Biomechanics: Manipulation And Mobilization

Front 1

Who is the author of "Manipulation and Importance of Good Health" and "Setting by Joint Leverage"?

Back 1

HIPPOCRATES

"Get knowledge of the spine, for this is the requisite for many diseases"

Front 2

He said, "Look to the nervous system as the key to maximum health"

Back 2

CLAUDIUS GLEN

he cured the paralysis Eudemus' hand and arm

Front 3

TRUE or FALSE

Bimechanical principles can be used to explain joint dysfuntion.

Back 3

TRUE

Front 4

What are the 2 biomechanical approaches (models) to joint assessment?

Back 4

STATIC MODEL
DYNAMIC MODEL

Front 5

TRUE or FALSE

By stimulating mechanoreceptors we can override nociceptors.

Back 5

TRUE

Front 6

What are some limitations to the static assessment?

Back 6

- incorrect assessment due to body anomalies
- may have goodd static alignment but have faulty joint function (movement)
- joints may be compensating for biomechanical faults elsewhere and falsely identified as the problem (lumbar compensation for short leg)

Front 7

STATIC or DYNAMIC model?

- Alterations in the position of adjacent bones create changes in the mechanical and neurological function of a joint

Back 7

STATIC MODEL

Front 8

STATIC or DYNAMIC model?

- based on the idea of "structure determines function"

Back 8

STATIC MODEL

Front 9

What are some advantages to the static assessment?

Back 9

- used in acute conditions when moving the body would be too painful
- can be used in areas where limited motion exists

Front 10

In the static model, malposition is determined by...

Back 10

1. static palpation
2. markings on x-rays
3. special instruments...thermography, electromyography, etc.

Front 11

In the dynamic model, restriction is determined by...

Back 11

1. motion palpation (looking for quality and quantity of motion)
2. posture and gain analysis
3. motion x-rays

Front 12

STATIC or DYNAMIC model

- based on the idea that function is often more significant than structure

Back 12

DYNAMIC MODEL

Front 13

What are the limitations to the dynamic model?

Back 13

- lack of consistent interexaminaer reliability
- less helpful in acute painful conditions and areas with limited motion
- may overlook postural stresses (poor posture but normal joint movement)
- motion may be limited by coexisting disease (normal motion is altered)

Front 14

STATIC or DYNAMIC model?

Alterations in motion of adjacent bones create altered mechanical and neurological function of a joint. Muscles and ligaments contribute to the cause of the altered motion (mechanical derangement)

Back 14

DYNAMIC MODEL

Front 15

What is the advantage of the dynamic assessment?

Back 15

- identifies components that become dysfunctional (joint, soft tissues)

Front 16

"Malposition of a bone" refers to a _____ finding and "restriction of joint motion" is a _____ finding.

Back 16

"Malposition of a bone" refers to a STATIC finding and "restriction of joint motion" is a DYNAMIC finding.

Front 17

Joint mechanics showing disturbances of function without structural or positional change...a subtle mechanical joint alteration affecting quality and range of motion. This is the definition of
a. joint dysfunction
b. joint fixation
c. join restriction

Back 17

a. JOINT DYSFUNCTION

Front 18

- An articulation that has become temporarily immobilized in a position that it would normally occupy during any phase of movement.
- An articulation that is immobilized in a position of movement when the joint is at rest, or in a positionof rest when the joint is in movement.
- This is the definition of
a. joint dysfunction
b. joint fixation
c. join restriction

Back 18

b. JOINT FIXATION

Front 19

Limitation of movement...describes the direction of limited movement in a dysfunctional joint. This is the definition of
a. joint dysfunction
b. joint fixation
c. join restriction

Back 19

c. JOINT RESTRICTION

Example...a vertebrae that does not rotate to the right has a "right rotation restriction"

Front 20

What are the 3 pain causes of joint dysfunction?

Back 20

1. MECHANICAL
2. CHEMICAL
3. PSYCHOLOGICAL STRESS

Front 21

What are some examples of MECHANICAL causes of joint dysfunction?

