Joint Mobilization & Traction Flashcards

Flashcards about Joint Mobilization and Traction

Joint Mobilization

Manual therapy technique involving passive accessory motion to restore optimal joint function.

Purpose of Joint Mobilization

Decrease pain & stiffness, stretch fibrotic tissue, increase neuromuscular control, and restore joint function

Physiological Motion

Involves Flexion/extension, abduction/adduction, internal/external rotation, concentric or eccentric contraction, active or passive movement enhanced with stretching

Accessory Motion

Occurs with physiological motions, is involuntary, not an active isolated motion, and enhanced with joint mobilization/traction

Spin

Rotation on longitudinal axis

Glide

One point contacts multiple points

Roll

Points contacts points

Arthrokinematics

The study of joint motion

Roll arthrokinematics

A series of points on one articulating surface comes in contact with a series of points on another articulating surface.

Slide arthrokinematics

A specific point on one articulating surface comes in contact with a series of points on another articulating surface

Spin arthrokinematics

Clockwise or counter-clockwise movement around a longitudinal axis. A single point on one surface in contact with a single point on another surface.

Hypermobile Joint Play

A failure of the tissue to limit mobility which can result in instability.

Hypomobile Joint Play

A tissue block or a failure of the tissue to elongate resulting in an interference with normal range of motion.

Kaltenborn Treatment Plane

The treatment plane always remains parallel with the concave joint surface and is perpendicular to a line running from the axis of rotation in the convex joint surface.

Kaltenborn Concave/Convex Rule

Move a bone with a convex joint surface opposite to the direction of the restricted bone movement and move a bone with a concave joint surface in the same direction as the restricted bone movement.

Loose-Pack Position

Position of comfort or rest. Position in which the periarticular tissues are the most lax, therefore allowing the greatest amount of accessory joint movement.

Close-Pack Position

Position of maximal articular surface contact. Position in which the periarticular tissues are the most tense, therefore allowing the least amount of accessory joint movement.

Grades of Mobilizations (Maitland)

Grade I: small motion @ start of JROM; Grade II: large motion @ mid-JROM; Grade III: large motion up to PL; Grade IV: small motion @ end of PL; Grade V: sharp thrust @ PL

Soft End Feel

Soft tissue approximation

Firm End Feel

Capsular or ligamentous end-point stretch.

Hard End Feel

Bone or cartilage approximation.

Boggy End Feel

Joint effusion.

Springy End Feel

Loose body or internal derangement.

Empty End Feel

No end point is reached.

Mobilization Protocol (Maitland)

1-3 oscillations per second, 20-60 seconds per set, 3-6 sets treat pain then stiffness. Treat pain daily with Grade I & II mobilization. Treat joint stiffness 3-4 times per week with Grade III & IV mobilization.

General Treatment Considerations

Patient should be relaxed. Place yourself and your patient in a position which allows for proper body mechanics. Stabilizing force and mobilizing force should both be as close to the joint as possible. Always apply a grade I traction force to the joint first. Always start treatments in the loose pack position. Glide parallel to the treatment plane and distract perpendicular to the treatment plane. Pain should be monitored and kept to a minimum. Always re-assess to determine treatment effectiveness.

Ankle Talocrural Joint: Posterior Glide (Open- Chain) Goal

Increase dorsiflexion

Ankle Talocrural Joint: Anterior Glide (Open-Chain) Goal

Increase plantarflexion

Knee Tibio-Femoral Joint: Posterior Femoral Glide Goal

Improve knee extension.

Knee Tibio-Femoral Joint: Posterior Tibial Glide Goal

Increase knee flexion.

Glenohumeral Joint Arthrokinematics - Flexion

Head of humerus glides posterior & inferior.

Glenohumeral Joint Arthrokinematics - Abduction

Head of humerus glides inferior.

Glenohumeral Joint Arthrokinematics - External Rotation

Head of humerus glides anterior.

Glenohumeral Joint Arthrokinematics - Internal Rotation

Head of humerus glides posterior.

G-H Inferior Glide in Abduction Goal

Assist in improving shoulder abduction.

G-H Anterior Glide Goal

Improve extension and external rotation.

G-H Posterior Glide Goal

Improve flexion and internal rotation.

Traction

Translations along a line perpendicular to the treatment plane

Traction Effects

Decrease pain, Decrease stiffness, return joint function

Joint Traction

Repeated 10 second pulls in loose-packed position

Grades of Joint Traction (Kaltenborn)

I: neutral joint with no separation, II: take up slack/play in joint, III: separation with soft tissue stretching

Joint Mobilization Indications

Articular Dysfunction: Muscle spasm pain (Grade I & II), Muscle spasm stiffness (Grade III & IV)

Joint Mobilization Contraindications

inflammatory arthritis, bone disease, fractures, neurological deficit, malignancy, untrained clinician, significant sprain, vertebral artery dysfunction

Joint Mobilization Precautions

Hypermobility, Joint effusion, Poor general health, Pain prior to end-feel, Pregnancy, Improper joint position

Treatment Considerations

Patient relaxed, resting position. Clinician close to patient, hands close to joint, monitor pain, re-assess

G-H Distraction Goal

Decrease pain and improve gleno- humeral joint mobility.

Knee Tibio-Femoral Joint Distraction Goal

Decrease pain and increase mobility for both knee flexion & extension.

Subtalar Joint Distraction

Distal traction of the calcaneus in relation to the talus. Technique may be used for pain relief and/or to improve inversion/eversion range of motion.