite direction if convex. Same if concave (uses concave convex rule)

Slide

If alone, separation and compression (may lead to joint damage)

Roll

Some movements can cause or control sliding movement

Roll-slide

In normal joints, does not occur alone

Roll

No pure movement of this motion because no joint surface is congruent

Slide

In roll slide, sliding does what?

Restore joint play Reverse joint hypomobility

In roll-slide, rolling is not used when?

To stretch tight joint capsule because it causes joint compression

Rarely occurs alone but in combination with rolling and sliding

Spin

Passive angular stretching (4)

May cause increased pain or joint trauma Use of a lever significantly magnifies force at the joint Excessive joint compression in direction of the rolling bone Roll without slide does not replicate normal joint mechanics

Joint glide stretching (4)

Safer, more selective Force applied close to joint surface, controlled at intensity compatible to pathology Direction of force replicates sliding component of joint mechanics, doesn't compress cartilage Amplitude of motion small but specific, forces selectively applies to the desired tissue

Decrease in joint space Occurs when weight bearing Provides stability when muscles contract

Compression

During rolling, compression occurs on?

Angulating side

In normal compression

Help move synovial fluid and maintain cartilage health

In abnormal compression

Articulate cartilage changes and deteriorates

Distraction or separation of joint surfaces

Traction

Pulling of long axis of bone

Long-axis traction

Pulling at right angle based on concave side

Distraction or joint traction or joint separation *I honestly don't get this

Effects of joint motion (3)

Stimulates biological activity by moving synovial fluid Maintains extensibility and tensile strength of articular and periarticular tissues Provides sensory input for proprioceptive feedback

How does immobilization lead to jt contra tired and ligament ours weakening

Immobilization Fibrofatty proliferation Intra-articular adhesions Jt contra tires and ligamentous weakening

Proprioceptive feedback relative to (5)

Static position and sense of speed of movement (1) Change of speed of movement (2) Sense of direction of movement (1&3) Regulation of muscle tone (1,2,&3) Nociceptive stimuli (4)

Indications (5)

Pain, muscle guarding, spasm Reversible joint hypomobility Positional faults/ subluxations Progressive limitations Functional mobility

Limitations (2)

Cannot change disease process Skill of therapist will affect outcome

Contraindications (3)

Hyper mobility Joint effusion Inflammation

Precautions (10) HB MUTE SEN

Hyper mobility in associated joints Bone disease detectable on X-ray Malignancy Unsealed fracture Total joint replacements Excessive pain Systemic connective tissue disease Elderly (weak connective tissue, diminished blood circulation) Newly formed connective tissues

Eval and assessment for pain

Before tissue limitation: inhibit pain At tissue limitation: gentle specific stretching After tissue limitation: aggressive stretching

Eval and assessment for joint capsule

Capsular pattern Firm capsular end-feel Decreased joint-play movement

Eval and assessment for ligaments

Limited when there is decreased joint play and pain when stressed Joint mob applied to their line of stress

Eval and assessment for subluxation (dislocation or loose intra-articular structures)

Joint manipulation or thrust

Small amplitude rhythmic oscillations beginning of range

Grade 1

Large amplitude rhythmic oscillations within range not reaching limit

Grade2

Uses for grade 1 & 2

For painful joints (inhibitory) Improve nutrition to cartilage

Large amplitude rhythmic oscillations up to the limit of available motion stressed into tissue resistance

Grade 3

Small amplitude rhythmic oscillations at the limit of available motion stressed into tissue resistance

Grade 4

Uses of grade 3 & 4

Stretching maneuvers

Small amplitude high velocity thrust technique

Grade 5

Uses of grade 5

Snap adhesions Reposition dislocation

Speed of grade 1 & 4

Rapid

Rhythm of grade 2 & 3

Smooth regular oscillations at 2-3 per second for 1 or 2 minutes

Small amplitude distraction, no stress on the capsule | Equalizes cohesive forces, minimal tension and atmospheric pressure acting on the joint

Grade I (loosen)

Enough distraction or glide to tighten tissues around joint. "Taking up the slack"

Grade II (tighten)

Distraction or glide; amplitude large enough to place a stretch on joint capsule and surrounding periarticular structured

Grade III (stretch)

Use of grade I (loosen)

All gliding motions relief of pain

Use of grade II (tighten)

Initial treatment: to determine sensitivity of the joint Done intermittently: may inhibit pain If glide, maintain jt play when ROM is not allowed

Use for grade III (stretch)

Stretch jt structures to increase jt play

Application of distraction for pain

7-10 seconds w/rest between cycles

Application of stretching for pain

Apply minimum of 6 sec w/ partial release then repeat with slow, intermittent stretches of 3-4 sec intervals

Low intensity | No stretch on joints

Grade I & II (graded oscillations)

Similar intensity | Applied stretch at end range

``` Grade III and IV (graded oscillations) Grade III ( sustained stretch ) ```

Dosage is determined by

Px response to treatment and state of disease

All joint mob techniques are done

At resting position of joint Or position of least joint pain then progress to end range then apply mobilization

To prevent unwanted stress

Stabilize bone

Movement should be _______ to the treatment plane(2)

Parallel or perpendicular

A plane perpendicular to a line running from the axis of rotation to the middle of the concave articular surface

Treatment plane

Position is determined by the concave bone

Treatment plane

Applied perpendicular to treatment plane

Joint traction

Applied parallel to the treatment plane

Gliding

Initiation and progression. (4)

Always start with grade II distraction (For joint reactivity) Note changes within 24 hours For mobilization of stretch, perform every other day ( for decrease of soreness and for tissue healing to occur) Joint and ROM should be reassessed after treatment and before next treatment

Manual therapy techniques that are used to modulate pain and treat joint dysfunctions that limit ROM by specifically addressing the altered mechanics of the joint

Joint mobilization

Lec Flashcards

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