peripheral & spinal mobilisations

what are the key aims of joint mobilisations?

restore motion, reduce pain and stiffness, and improve joint function

what physiological changes occur after injury or immobilisation?

muscle inhibition and atrophy, thicker synovial fluid, adhesion, cartilage breakdown and ligament weakening

why is early mobilisation important post injury?

prevents stiffness and degeneration, promoting recovery of joint function

what are the two main manual therapy approaches discussed?

Maitlands graded oscillation and Mulligans mobilisation with movement (MVM)

what is the key feature of Mulligans MWM technique?

passive accessory glide with simultaneous active movement by the patient to restore pain free motion

what is the concave-convex rule?

convex on concave glides in the opposite direction of bone movement; concave on convex glides in the same direction

what is the difference between physiological and accessory movements?

physiological = active (e.g. abduction); accessory = passive (e.g. glide)

what are maitlands grades 1-4 used for?

grades 1-2 = pain; grades 3-4 = stiffness

what characterises grade 1 and 4 movements?

grade 1: small amplitude early in range; grade 4: small amplitude into resistance at end of range

what speed and rhythm are typically used in mobilisation?

1-2 oscillations per second, adjusted for comfort and tissue response

how long are mobilisations usually applied?

pain relief: 30s - 2 min; stiffness: several minutes

how reliable are mobilisation grades between clinicians?

intra-clinician reliability is good; inter-clinician reliability is poor to moderate?

according to NICE, how should manual therapy for OA or LBP?

only alongside theraputic exercise (and possibly psychological support)

what are the two main neurophysiological theories behind mobilisation pain relief?

gate control theory and sympathetic nervous system response

how does gate control theory explain pain reduction?

mechanoreceptor stimulation activates A-fibres that inhibit nociceptive signals in the spinal cord

what brain structure is involved in the sympathetic response to mobilisation?

the dorsal periaquedal grey in the midbrain

what systemic effects accompany the sympathetic response?

analgesia, sympathetic excitation, improved motor function, reduced skin temperature

how do you document a passive physiological mobilisation of the left ankle into dorsiflexion, Grade 3, 60s?

PPM, L, TC joint, Dfx, G3, 60 seconds

what abbreviation describes a passive accessory intervebral mobilisation?

PAIVM

what factors should guide mobilisation technique selection?

patient feedback, pain level, muscle tone, and sin classification

what are the primary goals of grades 1-2 vs grades 3-4 mobilisations?

grades 1-2: pain modulation; grades 3-4: increase joint range