Mobilising principles Flashcards
(51 cards)
List factors which can contribute towards limited joint range
Degenerative changes, disease processes, trauma, immobility, muscle weakness, muscle spasm and pain
Give methods of joint mobilisation
Manual therapy techniques
Passive movements
Exercise interventions
List the principles of joint mobilisation which make movement in the desired plane easier, mobilising through range and to end range
Continuous movement (reduce inertia)
Increase Momentum (increase speed)
Increase Momentum (add mass)
Large amplitude, through range movement
Gravity-assisted movement
Auto-assisted movement
Reduce Friction
Mobilise to end-of range
End of range holds
Which law does the principle of ‘continuous movement’ follow?
Newton’s 1st Law
Reduces muscle work required to stop and start the movement.
Which law does the principle of ‘increased momentum’ follow?
Newton’s 2nd Law
Beware of using momentum to increase a range of movement which has a natural bony block (i.e. knee and elbow extension) as this could cause injury.
Which law does the principle of ‘large amplitude/through range movement’ follow?
Newton’s 2nd Law.
Increases sweep and squeeze of synovial fluid.
Which law does the principle of ‘gravity assisted movement’ follow?
Newton’s 2nd Law
Acceleration aided by gravitational force.
Which law does the principle of ‘auto-assisted movement’ follow?
Newton’s 2nd Law
Acceleration aided by own (healthy limb) force.
Which law does the principle of ‘reduced friction’ follow?
Newton’s 3rd Law
Reduces muscle work required to start or sustain the movement.
Which law does the principle of ‘end of range holds’ follow?
To effect neural (e.g. stretch tolerance) and viscoelastic changes in the connective tissue.
List key theraputic principles intended to increase patient compliance with exercises
- Use of targets (especially to achieve end range)
- Motivation (use of voice) & correction if required
- Competition (with self or others)
- Variety of exercise & individual approach (consider patient age & interests)
- Instruction & demonstration
- Explanation of potential benefits
Give the practical considerations behind mobilising exercise
- Patients should be appropriately undressed to allow the Physiotherapist to visualise the affected joint
- Consider the optimal starting position for each exercise from both patient comfort and exercise effectiveness perspectives
- Include a localised light warm-up for the body area that is being treated e.g. ankle circling for 1-2 minutes prior to dorsiflexion mobilising
- Use any available equipment to improve efficacy and to add interest for the patient
- Always give the patient at least 2 exercises that are suitable for home use with clear instructions for frequency, reps and sets
To be effective what should the ROM achieved be for each joint?
In order to be effective, it is essential that a mobilising exercise programme is performed both through range and to end range and with sufficiently high repetition.
How many reps and sets should be perfomed for each mobilising exercise?
3 sets of 10-15 reps should be performed for each exercise
How frequently should the at home exercises be performed by the patient?
1/2 times daily
How long should static stretches be held at end of range?
30 secs
Describe Proprioceptive Neuromuscular Facilitation (PNF)
PNF is a series of techniques that use the following principles in order to effect a specific change in the function of the patient:
* All movement is governed by voluntary and sensory sources and utilises both voluntary and reflex movements.
* Proprioceptors increase and reinforce the demands of the voluntary system.
* Reflex reactions are stimulated to initiate and reinforce voluntary movement.
Describe the process of ‘contract-relax’ PNF stretching
This is a method of stretching with the goal of increasing passive range of movement. It is typically used to stretch two-joint muscles (e.g. hamstrings). Following a maximal resisted contraction of the antagonist at end range, the muscle is relaxed and passively moved further into range.
* Position the patient with the muscle to be stretched (antagonist) at end range (remember to consider both joints for two-joint muscles).
* Therapist to position themselves at a mechanical advantage and provide resistance as the patient maximally contracts the muscle to be stretched for at least 5 seconds.
* Instruct the patient to “relax” and as they do so, move the limb passively further into range, sustaining the passive stretch for at least 30 seconds.
* Without releasing the tension, repeat the technique until no more range is gained, finishing with a final 30s stretch.
* As this is a therapist-assisted technique, always teach the patient static stretching for the same muscle group as an accompanying home exercise.
Give examples of intra and extra capular stuctures which if dysfunctioned can reduce joint movement
- Ligaments
- Capsule
- Cartilage
- Tendons
- Fascia
- Synovium
- Muscles
- Skin
- Bone
- Subcutaneous tissue e.g. fat or bursa
- Neurological Control
Reduced movement can lead to abnormalities in these structures
Mechanical stimulation is necessary to maintain function of these structures.
Briefly describe the composition of connective tissue
Made up of cells (e.g. fibroblasts/chondrocytes/chondroblasts/osteoblasts)
and the extracellular matrix.
The EC matrix is made up of fibres (reticulin/collagen/elastin) and ground substance (proteoglycans/GAGs/water)
Describe the turnover of collagen
Normally a balance between ongoing synthesis & degradation (enzyme-activated) of connective tissue matrix and ground substance mediated by fibroblasts. Turnover is relatively slow (especially compared with muscle) – collagen has a very long half-life in health, higher with injury or inflammation.
Describe ‘tensile loading’ of collagen
Tensile loading from normal movement and function e.g. weight bearing stimulates synthesis of collagen which is laid down oriented parallel to the lines of stress. Collagen has very high tensile strength.
Give factors that determine range of movement of a joint
- The structure of the joint itself (arthrology)
- Resistance within the joint itself
- Normally incredibly low co-efficient of friction
- The properties of each joint structure
- Intra-articular e.g. cartilage
- Peri-articular e.g. joint capsule
- Extra-articular e.g. muscle-tendon units
- How external forces are transmitted by the articular soft tissue
- Function of the passive viscoelasticity- exhibit time-dependent strain. Elastic structures stretch and reform, viscous structures resist strain when stress is applied.
- Elasticity – reformation of the substance after a stretch
- Viscosity – strain increases with time (creep) Creep is increasing deformation under constant load
- Varying concentrations of the following determine viscoelastic properties and hence the response to lengthening:
Elastin
Collagen
Proteoglycans
Water - Plasticity = deformation of a (solid) material undergoing non-reversible changes of shape in response to applied forces
- Type of collagen also important.
List mechanical properties of articular connective tissues
Dense connective tissue is very strong
* Organised structure
* Resistant to tensile stress = stiff
* Strongly resistant (rope-like) along lines of stress
* Tendon>Ligament>joint capsule strength
* Coiled coils. Example of MCL at the knee – strongly resists valgus stresses and under tension at end range knee extension
