02 lecture mt 9-s-15 'basics in manual therapy-1' by abdul ghafoor sajjad

MANUAL THERAPY DPT 9th Semester

SPINAL MOVEMENTS

Lecture No 02

Dr Abdul Ghafoor Sajjad HOD/Assistant Professor

Riphah Rehabilitation Center IIMC-T, Pakistan Railway Hospital

RCRS, RIU

IN THIS LECTURE

• The Mobile Segment

• Spinal ROM

• Bone & Joint movement

• Three-dimensional joint positioning

– Open pack …………………………. Close Pack

• Bone and joint Movements

• Treatment plan

• Concave Convex Rule

• Synchondrosis • Nucleus pulposis & Annulus

Fibrosis • Functions

• Static • Movement • Stabilization

• Bears Soft Load Impulses • The anterior aspect compress

slightly with spinal flexion and Vice Versa

• Posterior Disc Herniation is common

Revision CLASSIFICATION OF JOINTS

STRUCTURAL CLASSIFICATION OF JOINTS

1. Fibrous joints

– Generally immovable

2. Cartilaginous joints

– Immovable or slightly moveable

3. Synovial joints

– Freely moveable


FIBROUS JOINTS (SYNARTHROSIS)

• Collagen fibers span the space between bones

1. SUTURES,

2. GOMPHOSES

3. SYNDESMOSES


CARTILAGENOUS JOINTS (AMPHIARTHROSIS)

Articulating bones united by cartilage, Lack a joint cavity, Not highly movable

Two types

1. SYNCHONDROSES

2. SYMPHESES

• Zygapophyseal joints • Synovial Joint • Orientation of the Facet

Joint surface in different spinal level • Cervical 45 • Thoracic 60 • Lumber 90

Spinal Flexibility is influenced by Person’s Age Health of tissue

surrounding spine Physical

conditioning Hereditary Factors

THREE-DIMENSIONAL JOINT POSITIONING

For practical purposes, we classify joint positions into five categories:

1. Zero position

2. Resting position (Loose-packed position)

3. Actual resting position

4. Non-resting positions

5. Close-packed position

Zero Position

• Also known as position of reference

• Joints ROM measurements are taken from the zero starting position

• ROM is measured with a goniometer on both sides of zero

Zero Position

RESTING POSITION

• First described by McConnell

• It is a position in which

– Joint capsule and ligaments are most relaxed

– Little joint contact

– Maximum joint play

• Also called Loose/open-packed position

• How we measure the Open packed position

RESTING POSITION

THE ACTUAL RESTING POSITION

• Sometimes we are unable to test our patients joint in the resting position due to pain or significantly limited motion.

• This is often the position where treatment is initiated.

NONRESTING POSITIONS

• As your skills improve and your patients impairments decrease you will find that you need to perform joint play testing out of the resting position.

• In order to judge the degree of capsular looseness or tightness in these positions it is important to have a thorough sense of how these tissues feel normally in the resting position.

CLOSED-PACKED POSITION

• Joint surfaces are in maximal contact to each other

• Most ligaments & capsules surrounding the joint are taut

UNDERSTANDING MOVEMENT • Osteokinematics

– gross movements of bones at joints • flexion / extension • abduction / adduction • internal rotation / external rotation

• Arthrokinematics – small amplitude motions of bones at joint

surface • roll • glide (or slide) • spin

BONE AND JOINT MOVEMENT

• Two types of bone movements are important in OMT system:

1. Rotations: curved (angular) movement around an axis

2. Translations: linear (straight-lined) movement parallel to an axis in one plane

Bone Movements

Rotations

Standard bone

movement

Combined bone

movement

Coupled movements

Non coupled movements

Translations

Traction Compression Gliding


ROTATIONS

• Curved (angular) movements around an axis

• Produce roll-gliding

• Two types

A. Standard bone movement

B. Combined bone movement

ROTATIONS

A. Standard bone movement – Anatomical movements

– Uniaxial

– e.g. flexion, extension etc

ROTATIONS

B. Combined bone movement

– Functional movements

– Multiaxial

– e.g. Flex. + Lat. Flex. + Rot.

