Ortho PT Interventions & Joint Mobilizations Study Guide

What 6 questions do you need to ask while developing your plan?

-what is your hypothesis regarding the problem?

-is the pt acute, sub-acute, or chronic and what are the guidelines/precautions for the pts stage of healing?

-what type of tissue/structure is in lesion, and what are the tissue specific guidelines for tx?

-what is the pts level of irritability?

-are there additional condition specific guidelines for tx?

-are there pt specific precautions or considerations (age, culture, activity level, background etc)?

acute stage (common sx)

-pain at rest, aggravated w/ activity

-pain before tissue resistance in PROM

acute stage (common problems)

-pain

-edema

-redness

-heat

-loss of function

-muscle guarding***

acute stage (common goals)

-control pain

-control/reduce inflammation

-control/reduce edema

-promote healing

-reduce secondary effects of immobilization

acute stage common/appropriate interventions

-POLICE (protection, optimal loading, ice, compression, elevation

-manual therapy

-ther ex

what manual therapy should be done in the acute stage

-grade 1 and 2 soft tissue techniques

what ther ex should be done in the acute stage

-PROM

-isometric setting exercises

-unloaded or assisted exercises

-aerobic/conditioning exercise

sub-acute (common sx)

-pain not present at rest, but aggravated by activity

-pain at onset of tissue resistance in PROM

-overall decreased pain and swelling

-overall increase in AROM and PROM

sub-acute (common problems)

-ROM not typically normal

-stress of structure still produces pain

sub-acute (common goals)

-promote tissue healing

-increase tissue tolerance to mechanical stress

-improve coordination/ function if appropriate

-correct underlying/contributing factors

-control pain

sub-acute (common/appropriate interventions)

-manual therapy

-ther-ex

what manual therapy should be done in sub-acute stage

-grade 1 and 2 joint mobilizations as appropriate

-soft tissue techniques

what ther-ex should be done in sub-acute

-AAROM

-AROM

-sub max iso's inner ranges progressing tro multiplel angles

-concentric exercises initiated and progressed as tolerated

chronic/advanced (common sx)

-full pain free ROM

-good flexibility and balance

-pain at end range with PROM

-pain after tissue resistance occurs (pain w/ overpressure)

chronic/advanced (common problems)

-strength at 75-80% compared to uninvolved side

-remaining deficits in max tissue tolerance

-sport/activity/work specific functional deficits

chronic/advanced (common goals)

-continue to build strength

-improve work/sport/activity specific funcitons

-move toward full independence

chronic/advanced (common/appropriate interventions)

-manual therapy

-ther-ex

what manual therapy should be done in chronic/advanced stage

-grade 1-5 mobilizations as appropriate

what ther-ex should be done in chronic/advanced stage

-progression through resisted exerciese

-keep in mind specificity of training

what are the principles of treatment for articular cartilage injuries

-understand and app;y the biomechanics of the joint of interest

-respect the biomechanics of lubrication and nutrition (need compression and distraction)

-avoid chronic and acute joint overload

-design programs and educate pts regarding approprate exercise and activity programs

what are the principles of rehabilitation for tendons/tendinopathy

-ID and remove all negative internal and/or external factors

-establish a stable base for tx (treat pain, inflammation, irritability)

-determine tensile load starting point

-progress loading according to pts sxs

what are the principles of rehabilitation for ligament injuries

-minimize immobilization, early controlled motion

-progressively stress the ligament while exercising caution, don't overload

-build strength in muscles that are secondary stabilizers for injured ligament

-intra-articular ligaments don't heal as well as extra-articular ligaments, allow more time if necessary

-proprioceptors in ligaments are slow to rtn, include neuromuscular retraining

-pts regain function well before ligaments are fully healed, exercise caution, caution your pt

What are 4 things that may indicate you exceeded tissue tolerance during treatment?

-pain for > 2hrs post treatment

-aching at night

-overall increase in sxs

-loss of motion

What are conditions that are associated with intensity that exceeds tissue tolerance

-CRPS

-myositis ossificans

Is joint play assessment an intervention

-no

is joint mobilization an intervention

-yes

What are the absolute contraindications to joint mobilizations

-systemic or localized infection

-actue circulatory condition

-malignancy

-open wound at tx site/sutures over wound

-recent fx

-hematoma

-hypersensitive skin

-inappropriate end-feel (spasm, bony, empty) or evidence of joint ankylosis or hypermobility

-advanced diabetes

-RA (exacerbated)

-cellulitis

-constant, severe pain, incl. pain at rest or that which disturbs sleep (very irritable)

-extensive radiation of pain

-any condition that hasn't been fully eval'd

What are relative contraindications to joint mobilizations

-joint effusion or inflammation

-RA (not exacerbated)

-presence of neurologic signs

-osteoporosis

-pregnancy (if technique is applied to spine)

-dizziness

-steroid or anticoagulant tx

what are the variable of joint mobilizations

-range of mvmt (beginning, middle, end or arthrokin. range)

-type of mvmt (hold or oscillate)

-velocity of mvmt (spd at which it's applied)

-amplitude of mvmt (small or lrg amplitude)

what are potential therapeutic effects of joint mobilization

-mechanical

-neurophysiologic

-hydrodynamic effects

What are mechanical effects of joint mobilization

-reduce capsular or ligamentous restriction or accessory joint motion via mechanical tissue deformation to induce permanent changes

-prevent adhesions

what are neurophysiologic effects of joint mobilization

-reduce pain

-reduce guarding

-increase proprioception

what are hydrodynamic effects of joint mobilization

-increase nutrition

what range would you work in to reduce restriction of accessory joint motion

-hold at end range

what range would you work in to bring pain relief

-oscillate beginning to mid range (fire joint receptors in capsule)

what range would you work in to prevent adhesions

-all ranges

In acute stage healing what types of joint mobilization would you choose

-grade 1 or 2 glides

-distraction

In sub-acute stage healing what types of joint mobilization would you choose

-grade 1 or 2 glides

In chronic/advanced stage healing what types of joint mobilization would you choose

-grade 3 or 4

How many grades of motion does Maitland have

-5

Grade 1 Maitland

-beginning of range

-small amplitude

Grade 2 Maitland

-midrange

-large amplitude in middle of range

Grade 3 Maitland

large amplitude toward end range of movement (motion palpation)

Grade 4 Maitland

Small amplitude at the end of range of motion

Grade 5 Maitland

Small amplitude, high velocity thrust at the end of available range of motion

What is assumed in Maitland grades of motion

-that oscillations are being performed throughout whatever range is associated with the grade

How many grades does Kaltenborn have

-3

Describe Kaltenborn grades

-1: reduce compressive force

-2: take up slack (joint play)

-3: stretch joint capsule