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118 Cards in this Set

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Joint Mobilization
the concept of musculoskeletal evaluation and treatment in PT that applies principles of kinesiology, histology, neurophysiology, and pathophysiology to promote the well-being of clients
Joint mobilization
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
Manipulation
a sudden high velocity technique applied at the end of ROM that cannot be stopped by the patient. This technique is designed to release pathologically shortened or adhered structures. A rapid and forceful technique.
The concept of joint mobilization is used consistently within the scope of treatment strategies along with common interventions of
massage, Exercise, client education, traction, and MAR.
Joint Play
the motions that occur between the joining surfaces as well as the extensibility or give in the joint capsule, which allows the bones to move.
Joint Congruency
the degree to which joint surfaces match
Ovoid Joints
joints consisting of two surfaces: one is concave, the other is convex.
Sellar (saddle) Joints
joints possessing a convex and a concave surface on each opposing joint surface (Pringles Potato Chips).
With joint mobilizations, PTA's will use two techniques:
1) a sustained traction (or distraction) motion that occurs perpendicular to the articulating joint surface, and 2) a slide or glide that occurs parallel to the articulating joint surface.
Indications for mobilization
stretch supporting tissues for the restoration of normal accessory motion, to reduce pain, and to reduce muscle guarding per the plan of treatment.
Static Mobilization
is a sustained glide or distraction technique held for a brief 10-60 seconds
Dynamic Mobilization
consists of an oscillatory motion occurring in a sliding manner for 2-3 seconds
Graded Oscillation Techniques - Grades I-III used by PTA's
Grade I:
small amplitude, rhythmic oscillations performed at the beginning of the range. Used for the reduction of pain and for muscle guarding. A loosening technique with no stress placed on the joint capsule
Center of Gravity (COG)
point in the human body where the sagittal, frontal and transverse planes intersect. It is usually located at midline at the level of and anterior to S2. It is also anterior to the atlanto-occipital joint, medial/lateral malleoli, ankles, and knees and posterior to the hip joint.
C5
Lateral Shoulder area
Deltoid
Biceps reflex
C6
Lateral Arm
Thumb
Brachioradialis Reflex
C7
Middle of Arm
Index and Middle Fingers
Triceps Reflex
C8
Medial Arm
Ring and little finger
T1, T2
Axillary region
Elbow
T4
Nipple Ares
T6
Xiphoid Process
T10
Umbilicus
T12
Inguinal or groin area
Pubis
L1-L4
Anterior and inner surfaces of lower extremities
L2
Medial Thigh
L3
Medial Knee
L4
Medial Ankle
Medial side of great toe
Patellar reflex
L4-S1
Foot
L5
Dorsum of Foot
L5-S2
Posterior and outer surfaces of lower extremities
S1
Lateral Margin of foot
Little toe
Achilles Tendon reflex
S2-S4
Perenium
S2
Poteriomedial Thigh
S3-S5
Perianal area
What grades of Joint Mobilization are used for the reduction of pain
Grades I and II
What is Grade I Joint Mob
Small Occil at beginning of range, no stress on joint capsule
What is Grade II joint mob?
High amp, rythmic occil. within the range but not to the limit of the range. Also tests the sensitivity of joint and and preserves joint play.
What is Grade III Joint mob?
High amp occil withing available motion extending to the limits of range
What is grade III used for
After pain and gaurding go away it is used for increase tissue mobility, reduce joint limitations.
What is grade IV used For
By PT only,
small occil. at limit of range
What is Grade V Joint Mob
Small amp, high velocity thrust, snaps adhesions at the limit of motion.
What is the timing for Grade II and III Mob?
Smooth, Regular
2-3 per second
1-2 minutes
What are high speed/low amp oscill for?
Inhibit pain
What are slow speed oscill for?
relax muscle guarding
What is the timing for Sustained mobilization for painful joints?
7-10 second intermittent distractions with a few seconds in between serveral cycles. Note response and continue or not
What is the timing for sustaiined mob for restricted joints?
6 second minimum stretch force followed by partial releases (grade I and Ii) then repeat with slow intermittent stretches and 3-4 second intervals
What are the absolute contraindications for Joint Mob?
Bacterial Infection
Neoplasm
Joint Hypermobility
Recent Fracture
What are the relative contraindications for joint mob?
Joint Effusion
Degenerative Joint disease
Rheumatooid Arthritis
Osteoperosis
Derangement of the joint
Pregnancy
What is the resing position of the shoulder joint for Mobilization?
55 Degree Abduction
30 degree Horizontal Flexion
Convex Humeral head ________ in same direction as humerus and _____________ in opposite direction
Rolls
Glides
What grade of joint mob should you begin with for shoulder joint?
Grade II Sustained Mobilizaition
What glide should you use to increase shoulder abduction?
Inferior/caudal glide
What glide should you use to increase shoulder flexion/IR?
Posterior Glide
What glide should you use to increase shoulder Extention/ER?
Anterior Glide
No motion joint (fiberous) - sutures of skull
Synarthroidal
Small motion Joint(cartilagenous)
Amphiarthroidal
(hyaline or fibrocartilage)
Joint with no direct union between bones
Diarthroidal
What is a non-axial joint?
Movement is not around an axis
