lecture 5. joint mobilization
Post on 04-Apr-2018
275 Views
Preview:
TRANSCRIPT
-
7/30/2019 Lecture 5. Joint Mobilization
1/40
Joint Mobilization
Dr. Afaf A.M. Shaheen
Lecture 5
RHS 322
02/02/1434 1RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
2/40
Outlines
What is Joint Mobilization?
Terminology
Relationship Between Physiological & Accessory
Motion Basic concepts of joint motion : Arthrokinematics
Effects of Joint Mobilization
Contraindications for Mobilization Precautions
Techniques of joint mobilization
02/02/1434 RHS 322 2
-
7/30/2019 Lecture 5. Joint Mobilization
3/40
What is Joint Mobilization?
Joint Mobs Manual therapy technique
Used to modulate pain
Used to increase ROM
Used to treat joint dysfunctions that limit ROM byspecifically addressing altered joint mechanics
Factors that may alter joint mechanics: Pain & Muscle guarding
Joint hypomobility Joint effusion
Contractures or adhesions in the joint capsules orsupporting ligaments
Malalignment or subluxation of bony surfaces02/02/1434 3RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
4/40
Pondering Thoughts
Would you perform joint mobilizations on
someone who has a hypermobile joint?
02/02/1434 4RHS 322
http://images.google.com/imgres?imgurl=http://www.emedicine.com/ped/images/1381MF-JOINT.JPG&imgrefurl=http://www.emedicine.com/asp/image_search.asp%3Fquery%3DMarfan%2520Syndrome&h=151&w=200&sz=6&hl=en&start=13&tbnid=IXhZMP86wEhEOM:&tbnh=79&tbnw=104&prev=/images%3Fq%3Dhypermobility%26gbv%3D2%26svnum%3D10%26hl%3Denhttp://x.go.com/cgi/x.pl?name=SEARCH_photo&srvc=sz&goto=http://sports.espn.go.com/espn/apphoto/photo?photoId=1479941&sportId=10http://images.google.com/imgres?imgurl=http://thumbs.dreamstime.com/thumbimg_52/1144612278TUB4th.jpg&imgrefurl=http://www.dreamstime.com/searchkwy_joint&h=130&w=87&sz=5&hl=en&start=51&tbnid=WODGfXm_EWv1SM:&tbnh=91&tbnw=61&prev=/images%3Fq%3Dhypermobility%26start%3D36%26gbv%3D2%26ndsp%3D18%26svnum%3D10%26hl%3Den%26sa%3DNhttp://images.google.com/imgres?imgurl=http://www.kotaku.com/assets/resources/2006/09/curtschillingpitching.jpg&imgrefurl=http://kotaku.com/gaming/curt-schilling/ball-player-making-video-games-198663.php&h=286&w=500&sz=44&hl=en&start=76&tbnid=gz-Pk9oOO-zuTM:&tbnh=74&tbnw=130&prev=/images%3Fq%3Dbaseball%2Bpitcher%26start%3D72%26gbv%3D2%26ndsp%3D18%26svnum%3D10%26hl%3Den%26sa%3DN -
7/30/2019 Lecture 5. Joint Mobilization
5/40
Terminology
Mobilizationpassive joint movement forincreasing ROM or decreasing pain
Applied to joints & related soft tissues at varying speeds &
amplitudes using physiologic or accessory motions
Force is light enough that patients can stop the movement
Manipulationpassive joint movement for
increasing joint mobility Incorporates a sudden, forceful thrust that is beyond the
patients control
02/02/1434 5RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
6/40
Terminology
Self-Mobilization (Auto-mobilization)self-stretching techniques that specifically use jointtraction or glides that direct the stretch force to the
joint capsule
Mobilization with Movement (MWM)concurrent application of a sustained accessory
mobilization applied by a therapist & an activephysiologic movement to end range applied by thepatient Applied in a pain-free direction
02/02/1434 6RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
7/40
Terminology Physiologic Movements
Osteokinematicsmotions of the bones movements done voluntarily
traditional movements such as flexion, extension, abduction,rotation
Accessory Movementsmovements within the joint &surrounding tissues that are necessary for normal ROM, but can not be
actively performed by the patient
Component motionsmotions that accompany active motion,but are not under voluntary control
Ex: Upward rotation of scapula & rotation of clavicle that occur withshoulder flexion
Joint playmotions that occur within the joint Determined by joint capsules laxity
Can be demonstrated passively, but not performed actively
02/02/1434 7RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
8/40
Terminology Arthrokinematicsmotions of bone surfaces within the joint
5 motions - Roll, Slide, Spin, Compression, Distraction
Muscle energyuse an active contraction of deep musclesthat attach near the joint & whose line of pull can cause thedesired accessory motion
Therapist stabilizes segment on which the distal aspect of the muscleattaches; command for an isometric contraction of the muscle is given,which causes the accessory movement of the joint
Thrusthigh-velocity, short-amplitude motion that the patientcan not prevent
Performed at end of pathologic limit of the joint (snap adhesions,stimulate joint receptors)
Techniques that are beyond the scope of our practice!
