peripheral joint mobilization
TRANSCRIPT
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PERIPHERAL JOINT MOBILIZATION
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COURSE LEARNING OUTCOMES
At the end of this lesson, student should be able to :
Define terms used in peripheral joint mobilization techniques.
Explain basic concept of joint motion and position.
Explain the effects of joint mobilization.
Identify and list indication, contraindication, precautions and the limitation of joint
mobilization techniques.
Explain the concept of joint mobilization grading scale.
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OVERVIEW (PART 1)Introduction
Definition of terms
Basic Concept of Joint Motion (Arthrokinematics)
Effects of Mobilization
Indication and Contraindication
Limitation of Joint Mobilization
Closed and Loose Packed Joint Position
Grading Scales
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Introduction
Joint mobilization : Manual therapy techniques that are used to
modulate pain and treat joint dysfunctions that limit range of
motion and specifically altered mechanics of joint.(Kisner,C.& Colby, L.(2007) Therapeutic Exercise; Foundation and techniques,5th ed,F.A
Davis)
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Define the terms used in Joint Mobilization•passive, skilled manual therapy techniques
•applied at joint and related soft tissues
• varying speed and amplitude
•using physiological or accessory motion
Mobilization
•self stretching technique that specifically use joint traction/glides that direct the stretch force to the joint capsule. Self-mobilization
•concurrent application of sustained accessory mobilization applied by a therapist and an active physiological movement to ER applied by the patient.
Mobilization with movement (MWM)
•movement that patient can do voluntarilyPhysiological movement
•movement in the joint & surrounding soft tissues that are necessary for normal ROM, BUT not actively performed by patient.Accessory movement
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• motion that accompany active movement but not voluntarily control (scapula movt).
Component motion
• motion that occur between joint surface.Joint Play
• high velocity, short amplitude motion
• - end of pathological limit of the joint
• - alter positional relationship, snap, adhesions or stimulate joint receptor
Thrust
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Relationship Between Physiological & Accessory Motion Biomechanics of joint motion
Physiological motion Result of concentric or eccentric active muscle contractions
Bones moving about an axis or through flexion, extension, abduction, adduction or rotation
Accessory Motion Motion of articular surfaces relative to one another
Generally associated with physiological movement
Necessary for full range of physiological motion to occur
Ligament & joint capsule involvement in motion
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x
Y
Z
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Joint Shapes & Arthrokinematics Ovoid – one surface is convex, other surface
is concave What is an example of an ovoid joint?
Sellar (saddle) – one surface is concave in one direction & convex in the other, with the opposing surface convex & concave respectively What is an example of a sellar joint?
5 types of joint arthrokinematics Roll
Slide
Spin
Compression
Distraction
3 components of joint mobilization Roll, Spin, Slide
Joint motion usually often involves a combination of rolling, sliding & spinning
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Roll
A series of points on one articulating surface come into
contact with a series of points on another surface Rocking chair analogy; ball rolling on ground
Example: Femoral condyles rolling on tibial plateau
Roll occurs in direction of movement
Occurs on incongruent (unequal) surfaces
Usually occurs in combination with sliding or spinning
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Spin
Occurs when one bone rotates around a stationary longitudinal mechanical axis Same point on the moving surface creates an arc of a circle as the bone spins
Example: Radial head at the humeroradial joint during pronation/supination; shoulder
flexion/extension; hip flexion/extension
Spin does not occur by itself during normal joint motion
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Slide Specific point on one surface comes into contact
with a series of points on another surface
Surfaces are congruent
When a passive mobilization technique is applied to
produce a slide in the joint – referred to as a
GLIDE.
Combined rolling-sliding in a joint
The more congruent the surfaces are, the more sliding
there is
The more incongruent the joint surfaces are, the more
rolling there is
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Compression
Decrease in space between two joint surfaces
Adds stability to a joint
Normal reaction of a joint to muscle contraction
Normal compression occurs in spine and extremities during weight bearing.
Normal intermittent compressive load helps move synovial fluid and thus maintain cartilage health.
Abnormal high compression loads may lead to articular cartilage changes and deterioration.
Distraction
Two surfaces are pulled apart
Often used in combination with joint mobilizations to increase stretch of capsule.
Long axis traction is different form distraction.
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Convex-Concave & Concave-Convex Rule
Basic application of correct mobilization techniques -
**need to understand this!
Relationship of articulating surfaces associated with
sliding/gliding
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 joint is moving on stationary convex surface – glide
occurs in same direction as roll
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Convex-concave rule: convex joint surfaces slide
in the OPPOSITE direction of the bone
movement (concave is STABLE)
If convex surface in moving on stationary
concave surface – gliding occurs in opposite
direction to roll
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The shape of the joint surface influences the direction of the accessory movement
If surface of moving bone is convex, sliding is in the opposite direction of the
bone’s physiological movement
If the surface of the moving bone is concave, sliding is in the same direction as the
physiological movement of the bone
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EFFECTS
Moving synovial fluid.
