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87 terms

Joint Mobilization

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What is physiologic motion (osteokinematics)?
movement between 2 bones: flexion, extenion, abduction, adduction,etc, often limited by muscle length or fascia
what is accessory motion (arthrokinematics)?
movement between 2 joint surfaces: spinning, rolling and gliding (translation), limited by ligaments or joint capsules
Describe the Convex-Concave Rule
the relationship between osteokinematics and arthrokinematics,
when a convex surface is moving, gliding occurs in the ___________ direction of bone movement.
opposite
when the concave surface is moving, gliding occurs in the_________ direction as bone movement
same
list the indications for joint mobilization
Increasing accessory motion available at the joint, increasing joint nutrition to the articular surfaces, and pain control via counterirratant theory, stimulation of mechanoreceptors causes release of endorphins in the spinal cord that inhibit pain signal transmission to the brain
general rule for performing joint mobs
patient must be relaxed, (positioning for comfort and support, temperature)
general rule for performing joint mobs
therapist must be relaxed, (good body mechanics and let gravity help)
general rule for performing joint mobs
hondholds should be firm but comfortable
general rule for performing joint mobs
do not move into pain, there is a difference between discomfort of soft tissues stretch and pain with muscle gaurding
general rule for performing joint mobs
both the stabilizing force and the mobilizing fore should be as close to the joint surface as possible for good control
general rule for performing joint mobs
motion should be assessed by comparing it to the corresponding joint on the other side of the body when possible
general rule for performing joint mobs
assess joint movement in the loose-packed postion when possible
general rule for performing joint mobs
each technique is used both evaluation and treatment
general rule for performing joint mobs
never mobilize a joint in the close-packed positon
close-packed position of GH joint
full ABD and ER
loose packed position of GH joint
55-70 degrees ABD, 30 degrees HADD, 0 degrees ROT
close-packed postion of Humeroulnar joint
full EXT & SUP
loose packed position of Humeroulnar joint
70 degrees FLEX, 10 degrees SUP
close packed position of Humeroradial joint
90 degrees FLEX, 5 degrees SUP
loose packed position of Humeroradial joint
full EXT,& SUP
close packed postion of Prox. Radioulnar joint
5 degrees SUP, full EXt
loose packed postion of Prox. Radioulnar joint
70 degrees FLEX, 35 degrees SUP
close packed positon of Distal Radioulnar joint
5 degrees SUP
loose packed postion of Distal Radioulnar joint
10 degrees of SUP
close packed position of Radiocarpal joint
full EXT & radial deviation
loose packed postion of Radiocarpal joint
neutral with slight ulnar deviation
close packed postion of 1st MCP joint
full EXT
loose packe postion of 1st MCP joint
slight FLEX
close packed postion of 2nd-5th MCP joint
full FLEX
loose packed postion of 2nd-5th MCP joint
slight FLEX
close packed postion of IP ( hand)
full EXT
loose packed postion of IP (hand)
slight FLEX
close packed postion of Hip Ligamentous
full EXT, ABD,&IR
loose packed postion of Hip LIgamentous
30 degrees FLEX, 30 degrees ABD, slight ER
closed packed postion of Hip bony joint
90 degrees FLEX, slight ABD & ER
loose packed postion of Hip bony joint
30 degrees FLEX, 30 degrees ABD, slight ER
close packed postion of Patellofemoral joint
full FLEX
loose packe postion of Patellofemoral joint
full EXt
close packed postion of Tibiofemoral joint
full FLEX & ER
loose packed postion of Tibiofemoral joint
25 degrees FLEX
close packed postion of Talocrural joint
full dorsiflexion
loose packed postion of Talocrural joint
10 degrees plantarflexion
closed packed postion of MTP;s joint
full EXt
loose packed postion of MTP's joint
neutral
close packed postion of IP (foot) joint
full EXT
loose packe postion of IP (foot) joint
slight FLEX
Close-Packed:__________ contact between joint surfaces
maximal
Loose-packed /Resting postion: ____________ joint surfaces contact, and joint capsule is relaxed/slackened; postion of ___________ accessory motion available
minimal, maximal
Absolute contraindications for performing joint mobilization
any undiagnosed lesion, joint ankylosis(frozen), and joint hypermobility, if the technique pushes into resistance
relative contraindication
an infection in the area being treated
relative contraindication
malignancy in the area being treated
relative contraindication
an unhealed fx in the area being treated
relative contraindication
inflammatory arthritis in th area being treated, esp. if in a state of exacerbation
relative contraindication
metabolic bone diseases, such as osteoporosis, Paget's disease, and tuberculosis
relative contraindication
RA
relative contraindication
considerable joint effusion in the area, since it is difficult to obtain an accurate assessement of joint extensibility when swelling has taken up the slack in the joint capsule
relative contraindication
considerable joint irritability
relative contraindication
protective muscle spasm to the extent that the clinician is unable to assess mobility
0 grading of accessory joint motion
Ankylosed
1= grading of accessory joint motion
considerable hypomobility
2= grading of accessory joint motion
slight hypomobility
3= grading of accessory joint motion
Normal
4= grading of accessory joint motion
slight hypermobility
5= grading of accessory joint motion
considerable hypermobility
6= grading of accessory joint motion
unstable
grading of treatment techniques =1
Small amplitude oscillation, beginning of the range (no resistance)
grading of treatment techniques =2
Large amplitude oscillation midrange (no resistance)
grading of treatment techniques =3
Large amplitudes oscillation , into resistance
grading of treatment techniques =4
Small amplitude oscilation, to end of passive range
grading of treatment techniques=5
High velocity manipulation past the end of passive range
grades 1 and 2 can be used for
pain reduction and increased joint nutrituon
grades 3 and 4 are used to
increase joint accessory motion
GH distal moving bone is ________ and the shape is _________ gliding in ______ direction
humerus, convex, opposite
Humeroradial distal moving bone is_________ shape is _______ gliding direction is _________
radius, concave, same
Humeroulnar distal moving bone is __________ shape is __________ gliding direction is________________
ulnar, concave, same
Prox. Radioulnar distal moving bone is_________ shape is ________ gliding direction is ________
radius, convex, oppostie
Distal Radioulnar distal moving bone is ___________ shape is _________________ gliding direction is______________________
radius, concave, same
Radiocarpal distal moving bone is __________ shape is ____________ gliding direction is _________
carpal, convex, oppostie
Metacarpophalangeal distal moving bone is _____________ shape is _________ gliding direction is _________
prox. phalanx, concave, smame
Prox. Interphal distal moving bone is_________ shape is __________ gliding direction is____________
IP , concave, same
Distal Interphal distal moving bone is _________ shape is ________ gliding direction is________
DIP , concave, same
Hip distal moving bone is _______ shape is ________ gliding direction is_________
femur, convex, oppostie
Tibiofemoral distal moving bone is__________ shape is___________ gliding direction is__________
Tibia, concave, same
Talocrural distal moving bone is ________ shape is ________ gliding direction is_______
Talus, convex, opposite
Metatarsophalangeal distal moving bone is______________ shape is ____________ gliding direction is ________
Prox. phalanx, concave, same
IP (foot) distal moving bone is______ shape is_______ gliding direction is__________
distal phalanx, concave, same