Back 21

- macrotrauma: a single traumatic event
- microtrauma: repetitive minor cumulative trauma
- postural: habitual sedentary posture or continuous faulty posture

Front 22

What are some examples of CHEMICAL causes of joint dysfunction?

Back 22

- exposure to toxins from the environment, food and water
- hormonal, inflammatory, auto-immune and chemical stressors
- reflex interaction: somato-visceral, viscero-somatic, viscero-viceral reflexes

Front 23

What are some examples of PHYCHOLOGICAL STRESS that causes of joint dysfunction?

Back 23

- mental, emotional, phychological and spiritual stress
- psycho-somato-visceral reflexes

Front 24

What do we mean by interpretation of joint motion?

Back 24

- each joint has a characteristic end-feel
- a normal end-feel at one joint may be a pathological end-feel at another.

Front 25

Is this end-feel capsular, ligamentous, soft tissue approximation, bony or muscular?
- firm, but giving
- like stretching a piece of leather
- Normal: external rotation of the shoulder
- Abnormal: capsular fibrosis and adhesions

Back 25

CAPSULAR

Front 26

Is this end-feel capsular, ligamentous, soft tissue approximation, bony or muscluar?
- normal: knee extension
- abnormal: resistance as a result of ligamentous shortening

Back 26

LIGAMENTOUS

Front 27

Is this end-feel capsular, ligamentous, soft tissue approximation, bony or muscular?
- giving, squeezing qualitly
- typically painless
- normal: elbow flexion
- abnormal: muscle hypertrophy, soft tissue swelling

Back 27

SOFT TISSUE APPROXIMATION

Front 28

Is this end-feel capsular, ligamentous, soft tissue approximation, bony or muscular?
- hard, non-giving, abrupt stop
- normal: elbow extension
- abnormal: bony exostosis, articular hypertrophic changes

Back 28

BONY

Front 29

Is this end-feel capsular, ligamentous, soft tissue approximation, bony or muscular?
- firm, but giving
- builds with elongation
- normal: hip flexion

Back 29

MUSCULAR

Front 30

What are the types of end-feel that can be palpated only in abnormal conditions?

Back 30

- Muscle spasm
- Interarticular
- Empty

Front 31

What does "listing" refer to?

Back 31

The term "listing" refers to a description of the manner in which the joint is dysfunctional...naming and recording joint abnomalities

Front 32

Is this a description of a STATIC or DYNAMIC listing?
- uses standard joint motion terminology to describe the position of the joint
- uses the term "malposition"

Back 32

STATIC listing

Front 33

Is this a description of a STATIC or DYNAMIC listing?
- uses standard joint motion terminology to describe the direction the joint will not move or has lack of springy end-feel
- uses the term "restriction"

Back 33

DYNAMIC (motion) listing

Front 34

Mobilization or Manipulation?

passive joint movement for increasing range of motion or decreasing pain.

Back 34

MOBILIZATION

Front 35

Mobilization or Manipulation

accessory or physiologic motions applied to joints and related soft tissues at varying speeds and amplitudes (depths)

Back 35

MOBILIZATION

Front 36

Mobilization or Manipulation

applies a force that is light enough that a patient can stop the movement

Back 36

MOBILIZATION

Front 37

Mobilization or Manipulation

applied from the resting position up to the elastic barrier of the joint

Back 37

MOBILIZATION

Front 38

Mobilization or manipulation

passive joint movement for increasing joint mobility and reducing pain

Back 38

MANIPULATION

Front 39

Put these in order...
- limit of anatomical integrity
- paraphysiological space
- elastic barrier

Back 39

- elastic barrier
- paraphysiological space
- limit of anatomical integrity

Front 40

What is the orientation of the following facets?
- cervical spine
- thoracic spine
- lumbar spine

Back 40

- cervical: 45° transverse, parallel frontal
- thoracic: 60° transve, 20° frontal
- lumbar: 90° transverse, 90° frontal

Front 41

What are the two tools used to assess joint dysfunction and global range of motion?

Back 41

Goniometer- use is limited to extremity joints
Inclinometer- used for spinal measurements

Front 42

What are the five main ways to assess articular range of motion?