linear, angular, stairstep
ex carpal bones
What is a uniaxial joint?
Movement in angular pattern
hinge or pivot around on axis
ex. Elbow
What is a biaxial joint?
Movement around 2 planes/2 axes.
ex. wrist
What are the 2 types of biaxial joints?
Condyloid - mpc joints
Saddle (sellar)-
Ex. thumb
What is a triaxial joint?
3 planes/axes
Shoulder
Prime mover of muscle action
Agonist
Assisting mover, not prime, but helps
Synergist
performed opposite motion of agonist
Antagonist
antagonist and agonist contract at the same time to stablize a joint
Co-contractor
ex. pushups
Prevents unwanted motion to enable one action
Neutralizer
Ex neutralize supination to get true elbow flexion
Muslces that hold or support a joint to allow agonist to work more efficiently
Stablizer (fixator)
What is stress
Magnitude of the force or load
What is strain?
amount of deformation in response to stress
What is mechanical failure?
ex. bony fracture, skin laceration, ligament sprain, muscle strain
What are the types of mechanical stress?
Compression
Approximation
Tensile forces
Distraction
Shear Forces
What is compression
forces perpendicular to joint surface, PUSHING surfaces together
What is approximation
Moves joint surfaces Closer
THerapeutic technique
What are Tensile FOrces
FOrces perpendicular - PULLING joint surfaces apart
What is Distraction
Therapeutic Technique - Separation from opposting joint surfaces
What are shear forces
Forces applied PARALLEL to structure, SLIDES one surface over another
What is the time line for Immobilization?
3 days up to 4 weeks
How long does it take for ligaments to heal?
2-12 months
What is a grade I Ligament damage?
Less than 50% damage to fibers with no clinical instability
What is grade II Ligament Damage?
Damage to more than 50% of fibers with clinical instability and may or may not need surgery depending on function
What is grade III Ligament damage
Complete disruption of supporting structure fibers with pathological instability and usually need surgical repair
What is the time line for bone repair?
callus 6-8 weeks
heals in 1 year
What are bones made of?
Cartilagenous foundation
Calcium crystals
What is ossification?
Calcium crystals form in a cartilagenous network forming bone
What is endochondral growth
New bone deposits are made at the END OF LONG BONES
Growth LOGITUDINALLY
What is membraneous growth of bone?
New bone deposists are added to INNER MEMBRANEOUS LAYER
Growth CIRCUMFIRALLY
What is osteoperosis?
reduction of bone mass enough to interfere with mechanical support of the bone
What is wolfes law?
remodling of bone in response to physical stress placed on bone.
What is needed for response to exercise for increasing bone mass?
Weight bearing
Intense Activity
What is the time line for muscle healing?
4-8 weeks to 4-6 months
What is the time line for tendon healing?
10 days to 6 months.
What does collagen do?
Resist Tensile Loads
What do elastin fibers do?
provide extensibility and flexibility
What to reticulin fibers do?
bulk of the fiber
What are the phases of tissue healing?
Acute (inflammation-reaction)
Subacute (fibroplastic-repair-healing)
Chronic (maturation and remodling)
What happens and low long is Acute stage?
Cleansing, restoring blood flow
48-96 hours following injury
INFLAMMATION-REACTION
What happens and how long is Subacute stage?
Production of Collagen and Glycoaminoglycan (GAG), mobile scar
4 Days to 3 Weeks
FIBROPLASTIC -REPAIR-HEALING
What happens and low long is Chronic Stage of healing?
Fits new scar tissue to the surrounding tissue
Inflammation resolved
3 weeks to 3+ months
Theraputic interventions applied (mobilization, weight bearing, range of motion)
MATURATIN AND REMODLING
How long does inflammation last?
24-48 hours to two weeks
When does scar tissue start?
2-4 days to mature scar 60 to 360 days.
What is the normal soft end feel?
between soft tissues
Ex. Knee flexion against post thigh
What is the normal firm end feel?
stretch of muscle/ligaments
Ex. knee extension touching toes
What is the normal Hard end feel?
Bone contacs bone
Ex. Elbow flexion
What is the Path soft end feel?
occurs before end of range
ex. edema
What is path firm end feel?
before end of range as is spasticity and contractures
What is path hard end feel?
before normal end range
ex. chondromalacia and osteoarthritis.
What is path empty end feel?
before normal end range
ex. joint inflammation, bursitis, and fracture as result of GUARDING due to PAIN
Capsular pattern jonit restrictions?
specific joint with specific motion
ex. restrictin of elbow flexion compared to elbow extension
Non-capsular Pattern?
not in joint capsule
Range limitation due to pain
may affect only one joint motion
closed packed postion
maximal joint surface congruency
Loose packed
Resting position
joint surfaces non-congruous
What are two conditions of concave-convex law?
Roll and glide are same when tibia moving (concave moving on convesx
Roll and glide are opposite when femur moving (convex moving on concave)

Concave tib moves the same way

Convex femur rotates (rolls) opposite of its own shaft.
What is overload?
overload to produce strength
What is SAID principle?
Specific
Adaptation to
Imposed
Demands
Reversibility principle
use it or lose it
What are Type I Fibers?
Red/Tonic - slow twitch oxidative (SO)
Low level of tension for long time
Ex. postural muscles
What are Type II Fibers?
White -Phasic
Fast Twitch glycolytic (FG)
Burst of tension to lift body weight or to lift, lower, push or pull heave load
Fatigues quickly