– Two types

i. Coupled movements

ii. Non coupled movements

i. COUPLED MOVEMENTS

• Movement combinations that result in the most ease of movement

• These movements have – greatest range

– least resistance to movement

– softest end-feel

• e.g. lumbar side bending and rotation to opposite side are coupled when erect (or in extension)

ii. NON COUPLED MOVEMENTS

• Movement combinations that result in less ease of movement

• These movements have – less range

– more resistance to movement

– harder end-feel

• e.g. lumbar side bending and rotation to the same side (in ext)

ROTATIONS

• Standard, uniaxial

– MacConaill 's "pure, cardinal swing"

• Combined, multiaxial

– MacConaill 's "impure arcuate swing"


• Two types of bone movements are important in OMT system:

1. Rotations: curved (angular) movement around an axis

2. Translations: linear (straight-lined) movement parallel to an axis in one plane

Bone Movements

Rotations

Standard bone

movement

Combined bone

movement

Coupled movements

Non coupled movements

Translations

Traction Compression Gliding

Translation

• During translation of a bone all parts of the bone move in a straight line, at equal distance, in the same direction, and at the same speed

• Produces joint play movements of traction, compression, and gliding

• Before a/m movement, first we know about the treatment plan.

TREATMENT PLANE

• Treatment plane lies on the concave articulating surface, perpendicular to a line from the center of the convex articulating surface

• It moves when the concave surface moves

• It remains essentially still when the convex surface moves

TREATMENT PLANE

TRACTION

• Longitudinal bone separation away from the treatment plane

TRACTION/DISTRACTION

• Traction and distraction are not synonymous.

• Traction is a longitudinal pull.

• Distraction is a separation, or pulling apart.

COMPRESSION

• Decrease in space between two joint surfaces

• Longitudinal bone approximation towards the treatment plane

GLIDING

• Translatory movement where the joint surfaces are passively displaced parallel to the treatment plane

JOINT ROLL-GLIDING ASSOCIATED WITH BONE ROTATIONS

• In a healthy joint, functional movement (bone rotation) produces joint roll-gliding.

• Roll-gliding is a combination of rolling and gliding movement which takes place between two joint surfaces

Roll

• New points on one surface meet new points on the opposing surface

Glide

• Specific point on one surface comes into contact with a series of points on another surface

• Surfaces must be congruent either flat or curved

• Follow Concave-Convex Rule

JOINT ROLL-GLIDING

ROLLING AND GLIDING

• Since there is never pure congruency between joint surfaces; all motions require rolling and gliding to occur simultaneously

• This combination of roll and glide is simultaneous but not necessarily in proportion to one another

JOINT ROLL-GLIDING

• Combined rolling-gliding in a joint

– The more congruent (flat or curved) the surfaces are, the more gliding there is

– The more incongruent the joint surfaces are, the more rolling there is

Abnormal roll-gliding

• Usually the restricted movement is associated with an impaired gliding component which may allow joint rolling to occur without its associated gliding.

• Joint rolling movements in the absence of gliding can produce a damaging concentration of forces in a joint.


• A common goal in our approach to OMT is to restore the gliding component of roll-gliding to normalize movement mechanics.

Determining the Direction of the Restricted Gliding

• The direction of limitation for joint gliding may be determined either directly (using glide testing) or indirectly using Kaltenborn Concave-convex rule.

The Direct Method (Glide Testing)

• The therapist applies passive translatoric gliding movements in all possible directions and determines in which directions joint gliding is restricted.

• This is the preferred method as it gives the most information about the degree and nature of gliding restrictions !

The Indirect Method (Concave-Convex Rule)

• The therapist determines which bone rotations are decreased and also notes whether the moving joint partner is convex or concave

• Indirect method is used when

–Patient has severe pain

– Joint is extremely hypomobile

– Therapist is inexperienced with direct assessment

Concave-Convex & Convex-Concave Rule

• The shape of the joint surface influences the direction of the accessory movement

• One joint surface is MOBILE & one is STABLE


• Concave-convex rule: concave joint surfaces slide in the SAME direction as the bone movement (convex is STABLE) – If concave surface is

moving on stationary convex surface – glide occurs in same direction as roll


• Convex-concave rule: convex joint surfaces slide in the OPPOSITE direction of the bone movement (concave is STABLE) – If convex surface is moving

on stationary concave surface – gliding occurs in opposite direction to roll

Concave-Convex Rule of Joint Movement

References

ABDUL GHAFOOR SAJJAD 65

02 lecture mt 9-s-15 'basics in manual therapy-1' by abdul ghafoor sajjad

Healthcare