Joint Mobilization

Joint Mobilization Joint Mobilization Indications o o o o o Pain, muscle guarding, spasm Reversible joint hypomobility: Applying force to increase ROM Positional faults: Misalignments bt joints, mobility decreases, issues increase Progressive limitations: Age, injury, medical conditions, inactivity Functional immobility: Cant move Joint Mobilization contraindications o Hypermobility o Joint effusion o Inflammation Joint Mobilization limitations o Cant change disease process o Cant change inflammatory process o Skill of the therapist effects the outcome Special precautions for stretching o o o o o o o Malignancy Bone disease Unhealed fx Hypermobility in associated joints Total jt replacements Connective tissue issues Elderly induvial Evaluation - Quality of pain Capsular restriction Documentation requirements o Rate of applications of force: Speed at which the force is applied, measured in oscillations per second o Location in range of available motion: Measured in degrees, how much movement is in that joint o Direction of force as applied by therapist: Address direction to address the issue, tight shoulder IR, force is applied in ER o Relative structural movement (state moving structure first and then stable structure) o Target of force: Force o Patient position Joint mobilization effects o Helps move synovial fluid to maintain cartilage health o Maintains extensibility and tensile strength of articular and periarticular tissues o Provides sensory input for proprioceptive feedback important for balance response Non-thrust oscillation techniques grading scale Grade I o 0-25% of available ROM o Small amplitude at beginning of range o Goals: Stop pain, increase fluid movements (helps pts relax and prepare for deeper movements) Grade II o 0-50% of available ROM o LG amplitude within range (moving jt a lot but not coming close to end range) o Goals: Stop pain, increase fluid movement Grade III o 0-50% of available ROM o LG amplitude up to the limit into resistance o Goals: Stretching maneuver (Increasing ROM) Grade IV o Small amplitude at the end range of motion o Goals: Increasing ROM, stretching maneuver Non-thrust sustained joint play techniques Grade I o o o o Small amplitude distraction Goal: Decrease pain Loosen tissue Early stage of injury Grade II o o o o Distraction or glide to tighten tissue Goal: Pain relief, assess jt sensitivity, maintain jt play Tighten tissue Subacute/chronic as long as it meets above goals Grade III o Distraction or glide o Increase jt play o Stretch tissue Question - While working with a patient with whom range of motion is contraindicated, the therapist applies gentle, intermittent distractions to inhibit pain (sustained jointplay). The distraction motion is enough to tighten surrounding tissues but stops short of stretching the capsule. This is an example of which grade of non-thrust sustained joint play techniques? o Grade II Hip Joint Distraction (don’t use if knee has dysfunction, grasp femoral condyles instead) o Loose pack: 30 F, 30 ABD, lateral rotation o Closed pack: Full extension & medial rotation Talocrural jt distraction o Loose pack: 10 PF o Closed pack: Max DF Talocrural joint distraction: Anterior glide Talocrural joint distraction: Posterior glide Intertarsal dorsal glide Intertarsal plantar glide Knee o Loose pack: 25 F o Closed pack: Full E, lateral rotation of tibia Hip Anterior glide: Alternate position Hip posterior glide Hip anterior glide Manual therapy o Treats pain and joint impairments that limit ROM o Addresses altered mechanics of the joint Self-mobilization o Self-stretching techniques Thrust manipulation/HVT o Small amplitude, high velocity o Jt moved to the limit of range-remove all slack, performance only once o Indications: Snap adhesions, reposition joint surfaces Mobilization/Manipulation o Interchangeable terms Joint shapes - - Ovid o Convex oval shaped surface that articulates with a concave oval shaped surface on the other bone o Movements in two planes (F/E & ABD/ADD) o Wrist, finger joints, toe joints Sellar (Saddle) o One bone is concave, like a saddle, other bone is convex like a ride on a saddle o Movement in three planes (F/E, ABD/ADD, axial rotation o SC jt , carpometacarpal jt of the thumb, middle ear & heel Convex o Rounded outward Concave o Rounded inward Convex on concave rule - o Moving surface is rounded outward, sliding occurs in the opposite direction of bones angular movement o Femoral head (convex) moving in the acetabulum (concave) ABD of GH joint o Roll of humeral head is superior (convex) o Glide of acetabulum is inferior (concave) Concave on convex rule - o Moving surface is rounded inward, sliding occurs in the same direction as the bone’s angular movement o Tibial condyles (concave) moving on femoral condyles (convex) Tibiofemoral joint flexion open kinetic chain (tibia moves on top of the femur) o Roll of proximal tibia is posterior (concave) o Glide of distal femur is posterior (convex) Concave joints i. ii. iii. iv. v. vi. vii. Glenoid fossa Trochlear notch Radius/ulna Acetabulum Tibial plateau Distal tib/fib Talus (inferior) Convex joints i. ii. iii. iv. v. vi. vii. Humeral head Trochlea Carpals Femoral head Femoral condyles Talus (superior) Calcaneus Roll o One bone surface “rolls” over another one o Always in the same direction as the swinging bone in motion (whether convex or concave) o In isolation it compresses surfaces on the swinging side and separation on the other side o Typically, doesn’t occur alone but in combo with sliding and spinning Slide o Same point on one surface comes into contact with new points on the opposing surface o Direction of slide depends on whether the moving surface is convex or concave o Sliding in opposite direction: if moving surface is convex o Sliding in same direction: if moving surface is concave o Pure slides don’t occur bc the surfaces are not congruent Spin o o o o o Rotation of a segment around a stationary axis Same point on moving surface creates an arc of rotation as bone spins Humerus around scapula Femur around pelvis Radius around humerus Loose pack positions (Resting position) o Joint mobilization are performed in this position o Ligaments and capsular structures are more lax o Done when jt is irritable and needs less strain Closed pack positions o Typically avoided bc theres minimal space bt the joint surfaces, and force being applied, injury rate increases o No freedom of movement, ligaments are taught Traction o Longitudinal poll Distraction o Separation of joint surfaces Joint glide stretching o Replicates normal joint mechanics o Force is specific to target tissues Passive angular stretching o May cause increased pain or jt trauma o Force causes compression of the jt surfaces