02/02/1434 8RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
9/40
Terminology
Concavehollowed or rounded inward
Convexcurved or rounded outward
02/02/1434 9RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
10/40
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
02/02/1434 10RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
11/40
Basic concepts of joint motion :
Arthrokinematics
1. Joint ShapesType of motion is influenced by the
shapes of the joint surfaces
Ovoidone surface is convex,other surface is concave
What is an example of an ovoidjoint?
Sellar (saddle)one surface isconcave in one direction & convexin the other, with the opposingsurface convex & concaverespectively
What is an example of a sellarjoint?
02/02/1434 11RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
12/40
Basic concepts of joint motion :
Arthrokinematics
2. Types of joint motion
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
02/02/1434 12RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
13/40
Roll
A series of points on one articulating
surface come into contact with a series of
points on another surface 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
02/02/1434 13RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
14/40
Spin
Occurs when one bone rotates around a
stationary longitudinal mechanical axis
Same point on the moving surface createsan arc of a circle as the bone spins
Example: Radial head at the humeroradial
joint during pronation/supination; shoulderflexion/extension; hip flexion/extension
Spin does not occur by itself during normal
joint motion
02/02/1434 14RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
15/40
Slide Specific point on one surface comes
into contact with a series of points onanother surface
Surfaces are congruent
When a passive mobilization techniqueis 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 surfacesare, the more rolling there is
02/02/1434 15RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
16/40
Compression
Decrease in space between two joint surfaces
Adds stability to a joint
Normal reaction of a joint to muscle contraction
Distraction -
Two surfaces are pulled apart
Often used in combination with joint
mobilizations to increase stretch of capsule.
02/02/1434 16RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
17/40
Convex-Concave & Concave-Convex Rule
Basic application of correct mobilizationtechniques - **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 bonemovement (convex is STABLE)
If concave joint is moving on stationary convex
surfaceglide occurs in same direction as roll
02/02/1434 17RHS 322
http://images.google.com/imgres?imgurl=http://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructureAndFunction.files/ConcaveOnConvex.jpg&imgrefurl=http://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructionAndFunciton.htm&h=220&w=250&sz=28&hl=en&start=11&tbnid=GCFNu5JLPxT7xM:&tbnh=98&tbnw=111&prev=/images%3Fq%3Dconcave%2Bconvex%2Brule%26gbv%3D2%26svnum%3D10%26hl%3Denhttp://images.google.com/imgres?imgurl=http://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructureAndFunction.files/ConcaveOnConvex.jpg&imgrefurl=http://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructionAndFunciton.htm&h=220&w=250&sz=28&hl=en&start=11&tbnid=GCFNu5JLPxT7xM:&tbnh=98&tbnw=111&prev=/images%3Fq%3Dconcave%2Bconvex%2Brule%26gbv%3D2%26svnum%3D10%26hl%3Den -
7/30/2019 Lecture 5. Joint Mobilization
18/40
Convex-concave rule: convexjointsurfaces 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
02/02/1434 18RHS 322
http://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructureAndFunction.files/ConvexOnConcave.jpg -
7/30/2019 Lecture 5. Joint Mobilization
19/40
RULE OF CONCAVE-
CONVEX
02/02/1434 19RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
20/40
Effects of Joint Mobilization Neurophysiological effects
Stimulates mechanoreceptors to pain Affect muscle spasm & muscle guardingnociceptive stimulation
Increase in awareness of position & motion because of afferent nerveimpulses
Nutritional effects Distraction or small gliding movementscause synovial fluid movement Movement can improve nutrient exchange due to joint swelling &
