Spinal and Peripheral mobilisation

What is one of the early effects of injury on muscle activation?

Inhibition of muscle activation and consequent atrophy occurs early in the post-injury phase.

How does immobilisation affect the viscosity of synovial fluid?

It causes an increase in the viscosity of synovial fluid and resistance to motion.

What type of lesions can immobilisation cause within the joint capsule?

Immobilisation can cause fibrous fatty lesions within the joint capsule.

Where can adhesions occur within a joint due to immobilisation?

Adhesions can occur within the folds of the synovium.

What effect can immobilisation or injury have on articular cartilage?

It can cause the breakdown of articular cartilage.

How does immobilisation affect ligaments, tendons, and the joint capsule?

It weakens ligaments and decreases their proteoglycan content.

The Maitland concept of mobilisation is based on the idea of _____ _____ within joints.

positional faults

Mulligan's Mobilisation with Movement (MWM) involves a passive-accessory glide performed by the therapist whilst the patient is doing what?

The patient is actively moving an associated limb.

In Mulligan's MWM, pain should be reduced or eliminated within how many repetitions?

Within 3 repetitions.

What is the primary purpose of using passive mobilisation of peripheral and spinal joints?

To assess and to improve the quality of joint motion.

During a passive joint mobilisation assessment, what is the quality of joint motion compared to?

It is compared to the non-involved limb or spinal segment.

What is the Concave-Convex rule?

A rule describing the relationship between the shape of articulating joint surfaces and the direction of glide during osteokinematic movement.

According to the Concave-Convex rule, when a CONVEX surface moves on a fixed concave surface, in which direction does the surface slide?

The surface will slide in the OPPOSITE direction to the movement of the bone

According to the Concave-Convex rule, when a CONCAVE surface moves on a fixed convex surface, in which direction does the surface slide?

The surface will slide in the SAME direction as the bone's movement.

During shoulder abduction, the convex humeral head slides in the _____ direction to the movement of the humerus.

OPPOSITE

When the concave tibia moves on the fixed convex femur (e.g., open-chain knee extension), its surface slides in the _____ direction as the bone's movement.

SAME

During a squat motion where the femur moves on a fixated tibia, the convex femur's surface slides in the _____ direction to the femur's movement.

OPPOSITE

What is a physiological mobilisation?

A movement that can be performed actively by the patient.

What is an accessory mobilisation?

A movement that cannot be actively performed by the patient.

What is the definition of a Maitland Grade 1 mobilisation?

A small amplitude movement performed at the beginning of the available range.

What is the definition of a Maitland Grade 2 mobilisation?

A large amplitude movement within a resistance-free part of the available range.

What is the definition of a Maitland Grade 3 mobilisation?

A large amplitude movement performed into resistance or up to the limit of the available range.

What is the definition of a Maitland Grade 4 mobilisation?

A small amplitude movement performed into resistance up to the limit of the available range.

Which two Maitland grades are primarily used to reduce pain?

Grades 1 and 2.

Which two Maitland grades are primarily used to reduce stiffness?

Grades 3 and 4.

Grade 1 mobilisations are described as _____/_____ oscillatory mobilisations.

smooth/slow

What is the recommended speed for painless oscillations in a painful joint?

1-2 oscillations per second.

For pain-related mobilisations, what is the recommended duration and number of sets?

A duration of 30 seconds up to 2 minutes, for 2-3 sets.

For mobilisations targeting joint stiffness, what duration may be used?

Several minutes.

Why is an accessory technique the primary choice for mobilising a very painful joint?

Because larger amplitudes can be applied with less pain.

A systematic review found what level of reliability for a clinician's repetitive production of mobilisation forces (intra-clinician reliability)?

Good reliability, with an ICC of 0.75-0.99.

What level of reliability was found for the production of forces between different clinicians (inter-clinician reliability)?

Poor to moderate reliability, with an ICC of 0.04-0.70.

What was the conclusion of the Rao et al. (2018) study comparing Mulligan's vs Maitland's mobilisations for knee osteoarthritis?

Both treatment approaches were effective for reducing pain and improving function and mobility.

What was the conclusion of the Khan et al. (2018) study comparing Mulligan's SNAGS and Maitland's mobilisations for chronic low back pain?

Both approaches are effective for improving patient outcomes.

According to the manual therapy guidelines presented, under what condition should manual therapy be considered for hip or knee osteoarthritis?

Only alongside therapeutic exercise.

According to the guidelines, manual therapy for low back pain should only be part of a treatment package that includes what?

Exercise, with or without psychological therapy.

Which neurophysiological theory proposes that joint mobilisations produce a local hypoalgesic effect?

The Gate Control Theory.

In the Gate Control Theory, joint mobilisations stimulate mechanoreceptors and A-fibres to block nociceptive signals where?

At the Substantia Gelatinosa in the dorsal horn of the spinal cord.

Spinal mobilisations can stimulate the dorsal periaqueductal grey (dPAG) matter of the midbrain, leading to what three effects?

An analgesic effect, sympathoexcitation, and improved motor function.

What does the abbreviation 'PAIVM' stand for in clinical notes for mobilisations?

Passive Accessory Intervertebral Mobilisation.

The severity, irritability, and nature (SIN) of a condition are used to determine what aspect of mobilisation?

The grades and applications to be used.

The size and shape of the patient and therapist will determine _____ _____ and choice of the technique used.

handling positions

What is the ultimate goal of Mulligan's MWM approach in terms of function?

Pain-free function should be restored.

What two physiological changes in ligaments and articular cartilage can result from immobilisation?

• Decreased proteoglycan content in ligaments

• Increased water content in articular cartilage.

Why is early mobilisation encouraged after an injury?

To restore function and mobility and counteract the cascade effects of injury.

Besides patient feedback, what are three ways a therapist receives feedback during passive joint mobilisation?

• Through the patient's facial expressions

• Muscle spasm

• Through their hands feeling how the joint moves.