Back 42

AROM: Active Range of Motion
PROM: Passive Range of Motion
Physiological Barrier: end point of active joint movement
Joint Play: neutral position
End-feel: limit of passive range of motion

Front 43

T/F: Active Range of Motion is movement which is carried through by the operator without conscious assistance or resistance by the patient.

Back 43

False! Passive Range of Motion is is movement which is carried through by the operator without conscious assistance or resistance by the patient.
Active Range of Motion is movement accomplished w/out outside assistance, including osteokinematics.

Front 44

Joint play is determined by springing a bone of an articulation in a ____ position.

Back 44

neutral

Front 45

Forcing movement beyond this barrier would produce tissue damage.

Back 45

Anatomical limit

Front 46

The _____ space is at the end of the elastic barrier.

Back 46

Paraphysiological space- area of increased movement beyond elastic barrier available after a cavitation w/in the joint's elastic range.

Front 47

Name the resistance felt at the end of the passive range of motion.

Back 47

Elastic barrier

Front 48

In identifying joint dysfunction, what does P.A.R.T.S. stand for?

Back 48

P- Pain/tenderness produced by palpation & pressure over specific structures & soft tissues

A- Asymmetry of joint components identifies by static palpation

R- Range of motion... decrease/loss of specific movmnts identified thru palpation or global ROM

T- Tone, texture & temp changes in specific soft tissues identifies w/ palpation

S- Special tests or procedures

Front 49

What are 2 types of palpation?

Back 49

Static palpation

Motion Palpation

Front 50

What are 2 types of Range of Motion that can be assessed?

Back 50

Global ROM (osteokinematics)

Articular ROM (arthrokinematics)

Front 51

Name 2 ways in which joint dysfunctions are named.

Back 51

Static Listings

Motion Listings (dynamic)

Front 52

Name some things that can be assessed thru Inspection/Observation of joint dysfunction.

Back 52

Superficial (size, shape, skin, cuts, bruises, swelling, scars, moles...)

Posture

Gait

Front 53

Assessment of somatic structures in a neutral state.

Back 53

Static palpation

Front 54

Quantity, Quality, Joint-Play, End-Feel & Symptoms are all a part of what type of palpation?

Back 54

Motion Palpation

Front 55

Assessment of passive & active segmental joint range of motion.

Back 55

Motion Palpation

Front 56

What aspect of motion palpation asks the following questions:

What is the quality of the resistance?
At what point does the motion stop?

Back 56

End-feel

Front 57

Name that Maitland mobilization grade!
Neurophysical effect
Stimulate mechanoreceptors
Vascular effect
Mechanical effect (collagen, joint lubrication, neuromeningeal tissue)

Back 57

Grades I,II,III

Front 58

Unlike grades I-IV, Maitland's Grade V mobolization includes _____.

Back 58

Cavitation

Front 59

What is the Maitland treatment for pain?

Back 59

Grades I-II for 1-2 minutes.
Treated daily.
Pain should be treated prior to tightness.
Small amplitude oscillations used to stimulate mechanoreceptors and limit pain perception

Front 60

What type of mobilization technique combines traction and mobilization. It is used to decrease pain or reduce joint hypomobility.

Back 60

Kaltenborn

Front 61

Should mobilization and manipulation be done with acute arthritis?

Back 61

No

Front 62

The Kaltenborn treatment plane ___is applied parallel and ___ is applied perpendicular.
(Choose traction or gliding)

Back 62

The Kaltenborn treatment plane gliding is applied parallel and traction is applied perpendicular.

Front 63

In the Kaltenborn grades of traction, Grade ___ separates articulating surfaces, taking up slack or eliminating play within the joint capsule.

Back 63

II

Front 64

Describe the Kaltenborn treatment plan.

Back 64

1. Initially use Grade I traction to reduce a chance of painful reaction.
2. Use 10 second intermittent Grade I and grade II traction.
3. Distract with grade III and release- allow for return to resting position
4. Use grade III traction in conjunction with mobilization for hypomobile joints
5. Reduce hypomobility with grade III and IV oscillations within pain limitations.

Front 65

Name some Neurophysiological Effects of mobilization.

