Peripheral joint mobilization

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24 Οκτ 2013 (πριν από 3 χρόνια και 9 μήνες)

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Peripheral joint mobilization

Made by Sajida Mazhar


Joint mobilization


Joint mobilization refers to manual therapy
techniques
that are
used to


modulate
pain and


treat
joint dysfunctions


regain
range of motion (ROM)


addressing the altered
mechanics of the joint.



The altered joint mechanics may be due to


pain


muscle guarding


joint effusion


Contractures


adhesions in the joint capsules


Adhesions in supporting ligaments


Malalignment



subluxation

of the bony
surfaces


Joint mobilization


It differ
from stretching in that they


specifically address restricted capsular tissue by replicating normal
joint
mechanics


minimizing abnormal compressive stresses on the articular cartilage
in the joint
.



practitioner must know


anatomy


arthrokinematics and


pathology of the
neuromusculoskeletal system



recognize when the techniques are indicated


when other techniques would be more effective for regaining lost
motion
.


False use of may lead to potential
harm to the patient’s
joints.

Mobilization/Manipulation


They are passive skilled manual therapy
techniques


applied to joints and related soft tissues


at varying speeds and amplitudes using
physiological or accessory motions for therapeutic
purposes.



speeds and amplitudes could range from


a small
-
amplitude force applied at high velocity


to a large
-
amplitude force applied at slow velocity

Self
-
Mobilization (Auto
-
mobilization)


Self
-
mobilization refers to self
-
stretching
techniques


specifically use joint traction or glides that direct



the stretch force to the joint capsule.

Mobilization with Movement


Mobilization with movement (MWM) is


accessory mobilization Applied by a therapist



an active physiological movement to end range
applied by the patient


The techniques are always applied in


a pain
-
free direction and


described as correcting joint tracking from a
positional fault

Physiological Movements


Physiological movements are movements the
patient can do voluntarily


(e.g., the classic or traditional movements,


such as flexion, abduction, and rotation)



term osteokinematics is used for these

Accessory Movements


Accessory movements are movements in the joint
and surrounding tissues


that are necessary for normal ROM


cannot be actively performed by the patient.


Component motions


Accompany active motion


but are not under voluntary control.


E.g. motions such as upward rotation of the scapula
and rotation of the clavicle, which occur with shoulder
flexion, ext rotation of the tibia in knee extension.

Accessory Movements


joint play.


the motions that occur between the joint surfaces


the distensibility or “give” in the joint capsule


necessary for normal joint functioning through the ROM


Demonstrated passively


but they cannot be performed actively


The movements include


distraction,


Sliding,


compression,


rolling,


spinning of the joint surfaces.



The term arthrokinematics is used for these motions

Thrust


Thrust is a high
-
velocity,


short
-
amplitude motion


that
the patient cannot prevent
the motion.


The motion is performed
at the end of the
pathological limit
(end of the available ROM when
there is restriction.)



Is alter positional relationships



snap adhesions,


stimulate joint receptors.

Manipulation Under Anesthesia


Manipulation under anesthesia


is a medical procedure


used to restore full ROM


by breaking adhesions around a joint


while the patient is anesthetized.


The technique may be a rapid thrust or a passive
stretch


using
physiological or accessory movements

Muscle Energy


Muscle energy techniques use


active contraction of deep muscles that attach near
the joint and


whose line of pull can cause the desired accessory
motion.


The therapist stabilize the segment on which the
distal aspect of the muscle attaches.


A command for an isometric contraction of the
muscle, that causes accessory movement of the
joint

BASIC CONCEPTS OF JOINT

MOTION:
ARTHROKINEMATICS


Joint Shapes



The type of motion occurring between bony
partners in a joint


is influenced by the shape of the joint surfaces.


Joint Shapes


In ovoid joints


one surface is convex, the


other is concave


In sellar joints,


one surface is concave in one
direction


and convex in the other,


with the opposing surface
convex and concave

Types of Motion


As a bony lever moves about an axis of motion,


also movement of the bone surface on the opposing bone surface
in the joint.


The movement of the bony lever is called
swing


as flexion, extension, abduction, adduction, and rotation.


measured in degrees with a goniometer and is called ROM.


Motion of the bone surfaces in the joint is a combination of
rolling and sliding, or spinning
.


These accessory motions allow greater angulations of the bone as
it swings.


For the
rolling, sliding, or spinning


There must adequate capsule laxity or joint play.

Types of Motion


Roll


Characteristics of one bone
rolling on another are as follows.



The surfaces are incongruent.


New points on one surface meet
new points on the opposing
surface.


Rolling results in angular motion
of the bone (swing).


Rolling is always in the same
direction as the swinging bone
motion whether the surface is
convex or concave.

Rolling

Rolling, if it occurs alone, causes


compression of the surfaces on
the side to which the bone is
swinging


separation on the other side.


Passive stretching using


bone angulations alone may
cause stressful compressive
forces to portions of the joint
surface,


potentially leading to joint
damage.


In normally functioning joints,
pure rolling does not occur alone
but in combination with joint
sliding and spinning

Slide/Translation

Slide/Translation

Characteristics of one bone
sliding (translating) across
another include the following.



