Mobility Assessments & Alternate Force Assessments

each joint's motion can be

normal, hypermobile, hypomobile, or unstable

hypomobility

joint that moves less than what is considered normal or when compared to the other side

hypomobility may present as

capsular pattern

noncapsular pattern

How do you treat hypomobility?

joint mobilizations and stretching

capsular pattern of motion restriction

pattern of motion loss is caused by shortening of the joint capsule surrounding a joint

-generally, restricts motion in multiple directions

-each synovial joint has a unique capsular pattern of restriction

causes of capsular pattern

-effusion

-fibrosis

-inflammation

-associated with degenerative joint disease (arthritis), immobilization, and trauma

noncapsular patterns of restricted motion

-pattern of motion loss that does not follow the capsular pattern

-typically, a condition that does not involve the entire joint capsule, limiting to 1-2 motions

causes of noncapsular patterns

-ligamentous adhesion (limits motion in directions that stretch the adhesion)

-internal derangements (limits motion in directions that compress the fragment

-extra-articular lesion/muscle injury (limits motion in the direction of stretch or compression

capsular pattern

whole joint capsule pathology --> arthritis, adhesive capsulitis, synovitis, post-trauma, immobilization

non-capsular pattern

localized pathology --> tendon, ligament, loose body, extra-articular muscle tightness

hypermobility

-joint that moves more than considered normal or when compared to the other side

**generalized phenomenon (born with it, natural)

**localized to just one direction of movement (result of damaged connective tissue, acquired)

What shouldn't you do with someone who is hypermobile?

joint mobilizations or stretching

causes of hypermobility

-soft tissue laxity (natural or acquired) (ligaments, capsule, muscle, or joint stiffness)

-connective tissue disorders (Marfan's Syndrome, Rheumatic diseases, Osteogenesis Imperfecta, Ehlers Danlos Syndrome (EDS), Down's Syndrome

-Hypermobility Syndrome (HMS) or Benign Joint Hypermobility Syndrome (BJHS)

Hypermobility Syndrome or Benign Joint Hypermobility Syndrome (BJHS)

healthy individuals with generalized hypermobility and musculoskeletal pain

*score at least 4 on Beighton Hypermobility Scale

*joint pain in =/> 4 joints for > 3 months

Beighton Hypermobility Scale

- hyperextended knees

- hyperextended elbows

- passive extension of fingers beyond parallel

- passive abduction of thumb to forearm

- forward flexion of trunk with hands to the floor

(1 point for each, score of at least 4 indicates generalized hypermobility)

Instability

in contrast to a hypermobile joint, an unstable joint involves a disruption of the osseous and ligamentous structures of that joint and results in a loss of function

stability of a joint depends on

-joint integrity

-elastic energy

-passive stiffness

-muscle activation