Copyright © 2013. F.A. Davis Company Part II: Applied Science of Exercise and Techniques Chapter 5 Peripheral Joint Mobilization for Impaired Mobility

Copyright © 2013. F.A. Davis Company

Part II: Applied Science of Exercise and Techniques

Chapter 5

Peripheral Joint Mobilization for Impaired Mobility


Manual therapy techniques that are used to modulate pain and treat joint impairments that limit ROM by specifically addressing the altered mechanics of the joint

Joint Mobilization/Manipulation


Mobilization/Manipulation– Thrust manipulation/high-velocity thrust (HVT)

Self-Mobilization (Auto-Mobilization) Mobilization With Movement (MWM) Physiological Movements– Osteokinematics

Definition of Terms


Accessory Movements– Component motion

– Joint play: arthrokinematics

Manipulation Under Anesthesia Muscle Energy

Definition of Terms (cont'd)


Joint Shapes– Ovoid

– Sellar (saddle)

Basic Concepts of Joint Motion: Arthrokinematics


Types of Motion– Swing: Movement of the bony lever about an axis

of motion

– Motion of the bone surfaces in the joint• Roll

• Slide/translation

• Combined roll-sliding in a joint (glide)

• Spin

Basic Concepts of Joint Motion: Arthrokinematics (cont'd)


Basis for determining the direction of the mobilizing force when joint mobilization gliding techniques are used– Sliding is in the opposite direction of the angular

movement of the bone if the moving surface is convex

– Sliding is in the same direction if the moving surface is concave

Convex-Concave Rule


Passive-angular stretching may cause increased pain or joint trauma

Joint-glide is safer and more selective – Controlled

– Replicates normal joint mechanics

– Force is specific to target tissues

Passive-Angular Stretching Versus Joint-Glide Stretching


Compression Traction: Longitudinal Pull– Long axis traction

Distraction: Separation of Joint Surfaces– Joint traction or joint separation

Other Accessory Motions That Affect the Joint


Helps move synovial fluid to maintain cartilage health

Maintains extensibility and tensile strength of articular and periarticular tissues

Provides sensory input for proprioceptive feedback important for balance response

Effects of Joint Motion


Pain, Muscle Guarding, and Spasm– Neurophysiological effects

– Mechanical effects

Reversible Hypomobility Positional Faults/Subluxations Progressive Limitation Functional Immobility

Indications for Joint Mobilization/Manipulation


Cannot Change Disease Process Cannot Change Inflammatory Process Skill of the Therapist Affects the Outcome

Limitations of Joint Mobilization/ Manipulation Techniques


Hypermobility Joint Effusion Inflammation

Contraindications


Malignancy Bone Disease Detectable on Radiograph Unhealed Fracture (With Limitations) Hypermobility in Associated Joints Total Joint Replacements Newly Formed or Weakened Connective Tissue Elderly Individuals

Conditions Requiring Special Precautions for Stretching


Examination and Evaluation– Quality of pain

– Capsular restriction (specific pattern)

– Subluxation or dislocation

Procedures for Applying Passive Joint Techniques


Documentation– Use of standardized terminology– Characteristics of documentation• Rate of application of movement• Location of range in the available motion• Direction of force applied by the therapist• Target of force• Relative structural movement• Patient position

Procedures for Applying Passive Joint Techniques (cont'd)


Grade I: Small Amplitude at Beginning of Range– Pain inhibition and fluid movement

Grade II: Large Amplitude Within the Range– Pain inhibition and fluid movement

Grade III: Large Amplitude Up to the Limit into Resistance– Stretching maneuver

Grade IV: Small Amplitude at the Limit into Resistance– Stretching maneuver

Non-Thrust Oscillation Techniques


Grade I: Loosen: Small Amp Distraction– Pain relief

Grade II: Tighten: Distraction or Glide to Tighten Tissue– Pain relief, assess joint sensitivity, maintain joint

play Grade III: Stretch: Distraction or Glide– Increase joint play

Non-Thrust Sustained Joint-Play Techniques


Comparison of Oscillation and Sustained TechniquesRepresentation of Oscillation Techniques

Representation of Sustained Joint-Play Techniques


Application– Small-amplitude, high-velocity– Performed only once

Indications– Snap adhesions– Reposition joint surfaces

Thrust Manipulation/High-Velocity Thrust (HVT)


Positioning and Stabilization Direction and Target of Treatment Force– Treatment plane

Initiation and Progression of Treatment Patient Response Total Program

Procedures for Applying Passive Joint Techniques


Principles and Application of MWM in Clinical Practice– Comparable sign– Passive techniques– Accessory glide with active comparable sign– No pain – Repetitions– Description of techniques

Mobilization With Movement (MWM): Principles of Application


Patient Response and Progression – Pain as a guide– Self treatment– Total program

Theoretical Framework– Brian Mulligan

Mobilization With Movement (MWM): Principles of Application (cont'd)


Shoulder Girdle Complex Elbow and Forearm Complex Wrist and Hand Complex Hip Joint Knee Joint Complex Leg and Ankle Joints

Peripheral Joint Mobilization Techniques


Critical Thinking and Discussion Laboratory Practice

Independent Learning Activities

Documents

Copyright © 2013. F.A. Davis Company Part II: Applied Science of Exercise and Techniques Chapter 5 Peripheral Joint Mobilization for Impaired Mobility