KIN101-2&3-Notes on Joint Dysfunction and Mobilization

INTRODUCTION TO JOINT DYSFUNCTION AND JOINT MOBILIZATION

Joint dysfunction refers to disrupted normal joint mechanics, which affects the range of motion (ROM).

  • Joint mobilization is a manual therapy technique designed to address joint dysfunction.

JOINT MOBILIZATION

  • Definition: Manual therapy techniques that modulate pain and treat joint dysfunctions limiting ROM.

  • Purpose: It replicates normal joint mechanics by addressing the altered mechanics caused by:

    • Pain and muscle guarding.

    • Joint effusion.

    • Contractures or adhesions in joint capsule or ligaments.

    • Malalignment or subluxation of bony surfaces.

MOBILIZATION/MANIPULATION

  • Both are passive, skilled manual therapy techniques applied to joints and related soft tissues.

  • Manipulation: Small-amplitude force applied at high velocity (High-Velocity Low-Amplitude, HVLA).

  • Mobilization: Large-amplitude applied at slow velocity.

PHYSIOLOGIC MOVEMENT

  • Movements that the patient can perform voluntarily.

ACCESSORY MOVEMENT

  • Necessary for normal ROM but cannot be actively performed by the patient.

  • Component motions: Accompany active motion but are not under voluntary control.

    • Examples include: Upward rotation of the scapula during shoulder flexion.

  • Joint play: Movements between joint surfaces that allow bones to move (e.g., distraction, sliding).

  • Arthrokinematics: Refers to the motions of bone surfaces within the joint.

OSTEOKINEMATICS VS. ARTHROKINEMATICS

  • Osteokinematics: Visible gross movements of the bones at joints (e.g., flexion, extension).

  • Arthrokinematics: Small amplitude motions at the joint surface (e.g., roll, glide).

CONGRUENT VS. INCONGRUENT JOINTS

  • Congruent joints: Surfaces correspond entirely (e.g., hip joint).

  • Incongruent joints: Incomplete correspondence allowing greater freedom (e.g., knee joint).

TYPES OF MOTION

  • Swing: The movement of a bony lever.

  • Roll: New points on one surface meet new points on another.

  • Slide: One bone translating across another.

CONVEX-CONCAVE RULE

  • The direction of sliding and Roll depends on whether the moving surface is concave or convex:

    • Concave over convex: same direction.

    • Convex over concave: opposite direction.

SPIN

  • One bone spins on another; common in shoulder, hip, radiohumeral joint.

COMPRESSION

  • Decrease in joint space occurs during weight bearing and muscle contractions.

  • High compression may lead to articular changes.

TRACTION AND DISTRACTION

  • Traction: Longitudinal pull.

  • Distraction: Separation/pulling apart of joint surfaces.

PASSIVE-ANGULAR STRETCHING VS. JOINT MOBILIZATION

  • Passive-angular stretching can cause pain or trauma.

  • Joint mobilization is safer, uses sliding components to stretch joint capsules without excessive force.

JOINT MOTION

  • Stimulates biological activity and maintains joint health.

  • Immobilization can lead to atrophy, adhesions, and weakening of ligaments.

JOINT MOBILIZATION EFFECTS AND INDICATIONS

  • Used for pain relief, muscle guarding, subluxation, and to maintain ROM.

    • Not effective for chronic diseases like rheumatoid arthritis.

JOINT MOBILIZATION LIMITATIONS

  • Cannot change disease processes; must focus on pain management and maintaining joint play.

JOINT MOBILIZATION CONTRAINDICATIONS

  • Hypermobility, effusion, inflammation are contraindications for mobilization.

GRADES OF MOVEMENT

  • Two systems for grading mobilization techniques: oscillatory and translatory.

GRADED OSCILLATION TECHNIQUES

  • Non-corrective for relieving pain (Grade 1 & 2) and corrective for mobilizing and stretching (Grade 3 & 4).

SUSTAINED TRANSLATORY JOINT-PLAY TECHNIQUES

  • Goals vary by grade; focus on pain relief, maintaining ROM, or increasing mobility.

EXAMINATION OF JOINTS

  • Assess for pain quality, capsular restrictions, and possible subluxations.

QUALITY OF PAIN

  • Pain before tissue limitation indicates need for gentle techniques.

  • Concurrent pain suggests cautious stretching.

  • Pain after limitation warrants progressive stretching techniques.

CAPSULAR RESTRICTION

  • Limited passive ROM in a capsular pattern.

    • Signs include firm end-feel and decreased joint play.

POSITIONING AND STABILIZATION

  • Patient relaxation and proper stabilization are crucial for effective mobilization techniques.

FORCE AND DIRECTION

  • Apply forces close to the joint surfaces; proper application minimizes discomfort.

SPEED AND DURATION OF MOVEMENT

  • Oscillatory techniques vary by grade; sustained forces utilize longer application durations.

INITIAL PROGRESSION OF TREATMENT

  • Assess joint reactivity and adjust treatment based on pain response and range.

RESTING POSITION

  • Maximizes joint play and fluid accumulation, ensuring effective treatment setup.

CLOSE PACK POSITION

  • Tissues surround the joint are under maximal tension, affecting treatment approaches.