immobilization
Mechanical effects
Improve mobility of hypomobile joints (adhesions & thickened CT fromimmobilizationloosens)
Maintains extensibility & tensile strength of articular tissues
Cracking noise may sometimes occur
02/02/1434 20RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
21/40
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
02/02/1434 21RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
22/40
Precautions
Osteoarthritis
Pregnancy
Flu
Total joint replacement
Severe scoliosis
Poor general health
Patients inability to relax
02/02/1434 22RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
23/40
02/02/1434 23RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
24/40
02/02/1434 24RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
25/40
02/02/1434 25RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
26/40
10 simple steps
1. Evaluation and Assessment
2. Determine grades and dosage
3. Patient position
4. Joint position5. Stabilization
6. Treatment force
7. Direction of movement
8. Speed and rhythm9. Initiation of treatment
10. Reassessment
02/02/1434 26RHS 322
Maitland Joint Mobilization
-
7/30/2019 Lecture 5. Joint Mobilization
27/40
Maitland Joint Mobilization
Grading Scale Grading based on amplitude of movement & where
within available ROM the force is applied.
Grade I Small amplitude rhythmic oscillating movement at the
beginning of range of movement Manage pain and spasm
Grade II Large amplitude rhythmic oscillating movement within
midrange of movement Manage pain and spasm
Grades I & IIoften used before & after treatment withgrades III & IV02/02/1434 27RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
28/40
Grade III Large amplitude rhythmic oscillating movement up to point
of limitation (PL) in range of movement
Used to gain motion within the joint Stretches capsule & CT structures
Grade IV Small amplitude rhythmic oscillating movement at very end
range of movement
Used to gain motion within the joint Used when resistance limits movement in absence of pain
Grade V(thrust technique) - Manipulation
Small amplitude, quick thrust at end of range Accompanied by popping sound (manipulation)
Velocity vs. force
Requires training
02/02/1434 28RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
29/40
Indications for Mobilization
Grades I and II - primarily used for pain
Pain must be treated prior to stiffness
Painful conditions can be treated daily
Small amplitude oscillations stimulatemechanoreceptors - limit pain perception
Grades III and IV - primarily used to increase
motion Stiff or hypomobile joints should be treated 3-4
times per weekalternate with active motion
exercises02/02/1434 29RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
30/40
ALWAYS Examine PRIOR
to Treatment
If limited or painful ROM,examine & decide whichtissues are limitingfunction
Determine whethertreatment will be directedprimarily toward relievingpain or stretching a jointor soft tissue limitation
Quality of pain whentesting ROM helpsdetermine stage ofrecovery & dosage oftechniques
1) If pain is experienced BEFORE tissuelimitation, gentle pain-inhibiting jointtechniques may be used
Stretching under these circumstancesis contraindicated
2) If pain is experiencedCONCURRENTLY with tissuelimitation (e.g. pain & limitation thatoccur when damaged tissue begins toheal) the limitation is treatedcautiouslygentle stretchingtechniques used
3) If pain is experienced AFTER tissuelimitation is met because of stretchingof tight capsular tissue, the joint canbe stretched aggressively
02/02/1434 30RHS 322
J i t P iti
-
7/30/2019 Lecture 5. Joint Mobilization
31/40
Joint Positions Resting position
Maximum joint play - position in which joint capsule and ligaments aremost relaxed
Evaluation and treatment position utilized with hypomobile joints
Loose-packed position Articulating surfaces are maximally separated
Joint will exhibit greatest amount of joint play
Position used for both traction and joint mobilization
Close-packed position Joint surfaces are in maximal contact to each other
General rule: Extremes of joint motion are close-packed, &midrange positions are loose-packed.
