Joint Mobilization Term 4

what are joint mobilization

passive movements performed at a speed slow enough that the client can stop the movement.

how are joint mobilization applied

The technique may be applied with a sustained or oscillatory motion

what grade of joint mob does the RMT scope of practice not include

grade 5 this is what chiropractors do

physiological movements

these are movements that could be performed actively by the client. the client's success in doing so is dependent upon their willingness, joint range of motion, control, and muscular power. Physiological movements can be performed actively or passively

accessory movements

these can only be obtained through passive movements and are relatively small compared to the appropriate physiological movements available to the joint

osteokinematics

movements in anatomical planes, i.e. flexion, extension, rotation, physiological movements, voluntary

arthrokinematics

movements that occur inside the joint i.e. roll, glide, spin, accessory movements-involuntary

close packed position

joint surfaces are maximally congruent = maximum tension/compression

resting position (loose packed position)

joint surfaces are at their greatest degree of separation, the joint capsule is relaxed, and the ligaments are in a position of greatest l; anxiety = least amount of stress

distraction

a separation or pulling apart of joint surfaces

traction

a long-axis pull apart of joint surfaces

roll

an accessory movement where one articular surface rolls on another

slide (glide)

an accessory movement where one articular surface slides on another

spin

an accessory movement where the bone moves but the mechanical axis remains stationary

concave-convex rule

a) when a concave articular surface on a convex articular the roll and slide occur in the same direction

b) when a convex articular surface over on a concave articular surface, roll and slide occur in the opposite direction

effects of joint movement

• stimulates biological activity by moving synovial fluid nourishes cartilage

• maintains extensibility and strength of the articular and periarticular structures

• keep awareness in proprioceptors in joint

indications for joint mobilizations

• restore ROM decrease usually due to immobilization ( fracture, sprain, strain, adhesive capsulitis)

• joint dysfunction due to restrictions of accessory joint movement causing pain or restriction of normal ligamentous tightness

• ease holding patterns

• soft tissue restriction

• pain - override px receptors

contraindications

• hypermobility

• joint effusion

• inflammation - infection

• recent or unhealed fracture

precautions and contraindications

• malignancy

• bone disease

• unhealed fractures

• excessive pain

• hypermobility in associated joints (must be stabilized)

• newly formed or weakened CT (corticosteroids) gentle

• systemic CT disease (RA) only gentle techniques

• elderly with weak CT

• abnormal fusion

• pregnancy - do not do high grades

• OA with bony blocks

principles of joint play

1. the client must be relaxed-watch for signs of discomfort

2. the therapist must be relaxed

3. mobilize the distal on the proximal articular surface if possible

4. do not mobilize when the joint surfaces are fully approximated

5. position the joint for efficiency by moving the joint to the point of restriction, backing off ten degrees, and performing the mobilization

6. mobilize one joint in one direction at one time

7. do not mobilize if the client is in too much pain

8. assessment with joint play should be in or close to the resting position

9. correct stabilization is essential

10. do not lever a joint

11. use towels and pillows to stabilize proximal joints

joint play grades of glide or traction: grade one

the initiation of movement of the joint surfaces either perpendicular to the joint surfaces (distraction) or parallel (glide). This is the non-corrective grade of mobilization

joint play grades of glide or traction: grade two

movement of the joint surfaces up to the first tissue stop, either perpendicular to the joint surfaces (distraction) or parallel (glide). this is non corrective grade of mobilization

joint play grades of glide or traction: grade three

movement of the joint surface up to and through the first tissue stop. note: grade three if the corrective grade of mobilization and therefore stretches the joint capsule. perform this grade with caution

grades one and two sustained are used for

pain management, introductory and joint play assessment techniques

grade three sustained is used as

a corrective technique to stretch joint capsules and restore the glides within the joint

how long are glide or traction manipulations sustained

• for painful joints distract for 7-10 seconds with a few seconds of rest in between - several cycles

• for restricted joints, minimum 6 seconds stretch, partially release and repeat at 3-4 second intervals

joint play grades of oscillations: grade one

small amplitude oscillatory movement performed between the initiation of movement and tissue resistance. performed at approximately 5 cycles per second

joint play grades of oscillations: grade two

large amplitude oscillatory movement performed between the initiation of movement and tissue resistance. performed at 2 to 3 cycles per second

joint play grades of oscillations: grade three

large amplitude oscillatory movement performed within tissue resistance and backing out again. performed at approximately 2-3 cycles per second

joint play grades of oscillations: grade four

small amplitude oscillatory movement performed within tissue resistance. performed at approximately 5 cycles per second

joint play grades of oscillations: grade five

high velocity, small amplitude, a non-oscillatory movement that starts at the tissue resistance and follows through in a thrust manipulation. commonly known as the chiropractic thrust. this is out of the massage therapist’s scope of practice

grade one and two oscillations are

non-corrective manipulations are used for pain management, warm up or introductory techniques

grade three and four oscillations are generally used as

corrective techniques to mobilize and stretch the joint capsules

grade 5 thrust manipulations are generally used to

reduce subluxations, osseous positional faults, facet locks, and disc herniations

grade one and four oscillations are

rapid-like vibrations

grade two and three ossilations are

smooth at 2-3 per second for 1-2 minutes