02 lecture mt 9-s-15 'basics in manual therapy-1' by abdul ghafoor sajjad
TRANSCRIPT
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MANUAL THERAPY DPT 9th Semester
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SPINAL MOVEMENTS
Lecture No 02
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Dr Abdul Ghafoor Sajjad HOD/Assistant Professor
Riphah Rehabilitation Center IIMC-T, Pakistan Railway Hospital
RCRS, RIU
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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
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• 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
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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
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Revision CLASSIFICATION OF JOINTS
FIBROUS JOINTS (SYNARTHROSIS)
• Collagen fibers span the space between bones
1. SUTURES,
2. GOMPHOSES
3. SYNDESMOSES
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Revision CLASSIFICATION OF JOINTS
CARTILAGENOUS JOINTS (AMPHIARTHROSIS)
Articulating bones united by cartilage, Lack a joint cavity, Not highly movable
Two types
1. SYNCHONDROSES
2. SYMPHESES
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• Zygapophyseal joints • Synovial Joint • Orientation of the Facet
Joint surface in different spinal level • Cervical 45 • Thoracic 60 • Lumber 90
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Spinal Flexibility is influenced by Person’s Age Health of tissue
surrounding spine Physical
conditioning Hereditary Factors
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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
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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
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Zero Position
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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
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RESTING POSITION
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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.
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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.
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CLOSED-PACKED POSITION
• Joint surfaces are in maximal contact to each other
• Most ligaments & capsules surrounding the joint are taut
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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
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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
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Bone Movements
Rotations
Standard bone
movement
Combined bone
movement
Coupled movements
Non coupled movements
Translations
Traction Compression Gliding
BONE AND JOINT MOVEMENT
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ROTATIONS
• Curved (angular) movements around an axis
• Produce roll-gliding
• Two types
A. Standard bone movement
B. Combined bone movement
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ROTATIONS
A. Standard bone movement – Anatomical movements
– Uniaxial
– e.g. flexion, extension etc
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ROTATIONS
B. Combined bone movement
– Functional movements
– Multiaxial
– e.g. Flex. + Lat. Flex. + Rot.
– Two types
i. Coupled movements
ii. Non coupled movements
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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)
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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)
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ROTATIONS
• Standard, uniaxial
– MacConaill 's "pure, cardinal swing"
• Combined, multiaxial
– MacConaill 's "impure arcuate swing"
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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
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Bone Movements
Rotations
Standard bone
movement
Combined bone
movement
Coupled movements
Non coupled movements
Translations
Traction Compression Gliding
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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.
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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
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TREATMENT PLANE
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TRACTION
• Longitudinal bone separation away from the treatment plane
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TRACTION/DISTRACTION
• Traction and distraction are not synonymous.
• Traction is a longitudinal pull.
• Distraction is a separation, or pulling apart.
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COMPRESSION
• Decrease in space between two joint surfaces
• Longitudinal bone approximation towards the treatment plane
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GLIDING
• Translatory movement where the joint surfaces are passively displaced parallel to the treatment plane
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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
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Roll
• New points on one surface meet new points on the opposing surface
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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
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JOINT ROLL-GLIDING
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JOINT ROLL-GLIDING
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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
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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
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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.
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Abnormal roll-gliding
• A common goal in our approach to OMT is to restore the gliding component of roll-gliding to normalize movement mechanics.
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Abnormal roll-gliding
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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.
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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 !
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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
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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
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Concave-Convex & Convex-Concave Rule
• 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
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Concave-Convex & Convex-Concave Rule
• 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
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Concave-Convex & Convex-Concave Rule
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Concave-Convex & Convex-Concave Rule
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Concave-Convex & Convex-Concave Rule
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Concave-Convex Rule of Joint Movement
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References
ABDUL GHAFOOR SAJJAD 65