section 1 joint mobs explained

8/13/2019 Section 1 Joint Mobs Explained

1/76

1

Joint

MobilizationExplained!


2/76

2

Definitions

" Mobilization" Physiologic Movements/Mobilization" Accessory/Joint Play Movement"

Manipulation


3/76

3

Remember: Joint Positions (Magee p. 54)

" Resting position AKA Loose packed position:" Maximum joint play- position in which joint

capsule and ligaments are most relaxed

" Evaluation and treatment position utilized withhypomobile joints" Articulating surfaces are maximally separated" Joint will exhibit greatest amount of joint play" Position used for both traction and joint

mobilization

" Close-packed position" Maximal contact of articulating surfaces


4/76

4

Osteokinematics:

movement ofthe bone

Arthrokinematics:

movement ofthe joint surface


5/76

5

Joint Surfaces

SellarOvoid


6/76


7/76

7

AB

Roll


8/76

8

AB

C

Roll


9/76

9

D

AB

C

Roll


10/76

10

A

Glide


11/76

11

A

B

Glide


12/76

12

A

B

C

Glide


13/76

13

A

B

C

DGlide


14/76

14

A

Spin


15/76

15

A

Spin


16/76

16

A

Spin


17/76

17

A

Spin


18/76

18

Knee:Roll/No Glide


19/76

19

Knee:Roll/No Glide


20/76

20

Knee:Roll/No Glide


21/76

21

Knee:Roll/No Glide


22/76

22

Knee:Roll/No Glide


23/76

23

Knee:Roll/Glide

Knee:Roll/NoGlide


24/76

24

Knee:Glide...Roll

Spin


25/76

25

Knee:Glide...Roll


26/76

26

Knee:Glide...Roll


27/76

27

Knee:Glide...Roll


28/76

28

Knee:Glide...Roll

Spin


29/76

29

Knee:Roll/Glide

Knee:Roll/NoGlide


30/76

30

concave

convex


31/76

31

concaveconcave

convex

convexconvex

Convex onConcave

joints

Concave onConvex

joints

concave

Name all Name all


32/76

32

Convex Concave Rule

A convex on a concave joint surfaceglides the opposite direction that the

bone swings.

Example: When the humerus swingsup into abduction, the head of the

humerus glides downward.


33/76

33

Glenohumeral:Roll /Glide


34/76

34



35/76

35



36/76

36



37/76

37

Glenohumeral:Roll / No Glide


38/76

38



39/76

39



40/76

40

A concave on a convex joint surfaceglides the same direction that the bone

swings.

Example: When the tibia swingsposteriorly in knee flexion, the tibial

joint surface glides posteriorly.

Concave Convex Rule


41/76

41

Knee:Posterior GlidePosterior Swing


42/76

42



43/76

43



44/76

44



45/76

45

Mobilization - Indications and Goals

" Indications:" Capsular pattern- pattern of motion loss" 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:

"Gentle joint play techniques stimulate bothmechanical and neurophysiological effects

" Restore Normal Joint Play" Increase Pain-Free Joint ROM


46/76

46

Indications for Type of Mobilization

" Grades I and II are used primarily for pain" Grades III and IV can be utilized for stiffness" Pain must be treated prior to stiffness" Small amplitude oscillations are utilized tostimulate mechanoreceptors, limiting pain

perception

" Painful conditions can be treated daily" Stiff or hypomobile joints should be treated 3-4times per week alternate with active motion

exercises


47/76

47

Joint Mobilization Application" All joint mobilizations follow the convex-

concave rule or concave-convex rule" Patient should be relaxed" Explain purpose of treatment &

sensations to expect to patient" Evaluate BEFORE & AFTER treatment" Stop the treatment if it is too painful for

the patient" Use proper body mechanics" Use gravity to assist the mobilization

technique if possible" Begin & end treatments with Grade I or II

oscillations


48/76

48

Effects ofJoint Mobilization

" Synovial Fluid" Stretching" Improve tissue tensile strength" Decrease Pain (Neurophysiological)

Mechanical Receptor: Gate Mechanism

" Increase Relaxation(Neurophysiological)


49/76

49

Effects of Joint Mobilization

" To restore motion in hypomobile jointstissue deformation occurs

" Tissue stretch within elastic range does notproduce permanent structural change

" Stretching in plastic range cause permanentstructural changes

" Traction and joint mobilization can be usedto stretch tissue and break tissue adhesions

" Treatments generally involve slow, smallamplitude movements" Joint mobilizations involve small

amplitude oscillations


50/76

50

Ankle:Plantar Flexion

What do you expect?


51/76

51



52/76


53/76

53



54/76

54



55/76

55

MTP:Flexion

What do you expect?


56/76

56

MTP:Flexion


57/76

57

MTP:Flexion


58/76

58

MTP:Flexion


59/76

59

MTP:Flexion


60/76

60

Contraindications/Precautions

" See ROM/Stretching" Hypermobility" Inflammation and Joint Effusion


61/76

61

Joint Traction:

Longitudinal pull along the shaftof the long bone


62/76

62

Hip:Traction


63/76

63

Hip:Traction


64/76

64

Spine Traction:Longitudinal pull along the lineof the spinal column


65/76

65

Spine TractionVertebral Bodies Separate


66/76

66

Spine TractionVertebral Bodies Separate


67/76

67

Spine TractionFacets Glide Apart Foramen Open


68/76

68

Spine TractionFacets Glide Apart Foramen Open


69/76

69

Joint Traction Techniques

" Technique involving pulling one articulatingsurface away from another creating separation

" Performed perpendicular to treatment plane" Used to decrease pain or reduce joint hypomobility" Kaltenborn classification system

" Combines traction and mobilization" Joint looseness = slack


70/76


71/76


72/76

72

Grades of Vigor

I

II

III

IV

BeginAvailable

Range

EndAvailable

Range

III-

IV-


73/76

73

Procedures for Application of JointMobilization Techniques

"Position patient in a relaxed, distracted, supportedposition so the joint capsule is lax (loose-packed orresting position)

"Stabilize proximal bone

"Position joint in open (loose packed) position"Apply treatment force close to the joint line as

possible (decrease lever)

"Use treatment plane

"Joint mobilization sessions usually involve 3-6 setsof oscillations lasting 20-60 seconds, 1-3 oscillationsper second


74/76

74

10 simple steps:1. Evaluation and

Assessment

2. Determine gradesand dosage

3. Patient position

4. Joint position

5. Stabilization

6. Treatment force

7. Direction ofmovement

8. Speed and rhythm

9. Initiation oftreatment

10. Reassessment


75/76

75

Mobilization

" If there is pain beforetissue limitation, use gentletechniques for decreasing pain and no stretching

" Grades I and II" If pain is concurrentwith tissue limitation, treat

cautiously with gentle techniques, then graduallyincrease movement without exacerbating pain

" Grade I and II" If pain is experienced after tissue limitation, a stiff

articulation can be aggressively mobilized with jointplay techniques

" Grades III and IV


76/76

76

Recommendations for using

the Grades

" Pain and spasm" I and II

" Tissue resistance" III and IV

" Treatment amplitude" Low - I, IV" High - II, III

"Treatment speed" Fast I, IV" Slow II, III

" Gentle techniques" I, II

"Treatment force" Low I, II" High III, IV

section 1 joint mobs explained

Documents