Principles of Joint Play Assessment

How many grades of Sustained Glides are there?

3 Grades

How many Grades of Oscillations are there and what are they for?

5 Grades Grades I and II are for pain modulation/inhibition and assessing irritability of joint Grades III, IV, and V used for soft tissue lengthening, pain inhibition, inhibition of muscle spasm Grade III is used for joint play assessment because end range is reached

Component Motions

Accompany active motion but are not under voluntary control Clavicle rotation

What are some questions you try to answer with Joint Play Assessment?

Can the patient move the joint through full, pain free ROM? Can the therapist move the joint through a full, pain free ROM? Why can't you move the joint?

Concave on Convex, where does the treatment plane go?

Changes with joint position

Treatment Plane

Determined by the concave surface Perpendicular to angle of rotation Direction goes with concave surface

Grade II (tighten)

Distraction or glide applied to tighten the tissues around the joint - "taking up the slack" Pain inhibition Determine joint reactivity

Grade III (stretch)

Distraction or glide applied with an amplitude large enough to place stretch on joint capsule and surrounding structures Stretch joint structures

Mobilization

Either end of the kinetic chain needs to be moved against a stable bone to achieve the desired arthrokinematic result Force applied directly with treatment plane

What are the steps that need to be taken to appropriately apply sustained glides or graded oscillations?

Identify quality of pain Identify motion restriction Identify treatment plane Place stabilizing and mobilizing hands close to joint line Soften Hands Determine appropriate position Determine appropriate grade and speed

What are some precautions for Joint Play Assessment?

Immature/healing tissue Considerable joint effusion or irritability Genetic disorders Spondylolisthesis in treatment area Pregnancy Total joint arthroplasty Inflammatory joint disease (RA) Infection/Malignancy in treatment area Metabolic bone disease Advanced diabetes

Grade II

Large amplitude rhythmic oscillations performed within the range, but not end range

Grade III

Large amplitudes rhythmic oscillations performed up to the limit of available motion stressed into the tissue resistance

Traction

Longitudinal Pull

What joint position is used for assessment?

Loose packed position Allows for most movement, gives clearest picture

Comfort

Maximum comfort is achieved when both patient and therapist are stable and positioned with as little stress as possible and both positioning and stability allow desired arthrokinematic motion to be achieved with the least amount of force

Joint Play

Motions that occur between the joint surfaces and the "give" in the capsule that allows the bones to move Distraction

Accessory Motions

Movements at the joint that are necessary for normal ROM but cannot be actively performed by the patient Useful for clearing structures, reduce contact points and surface areas to reduce compression Allow for greater angulation and minimize compressive forces

Roll

New points on one surface meets new points on the opposing surface Results in angular motion Always in same direction as swing Causes compression of joint surfaces in isolation Glide accompanies to reduce compression

Sellar (saddle) Joints

One surface is concave in one direction, convex in the other CMC

Ovoid

One surface is convex, one concave

Mennell has 7 Rules of Joint Play Testing, what are they?

Patient relaxed and fully supported Therapist relaxed with firm, comfortable grip One joint examined at a time One movement is examined at a time One aspect of the joint is stabilized while the other is moved Movements must be normal and not forced Movements should not cause undue discomfort

What are the 4 principles of Effective Technique for Joint Play Assessment?

Positioning Comfort Mobilization Stabilization

Stabilization

Quality and efficacy of the mobilization is directly proportional to the amount of stabilization of both the patient and therapist during delivery of manual therapy

Positioning

Quality of the mobilization is optimized when positioning of the patient and therapist minimizes discomfort to the patient

What constructs do we assess? What do we assess?

Quantity and Quality Glide, Distraction, Compression

What are 4 accessory motions?

Roll Glide/Slide (translation) Traction/Distraction Spin

Convex moving on Concave

Roll and glide occur in opposite directions Glide occurs opposite limb movement Glenohumeral joint

Concave moving on Convex?

Roll and glide occur in same direction Glide occurs in same direction as limb movement Tibia on Femur

Spin

Rotary motion about a stationary axis Shoulder, hip, radioulnar joint Don't do much with spin from a treatment standpoint

Glide/Slide

Same point on one surface meets new points on opposing surface Direction of glide depends on shape of moving surface Convex/Concave Rule

Distraction

Separation of joint surfaces Requires force perpendicular to joint surface

Grade I (loosen)

Small amplitude distraction with no stress applied to capsule Pain inhibition Used with all gliding mobilizations

Grade V

Small amplitude high velocity thrust beyond end range

Grade I

Small amplitude rhythmic oscillations performed at beginning of the range

Grade IV

Small amplitude rhythmic oscillations performed at the limit of available range into tissue resistance

Plane Joints

Translation and distraction (facet joints)

Convex on Concave, where does the treatment plane go?

Treatment plane will stay the same