Joint mobilization - thera ex

Effects of joint mobilization (joint motion)

stimulates biological activity by moving synovial fluid → prevents atrophy of the articular cartilage due to immobilization

maintains extensibility and tensile strength of articular tissues (as long as its not contraindicated)

cause afferent nerve impulses to be sent from joint receptors to the CNS regarding position and motion → loss of sensory input can lead to impaired balance

Indications

pain, muscle guarding and spasm

• small-amplitude oscillatory movements stimulate mechanoreceptors → inhibit transmission of pain signals

• small amplitude distraction or gliding increases synovial fluid movement

reverse joint hypomobility - sustained or oscillatory forces are used to distend shorted tissue

position faults/hypomobility

• realignment with mobilization with movement techniques

• thrust techniques to reposition subluxations (we will not do this in lab)

progressive limitation

• maintain availability motion with joint-play techniques

functional immobility

• non-stretch or gliding techniques to maintain joint mobility and prevent degeneration

contraindications

necrosis of ligament or capsule

hypermobility

joint effusion (don’t stretch capsule, already distended, oscillations may be ok

inflammation (don’t stress tissue, oscillations may be okay) (think about acute other than chronic)

• ex of chronic: adhesive capsulitis

osteogenesis and perfecta

precautions

malignancy

bone disease (osteopenia) - can do low level

unhealed fracture

excessive pain (immediate inc in pain that is sharp)

weakness of connective tissue due to injury, surgery, disease (RA)

elderly with weakened tissue

pain as guide

pain before tissue limitation

• gentle pain-inhibiting joint techniques

pain concurrently with tissue limitation

• gentle stretching to light tissue that doesn’t exacerbate pain

pain after limitation

• joint play technique

non-thrust oscillations grade 1

small amplitude oscillations at beginning of range. Rapid oscillations

grade 2

large-amplitude rhythmic oscillations performed within range. 2-3 oscillations/sec, 1-2 min

grade 3

large amplitude rhythmic oscillations performed up to the limit of the available range and tissues are stressed. 2-3 osc/sec, 1-2 min

grade 4

small-amplitude rhythmic oscillations at the limit, stressed into tissue resistance. rapid oscillations

non-thrust sustained joint play grade 1

small amplitude distraction, no stress to capsule

does not get to tissue limit

non-thrust grade 2

distraction or glide to tighten tissues. “taking up the slack”

grade 3

large amplitude stretch or distraction to stretch joint capsule and surrounding periarticular structures

comparing oscillations and sustained techniques

main differences are in the rhythm and speed of force application

remember:

• grade 1 and 2 for both techniques are low intensity and do not cause a stretch force to the joint capsule

• grade 3 (both) and 4 (oscillations only) are applying a stretch

many clinicians will combine the techniques within one treatment session

thrust manipulation/high velocity thrust

small-amplitude, high-velocity thrust performed at end range to snap adhesion or reposition

one repetition only

also called grade V mobilization

traction vs distraction

traction is longitudinal pull

distraction is a separation, or pulling apart

• important to prevent damage to the joint with mobilization

see comparison figures 5.8 A and B in text

must distract before traction

direction and target of treatment force

treatment force is applied as close to the opposing joint surfaces as possible (get your hands close to the joint line)

applying the force through a larger surface (hand vs. fingertips) will make it more comfortable for the patient

concave/convex rule → gliding only

• if the surface of the moving bone surface is convex, the treatment glide should be opposite to the direction in which the bone

• convex - if moving bone is concave, the treatment guide should be in the same directions as the direction in which the bone swings/move

joint mobilization mimics missing gliding motion that body will not do naturally

mobilization with movement

treatment concept developed by Brian Mulligan

Application of pain free accessory mobilization with active and/or passive physiological movement

pain is the barrier

documentation

rate of application of force

location in range of available movement

direction of force as applied by PT/PTA

target of force

patient position

adverse effects

tearing/damage of tissue, joint surfaces, etc

damage to surgical repair

inflammation

swelling

impaired function

hypermobility

loss of patient trust

position for joint mobs

open pack

do not lock out your joints - protect your joints