Retard cartilage atrophy
Maintain extensibility/tensile strength
Stimulate afferent nerve impulse
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Indications
Pain - small amplitude oscillations to treat
Muscle spasm/guarding - gentle oscillations
and sustained stretch to maintain joint play
Joint hypomobility/stiffness - oscillatory
forces used to stretch joint capsule
Goals: stimulate neurophysiological and
mechanical effects.
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- Positional faults/subluxations – after prolonged
immobilized, faulty tracking of the joint surface
- Progressive limitation- mechanical restrictions
- Functional immobility – maintain available joint play and
prevent degenerating and restricting effect.
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Contraindications for Mobilization Should not be used haphazardly
Avoid the following:
Inflammatory arthritis
Malignancy
Tuberculosis
Osteoporosis
Ligamentous rupture
Herniated disks with nerve compression
Bone disease
Neurological involvement
Bone fracture
Congenital bone deformities
Vascular disorders
Joint effusion
May use I & II mobilizations to
relieve pain
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Limitation
Techniques cannot change a disease process Be careful with unexplained pain syndromes
Therapist skill will affect the outcome
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Precautions
Malignancy
Total joint replacement
Healed tissue
Systemic connective tissue disease
Elderly
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Position of the joints
Closed packed position (tightly packed
position)
- maximal contact of the articular surface
- extreme end of the ROM
- avoid position for joint mobilization
Loosed packed position (resting position)
- joint structures are most relaxed
- contacts between joint surface are lesser
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Grading scale
2 systems of grading:
Graded oscillation techniques. (Maitland)
Sustained translatory joint play techniques. (Kalterborn)
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Grades of Oscillations (Maitland)
Dosages:
Grade I - small amplitude rhythmic oscillations at the beginning of the range (pain and spasm)
Grade II - large amplitude rhythmic oscillations within the midrange of the movement, not reaching the limit (pain and spasm)
Grade III - large amplitude rhythmic oscillations up to the limit of available motion and stressed into tissue resistance (into restriction)
Grade IV - small amplitude rhythmic oscillations to the limit of available motion and stress into the tissue resistance (not pain)
Grade V - small amplitude, high velocity(quick) thrust manipulation at end range- required advanced training!
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Grades of Oscillations (Maitland)
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GRADED OSCILLATION TECHNIQUES
Uses
Grades I and II
for joints limited by pain
Grades III and IV
stretching maneuvers
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Sustained Translatory Joint-Play Techniques
Dosages:
Grade I (loosen)- small amplitude distraction is applied
where no stress is placed on the capsule. It equalizes cohesive
forces, muscle tension, and atmospheric pressure acting on the
joint.
Grade II (tighten) – enough distraction or glide is applied
to tighten the tissues around the joint.
Grade III (stretch) – a distraction or glide is applied with an
amplitude large enough to place stretch on the joint capsule
and surrounding periarticular structures.
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SUSTAINED TRANSLATORY JOINT-PLAY TECHNIQUES
Uses
Grade I distraction
Used with all the gliding motions
For relief of pain
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SUSTAINED TRANSLATORY JOINT-PLAY TECHNIQUES
Grade II distraction
For INITIAL TREATMENT
May be used to inhibit pain when applied
intermittently
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SUSTAINED TRANSLATORY JOINT-PLAY TECHNIQUES
Grade II glides
May be used to maintain joint play when ROM
is not allowed
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SUSTAINED TRANSLATORY JOINT-PLAY TECHNIQUES
Grade III distraction or glides
Used to stretch the joint structures and thus
increase joint play
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REFERENCE:
Kisner, C. & Colby, L.A. (2007). Therapeutic Exercise Foundations and
Techniques, 5th ed. Chapter 5.
Lakshmi,S.N. (2005). Textbook Therapeutic Exercises,1st ed. Chapter 10.
http//www.podcaster.tv-episodes-joint traction versus bone traction in shoulder
joint 5782985.html
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BRAIN CHALLENGE
What are the different between
mobilization and manipulation?
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PRACTICAL SESSIONS (3 hours)
1) Find out the human joint shape for:
- UL (shoulder complex, elbow, radioulnar, carpometacarpal)
- LL (hip, knee, ankle, metatarsophalangeal)
2) Find out the closed and loosed packed position for joint:
- UL (shoulder complex, elbow, radioulnar, carpometacarpal)
- LL (hip, knee, ankle, metatarsophalangeal)
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THANK YOU