Back 65

-Stimulates mechanoreceptors that inhibit transmission of nociception

-Decreases muscle spasm & guarding due to nociception

-Stimulates Golgi tendon organs that inhibit muscle tone

-Increases awareness of position & motion by stimulating afferent nerves

-Stimulates proprioceptors

Front 66

Name some Nutritional Effects of mobilization.

Back 66

-Small movements stimulate synovial fluid that nourishes articular cartilage

-Movement exchanges nutrients during joint swelling & immobilization

-Increases nutrition to the avascular portions of articular cartilage

Front 67

Name some Mechanical Effects of mobilization.

Back 67

-Improves mobility of hypomobile joints (loosens adhesions & scarring)

-Maintains extensibility & tensile strength of articular tissues

Front 68

Name some indications for Mobilization.

Back 68

- Improve joint hypomobility and/or stiffness
- Decrease pain
- Decrease muscle spasm &/or guarding
- Decrease soft tissue restrictions preventing normal joint motion
- Reflexogenic effects (facilitate muscle tone, stretch reflex)
- Proprioceptive effects

Front 69

What are the goals of mobilization?

Back 69

Gentle joint play techniques stimulate neurophysiological, nutritional & mechanical effects

Front 70

What are the motions used for mobilization?

Back 70

Roll
Spin
Glide (Slide)
Distraction & traction
Compression

Front 71

Which of the following is NOT a rationale for mobilization:
-In order to restore motion in hypomobile joint, tissue deformation must occur
-Tissue stretch w/in the elastic range does not produce a permanent structural change
-Stretching in the plastic range does not cause permanent structural changes
-Joint mobilization can be used to stretch tissue and break tissue adhesions
-Joint mobilization involves slow, small amplitude oscillations &/or traction

Back 71

INCORRECT-Stretching in the plastic range does not cause permanent structural changes

Stretching in the plastic range DOES CAUSE permanent structural changes

Front 72

What rule of movement do all joint mobilizations follow?

Back 72

Convex-Concave Rule

Front 73

If moving convex on concave: mobilization is in ___ direction as joint restriction.

If moving concave on convex mobilization is in ___ direction of the joint restriction.

Back 73

If moving convex on concave: mobilization is in SAME direction as joint restriction.

If moving concave on convex mobilization is in OPPOSITE direction of the joint restriction.

Front 74

If convex surface is moving on stationary concave surface, gliding occurs in _____ direction of roll.

If concave joint is moving on stationary convex surface, gliding occurs in _____ direction of roll.

Back 74

If convex surface is moving on stationary concave surface, gliding occurs in OPPOSITE direction of roll.

If concave joint is moving on stationary convex surface, gliding occurs in SAME direction of roll.

Front 75

What are the Rules for Mobilization Techniques?

Back 75

-Patient must be relaxed
-Operator must be relaxed
-When performing any joint mobilization technique, one hand will usually stabilize while the other hand performs the movement

Front 76

Name some things the operator must consider for Mobilization.

Back 76

- Direction of restricted movement

- Velocity of movement (slow stretching for large capsular restriction; faster oscillation for minor restriction)

- Amplitude of movement (graded according to pain, guarding & degree of restriction)

Front 77

True/False

In a joint mobilization, the smaller the contact surface is, the more comfortable the procedure will be.

Back 77

FALSE

In a joint mobilization, the LARGER the contact surface is, the more comfortable the procedure will be.

And use flat surface of hand instead of thumb.

Front 78

In what position should the joint be in to perform a mobilization?

Back 78

Patient is in relaxed, distracted, supported position so joint capsule is lax.

Joint is positioned in the open position... loose packed.

Front 79

What are the Maitland Grades of Oscillations?

Back 79

Grade I- Sm amplitude movmnt at beginning of ROM (manages pain & spasm)

Grade II- Lg amplitude movmnt btwn beginnign & mid-range of mvmnt (manages pain & spasm)

Grade III- Lg amplitude movmnt reaching limit of available range (increases ROM & decrease stiffness)

Grade IV- Sm amplitude movmnt at end of available range (increases ROM & decreases stiffness)

Grade V- Sm amplitude, hi-velocity thrust beyond end ROM (increases ROM, decreases pain, decreases stiffness)