section 1 joint mobs explained
TRANSCRIPT
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Joint
MobilizationExplained!
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Definitions
" Mobilization" Physiologic Movements/Mobilization" Accessory/Joint Play Movement"
Manipulation
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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
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Osteokinematics:
movement ofthe bone
Arthrokinematics:
movement ofthe joint surface
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Joint Surfaces
SellarOvoid
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AB
Roll
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AB
C
Roll
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D
AB
C
Roll
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A
Glide
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A
B
Glide
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A
B
C
Glide
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A
B
C
DGlide
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A
Spin
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A
Spin
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A
Spin
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A
Spin
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Knee:Roll/No Glide
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Knee:Roll/No Glide
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Knee:Roll/No Glide
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Knee:Roll/No Glide
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Knee:Roll/No Glide
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Knee:Roll/Glide
Knee:Roll/NoGlide
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Knee:Glide...Roll
Spin
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Knee:Glide...Roll
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Knee:Glide...Roll
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Knee:Glide...Roll
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Knee:Glide...Roll
Spin
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Knee:Roll/Glide
Knee:Roll/NoGlide
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concave
convex
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concaveconcave
convex
convexconvex
Convex onConcave
joints
Concave onConvex
joints
concave
Name all Name all
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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.
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Glenohumeral:Roll /Glide
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Glenohumeral:Roll /Glide
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Glenohumeral:Roll /Glide
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Glenohumeral:Roll /Glide
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Glenohumeral:Roll / No Glide
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Glenohumeral:Roll / No Glide
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Glenohumeral:Roll / No Glide
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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
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Knee:Posterior GlidePosterior Swing
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Knee:Posterior GlidePosterior Swing
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Knee:Posterior GlidePosterior Swing
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Knee:Posterior GlidePosterior Swing
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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
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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
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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
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Effects ofJoint Mobilization
" Synovial Fluid" Stretching" Improve tissue tensile strength" Decrease Pain (Neurophysiological)
Mechanical Receptor: Gate Mechanism
" Increase Relaxation(Neurophysiological)
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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
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Ankle:Plantar Flexion
What do you expect?
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Ankle:Plantar Flexion
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Ankle:Plantar Flexion
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Ankle:Plantar Flexion
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MTP:Flexion
What do you expect?
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MTP:Flexion
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MTP:Flexion
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MTP:Flexion
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MTP:Flexion
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Contraindications/Precautions
" See ROM/Stretching" Hypermobility" Inflammation and Joint Effusion
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Joint Traction:
Longitudinal pull along the shaftof the long bone
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Hip:Traction
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Hip:Traction
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Spine Traction:Longitudinal pull along the lineof the spinal column
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Spine TractionVertebral Bodies Separate
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Spine TractionVertebral Bodies Separate
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Spine TractionFacets Glide Apart Foramen Open
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Spine TractionFacets Glide Apart Foramen Open
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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
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Grades of Vigor
I
II
III
IV
BeginAvailable
Range
EndAvailable
Range
III-
IV-
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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
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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
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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
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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