Joint Play
Limitations for using Joint Mobilization:
- CANNOT change a systemic disease (i.e. Rheumatoid Arthritis) ...BUT we can use mobilization techniques to treat the impairments associated w/ the disease process
Glide or Slide:
- Congruent surfaces - SAME point on one surface contacts NEW points on the opposing surface - Direction depends on whether the MOVING surface is concave or convex
Osteokinematic (physiologic) movements include:
- Flexion/Extension - Abduction/Adduction - Rotation
Arthrokinematic (accessory) movements include:
- Glide or slide - Roll - Spin
Grade uses...
- Grades 1 & 2 = Pain management - Grades 3 & 4 = to stretch capsule/gain mobility (increase extensibility of capsule & ligamentous tissue)
Roll:
- Incongruent surfaces - NEW points on one surface meet NEW points on the other - Results in angular motion of the bone (swing) - Always in the SAME direction as the osteokinematic movement on the bone!!!
Direction of Mobilization - Treatment Plane:
- Joint Traction = Perpendicular to the Treatment Plane - Glides = Parallel to the Treatment Plane
Relative Precautions:
- Joint hypomobility - Unhealed fracture - Excessive pain - Total joint replacement - Newly formed or weakened connective tissue - Systemic connective tissue diseases - Old age - Rheumatoid Arthritis - Osteoporosis - Previous malignant disease - Pregnancy - Pt taking anticoagulants or blood thinners
Indications for Joint Mobilization:
- Pain - Muscle Guarding - Spasm - Joint Hypomobility
Joint Mobilization Procedures:
- Position pt comfortably - Usually begin glide or traction in "LOOSE pack" position & then progress to restricted positions - MUST STABILIZE bony segments above & below the joint being mobilized - Therapist MUST grasp bony segments above & below w/ WHOLE hand & NOT fingers... (NOTE: grasp should be firm, DO NOT allow fingers to "dig" into skin, pt MUST stay relaxed for Grades 3 & 4 mobilizations to be effective!!!)
Spin:
- Rotation of the segment about a stationary mechanical axis - SAME point on the moving surface creates an arc of a circle as the bone spins
ABSOLUTE Contraindications:
- Suspicion of an UNSTABLE fracture OR dislocation - Suspicion of a ligamentous tear - Malignancy - Advanced bone disease (i.e. Osteoporosis) - Active septic or infectious arthritis (NOT osteoarthritis)
Grades graphic representation...
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Levels of Graded Oscillation Techniques used for Joint Mobilization:
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What is joint play used for?
...to assess arthorkinematic (or accessory) motion
Joint Mobilization Grades or Dosages:
1) Graded Oscillatory Techniques = 4 Grades of Movement 2) Sustained Translatory Joint-Play Techniques = 3 Grades ***For this course we will use #1 as it is most common clinically***
Amplitude:
= how far are we really pulling the joint apart
Convex-on-Concave Rule
= sliding is in the OPPOSITE direction of the osteokinematic movement (roll) of the bone
Concave-on-Convex Rule
= sliding is in the SAME direction of the osteokinematic movement (roll) of the bone
Joint Play
= the passive translatory (or uniform motion in one direction) gliding or distraction mobility that is characteristic of all diarthrodial joints
Closed Pack Position
= the position in which the joint capsule & ligaments are maximally taunt ...allowing minimal or NO joint play
Loose Pack Position
= the position in which the joint capsule & surrounding ligaments (INERT tissues) are most relaxed ...allowing for the GREATEST amount of joint play
Joint Kinematics
Kinematics = motion of the body w/o regard to forces or torques that may produce motion Osteokinematics (Physiologic Movements) = movement of the bone segment...pt/client CAN perform voluntarily Arthrokinematics (Accessory Movements) = articular or joint surface motion in relation to one another during osteokinematics ...pt/client CANNOT perform voluntarily
What is Grade 5?
MANIPULATION = Small amplitude, high-velocity thrust beyond the limit of available joint play
Generally, which component of motion is used when attempting to restore JOINT PLAY & address articular hypomobility?
SLIDE