For a pure slide,
the surfaces
must be congruent
, either


Flat or curved



The same point on one surface
comes into contact with


the new points on the
opposing surface.

Slide/Translation


Pure sliding does not occur in
joints


because the surfaces are not
completely congruent.


The direction in which sliding
occurs depends on


whether the moving surface is
concave or convex.


Sliding is in the opposite
direction of the angular
movement of the bone if the
moving joint surface is convex.



Sliding is in the same
direction


as the angular movement of
the bone


if the moving surface is
concave.

Combined Roll
-
Sliding in a Joint


The more congruent the joint surfaces are, the
more sliding



The more incongruent the joint surfaces are, the
more rolling



Spin


There is rotation of a segment
about a stationary mechanical
axis


The same point on the moving
surface creates an arc of a
circle as the bone spins


Spinning rarely occurs alone in
joints but


in combination


with rolling and sliding.


Three examples of spin
occurring in joints of the body


are the shoulder with
flexion/extension, the hip with


flexion/extension, and the
radiohumeral joint with


pronation/supination


Other Accessory Motions


Compression


Compression is the decrease in the
joint space between


bony partners.


weight bearing jts


With muscle contration
(stabilization)


With rolling


help move synovial fluid and thus
help maintain cartilage health.


Abnormally high loads may lead


articular cartilage changes and
deterioration



Traction/Distraction


Traction isa longitudinal pull.


Distraction is a separation, or
pulling apart


if traction is applied


to the shaft of the humerus, it
results in a glide of the joint
surface Distraction of the
glenohumeral


joint requires a pull at right
angles to the glenoid fossa


whenever there is pulling on
the long axis of a bone, the
term
long
-
axis traction


the surfaces are to be pulled
apart, the term
distraction,
joint traction, or joint
separation is used.

Open and close pack position

Position patient in a relaxed, distracted,
supported position so the joint capsule is lax
(
loose(open)
-
packed
position).



Close
-
packed

position is one in which
there is maximal contact of the articulating
surfaces.

Joint

Closed
-
packed Position

Open
-
packed Position

Glenohumeral

90
o

ABD & Full ER combo

55
o

flexion w/ 20
-
30
o

HABD

Elbow


Humeroulnar


Humeroradial


Raduioulnar


Full Extension

90
o

flex w/ mid
-
pronation

Full
pronation

or
supination


70
o

Flex w/ 10
o

supination

Full ext w/ full supination

70
o

flex w/ 35
o

supination

Distal Radiocarpal Joint

Full extension & radial
deviation or full flex

Neutral position

MCP joints

2
-
5

1


Full flexion

Full opposition


20
o

flexion

20
o

flexion

IP joints

Full Extension

20
o

flexion

Hip

Full IR, Ext & ABD

55
o

flex w20
-
30
o

HABD

Knee (tibiofemoral)

Full Ext & ER

20
-
25
o

flexion

Ankle Mortise

Full DF

10
o

PF

Subtalor

Full EV or INV

Midrange PF & DF

Forefoot

Full DF

1 MTP = 20
o

DF

2
-
5 MTP = 20
o

PF

IP’s = 20
o

PF

10 simple steps

1.
Evaluation and Assessment

2.
Determine grades and dosage

3.
Patient position

4.
Joint position

5.
Stabilization

6.
Treatment force

7.
Direction of movement

8.
Speed and rhythm

9.
Initiation of treatment

10.
Reassessment


Grades of Oscillations (Maitland)


Grade I

-

small amplitude movement at the
beginning of the range (pain and spasm)


Grade II

-

large amplitude movement within
the midrange of the movement (pain and
spasm)


Grade III

-

large amplitude movement at the
end of the range (into restriction)


Grade IV
-

small amplitude movement at end
range when tissue resistance (not pain) is
limiting


Grade V

-

small amplitude, quick thrust
manipulation

at end range
-


Normal motion

Grades of Oscillations (Maitland)

INDICATIONS FOR JOINT

MOBILIZATION


Pain, Muscle Guarding, and Spasm


Painful joints, reflex muscle guarding, and muscle
spasm treated
gentle joint
-
play techniques to
stimulate
neurophysiological and mechanical
effects


neurophysiological and mechanical effects


stimulate the mechanoreceptors


Inhibit nociceptive stimuli


mechanical effects


Synovial fluid motion provide neutrients to jts



The small
-
amplitude joint techniques used to


treat pain, muscle guarding, or muscle spasm
should not


place stretch on the reactive tissues


Reversible Joint Hypomobility


joint
-
play stretching techniques to elongate


hypomobile capsular and ligamentous connective
tissue


Positional Faults/Subluxations


Malposition / regain ROM


realign the bony partners


Progressive Limitation


Diseases that progressively limit movement can be
treated with joint
-
play


Functional Immobility


Patient functionaly imobile

CONTRAINDICATIONS

AND PRECAUTIONS


Hypermobility


Joint Effusion


Inflammation

Conditions Requiring Special

Precautions for Stretching


Malignancy


Bone disease detectable on radiographs


Unhealed fracture


Excessive pain


Hypermobility in associated joints


Total joint replacements


Newly formed or weakened connective tissue


Systemic connective tissue diseases such as rheumatoid


Elderly individuals