Peripheral Joint Mobilization

Front 1

Mobilization/manipulation

Back 1

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

Manual therapy techniques that are used to modulate pain and treat joint dysfunctions that limit ROM. They specifically address restricted capsular tissue by replicating normal joint mechanics while minimizing abnormal compressive stresses on the articular cartilage in the joint.

Front 2

Self-mobilization (auto-mobilization)

Back 2

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

Front 3

Mobilization with movement

Back 3

Therapist provides accessory mobilization while pt performs active physiological movement to end range

Front 4

Physiological movements

Back 4

Movements pt can do voluntarily

Front 5

Accessory movements

Back 5

Component motions
Motion that accompany active motion but are not under voluntary control

Front 6

Joint play

Back 6

Motions that occur between joint surfaces
“give” of a joint capsule
arthrokinematics

Front 7

Give me an example of component motions

Back 7

Upward rotation of scapula and rotation of clavicle with shoulder flexion
Rotation of fibula with ankle movement

Front 8

What motions would be included under jt play??

Back 8

Distraction, sliding, compression, rolling, spinning

Front 9

Thrust

Back 9

High-velocity, short amplitude motion
Performed at end range
Intended to alter positional relationships, snap adhesions, or stimulate jt receptors

Front 10

Manipulation under anesthesia

Back 10

Medical procedure used to restore full ROM by breaking adhesions around a joint while the pt is under anesthesia
May be a rapid thrust or a passive stretch

Front 11

Muscle energy

Back 11

Use active contraction of deep muscles that attach near the joint and whose line of pull can cause the desired accessory motion
Specialization courses offered in this

Front 12

Joint Shapes

Back 12

Ovoid or sellar

Front 13

Ovoid joints are?

Back 13

on surface is convex and the other is concave

Front 14

Sellar Joints are?

Back 14

One surface is concave in one direction and convex in the other, with opposing surface convex and concave.

Front 15

Types of motion

Back 15

Roll
Slide/translation
Combined roll-sliding in a joint
Spin

Front 16

Does roll ever occur alone?? Does Slide/translation ever occur alone??

Back 16

Rolling, if occur alone, causes compression of the surfaces on the side to which the bone is swinging and separation on the other side.

Front 17

Examples of spin:

Back 17

Shoulder with flexion/extension
Hip with flexion/extension
Radiohumeral jt with pronation/supination

Front 18

Compression

Back 18

Decrease in joint space
Occurs with normal WB
Good or bad??? Compression is good in that is causes nutrient transfer through synovial fluid. Can be bad if there is abnormally high compression resulting in cartilagenous changes and deterioration

Front 19

Traction

Back 19

Longitudinal pull

Front 20

Distraction

Back 20

Separation or pulling apart

Front 21

Indication for Joint mobilizations

Back 21

Pain, muscle guarding, and spasm
-Neurophysiological effects = small amplitude oscillatory and distraction movements are used to stimulate mechanoreceptors that may inhibit transmission of pain receptors at the brain or spinal cord level
-Mechanical effects = cause synovial fluid motion to bring nutrients to avascular portions of cartilage thereby preventing painful and degenerative effects
Positional faults/subluxations = malposition of one bony segment can occur with traumatic injury, after immobility, or with muscle imbalance; would use manipulation with movement; could be used to relocate a dislocation
Progressive limitations = use mobilization to maintain what movement they have
Functional immobility
Reversible joint hypomobility

Front 22

Limitations to Joint Mobilization

Back 22

Cannot change disease process
Cannot change inflammatory process
Skill of therapist

Front 23

What are some altered joint mechanics may be due to and need joint mobilization?

Back 23

Pain and muscle guarding, joint effusion, contractures or adhesions in the joint capsules or supporting ligaments, or malalignment or subluxation of bony surface.

Front 24

Contraindiciations and precautions

Back 24

Hypermobility
Joint effusion
Can use gentle oscillations for pain but want to avoid stretching joint capsule as it is already inflamed
Inflammation
Same as above

Front 25

Conditions requiring special precautions for stretching
Examples?

Back 25

Malignancy
2. bone disease
3. unhealed fx,
4. excessive pain,
5.hypermobility in associated jts,
6. total joint replacements
7. newly formed or weakend connective tissue – i.e. after surgery, injury
8. Systemic connective tissue diseases – i.e. RA
9. Elderly individuals with weakened connective tissue and dimished circulation

Front 26

Contraindiciations and precautions

Back 26

Hypermobility
Joint effusion
Can use gentle oscillations for pain but want to avoid stretching joint capsule as it is already inflamed
Inflammation
Same as above

Front 27

Conditions requiring special precautions for stretching
Examples?

Back 27

Malignancy
2. bone disease
3. unhealed fx,
4. excessive pain,
5.hypermobility in associated jts,
6. total joint replacements
7. newly formed or weakend connective tissue – i.e. after surgery, injury
8. Systemic connective tissue diseases – i.e. RA
9. Elderly individuals with weakened connective tissue and dimished circulation

Front 28

Grade I Oscillation Technique

Back 28

Small-amplitude rhythmic oscillations are performed at the beginning of the range.

Front 29

Grade II Oscillation Technique

Back 29

Large-amplitude rhythmic oscillations are performed within the range, not reaching the limit

Front 30

Grade III Oscillation Technique

Back 30

Large-amplitude rhythmic oscillations are performed up to the limit of available motion and are stressed into tissue resistance

Front 31

Grade IV Oscillation

Back 31

Small-amplitud rhythmic oscillations are performed at the limit of available motion and stressed into tissue resistance.

Front 32

Grade I (loosen):

Back 32

Small-amplitude distraction is applied where no stress is placed on the capsule. It equalizes cohesive forces, muscle tension, and stmospheric pressure acting on joint.

Front 33

Grade II (tighten)

Back 33

Enough distraction or glide is applied to tighten the tissues aroudn the joint
"Taking up the slack"

Front 34

Grade III (Stretch)

Back 34

A distraction or glide is applied with an amplitude large enough to place stretch on the joint capsule and surrounding periartictular structures.

Front 35

When is sustained grade I used?

Back 35

Grade I Distraction is used with all gliding motions and may be used to relieve pain.

Front 36

When is sustained grade II used?

Back 36

Grade II distraction is used for the initial treatment to determine how sensitive the joint is. Once the joint reaction is known, the treatment dosage is increased or decrease accordingly. Inhibit pain and Grade II glide may be used to maintain joint play when ROM is not allowed

Front 37

When is sustained grade III used?

Back 37

USed to stretch joint structures and thus increase joint play.