02/02/1434 31RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
32/40
Joint Mobilization Application
All joint mobilizations follow the convex-concave 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 ifpossible
Begin & end treatments with Grade I or II oscillations
02/02/1434 32RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
33/40
Positioning & Stabilization Patient & extremity should be positioned so that the
patient can RELAX
Initial mobilization is performed in a loose-packed
position
In some cases, the position to use is the one in which the jointis least painful
Firmly & comfortably stabilize one joint segment,
usually the proximal bone Hand, belt, assistant
Prevents unwanted stress & makes the stretch force more
specific & effective
02/02/1434 33RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
34/40
Treatment Force & Direction of
Movement
Treatment force is applied as close to theopposing joint surface as possible
The larger the contact surface is, the more comfortable the
procedure will be (use flat surface of hand vs. thumb)
Direction of movement during treatment is
either PARALLEL or PERENDICULAR to the
treatment plane
02/02/1434 34RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
35/40
Treatment plane lies on theconcave articulating surface,perpendicular to a line from thecenter of the convex articulatingsurface (Kisner & Colby, p. 226 Fig. 6-11)
Joint traction techniques areapplied perpendicular to thetreatment plane
Entire bone is moved so that thejoint surfaces are separated
Treatment Direction
02/02/1434 35RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
36/40
Gliding techniques are applied parallel to the treatmentplane
Glide in the direction in which the slide would normally occur for thedesired motion
Direction of sliding is easily determined by using the convex-concaverule
The entire bone is moved so that there is gliding of one joint surface onthe other
When using grade III gliding techniques, a grade I distraction should beused
If gliding in the restricted direction is too painful, begin glidingmobilizations in the painless direction then progress to gliding inrestricted direction when not as painful
Reevaluate the joint response the next day or have the
patient report at the next visit If increased pain, reduce amplitude of oscillations If joint is the same or better, perform either of the following:
Repeat the same maneuver if goal is to maintain joint play
Progress to sustained grade III traction or glides if the goal is to increase jointplay
02/02/1434 36RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
37/40
Speed, Rhythm, & Duration of
Movements
Joint mobilization sessionsusually involve:
3-6 sets of oscillations
Perform 2-3 oscillations persecond
Lasting 20-60 seconds fortightness
Lasting 1-2 minutes for pain2-3 oscillations per second
Apply smooth, regularoscillations
Vary speed of oscillationsfor different effects
For painful joints, applyintermittent distraction for 7-
10 seconds with a fewseconds of rest in betweenfor several cycles
For restricted joints, apply aminimum of a 6-second
stretch force, followed bypartial release then repeatwith slow, intermittentstretches at 3-4 secondintervals
02/02/1434 37RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
38/40
Patient Response
May cause soreness
Perform joint mobilizations on alternate days to
allow soreness to decrease & tissue healing tooccur
Patient should perform ROM techniques
Patients joint & ROM should be reassessed after
treatment, & again before the next treatment
Pain is always the guide
02/02/1434 38RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
39/40
Joint Traction Techniques
Technique involving pulling one articulating surface
away from anothercreating separation
Performed perpendicular to treatment plane Used to decrease pain or reduce joint hypomobility
Kaltenborn classification system
Combines traction and mobilization
Joint looseness = slack
02/02/1434 39RHS 322
-
7/30/2019 Lecture 5. Joint Mobilization
40/40
References
Houglum, P.A. (2005). Therapeutic exercise formusculoskeletal injuries, 2nd ed. Human Kinetics:Champaign, IL
Kisner, C. & Colby, L.A. (2002). Therapeuticexercise: Foundations and techniques, 4th ed. F.A.Davis: Philadelphia.
http://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructionAndFunciton.htm
www.google.com (images)
02/02/1434 40RHS 322
http://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructionAndFunciton.htmhttp://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructionAndFunciton.htmhttp://www.google.com/http://www.google.com/http://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructionAndFunciton.htmhttp://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructionAndFunciton.htm
top related