Motion Restrictions

What are the four primary clinical indications for the use of modalities?

reduce inflammation and accelerate tissue healing

manage abnormal muscle tone

relieve pain

address motion restrictions

What are motion restrictions?

impairments that may contribute to functional limitation and disability

When is motion considered restricted?

when it is less than the same segment on the contralateral side

when it negatively impacts function and/or participation

Restricted motion can be the result of:

disease, dysfunction, or pathology

pain, edema, adhesion, inflammation, fibrosis, mechanical block, contracture, etc.

Motion restrictions can:

be treated conservatively by stretching, movement, manual therapy, modality application

some require surgery to resolve

True or false: modalities alone are NOT sufficient to reverse or prevent motion restrictions

true

When are modalities used?

to assist in the treatment of motion restrictions

Why are modalities beneficial?

they can control pain inflammation, edema, effusion

increase soft tissue extensibility

stimulate a muscle contraction

ALL of which can facilitate increased motion

What is active motion?

the movement produced by contraction of the muscles crossing a joint

What may restrict active motion?

Muscle weakness, abnormal muscle tone, pain, fear, edema or effusion, joint mobility, boney approximation, approximation of soft tissues, muscle length, etc.

What is passive motion?

the movement produced by contraction of the muscles crossing a joint

What may restrict passive motion?

Soft tissue shortening, edema or effusion, adhesion, mechanical block, muscle length, adverse neural tension, abnormal muscle tone, patient guarding, boney approximation, approximation of soft tissues, etc.

What is physiological motion?

motion of one segment of the body relative to another - result of active muscle contraction

osteokinematic motion

What is accessory motion?

motion that occurs between the joint surfaces during normal physiological motion - the way one articulating joint surface moves relative to another

joint play

What is required for normal ROM?

normal accessory motion!!

What is capsular pattern of restriction?

a specific combination of motion loss caused by shortening of the joint capsule

if the capsule surrounding a joint is the primary structure affected - motion restriction

Capsular pattern of restriction usually produces limitations of motion in…

MORE than one direction

What is noncapsular pattern of restriction?

motion loss that does NOT follow the capsular pattern caused by ligamentous adhesion, internal derangements, extraarticular edema, or extraarticular lesion in the region of a joint

What is the difference between intraarticular edema and extraarticular edema?

intra restricts motion in a capsular pattern

extra edema restricts motion in a noncapsular pattern

What is contractile tissue?

the tissue in the musculotendinous unit of an area of a motion restriction - muscle, tendon, musculotendinous junction, and tendon’s interface with bone

What is non contractile tissue?

all tissues that are NOT components of the musculotendinous unit of an area of a motion restriction - skin, ligament, bursa, capsule, articular cartilage, intervertebral disc, nerve, dura mater, scar tissue

What is tissue shortening?

contracture

What is abnormal joining of tissue to each other?

adhesion

What are the treatment approaches for motion restrictions?

creep

stress relaxation

plastic deformation

What is creep?

transient lengthening or deformation with the application of a fixed load

can occur in soft tissue in a short time

What is stress relaxation?

a decrease in the force required over time to hold a given length

can occur in soft tissue in a short time

What is plastic deformation?

the elongation produced under loading that remains after the load is removed - after, tissue will permanently increase its length

a controlled stretch for a prolonged time will cause this