Lecture 3- Joint play assessment and joint mobilization

Many therapists use a combination of Maitland and Kaltenborn grades to describe mobilizations. If in doubt, describe the characteristics of the technique, as opposed to using a number.

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see slide 23

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what are the kaltenborn 3 grades of joint motion?

1. Grade 1 simply reduces compressive forces on articular surfaces, moves from negative pressure to neutral. Not really traction but in the direction of distraction. 2. Grade 2 takes up the "slack" or joint play. Sometimes called "first stop" 3. Grade 3 stretches the joint capsule and surrounding tissues. Sometimes called "second stop"

what are the relative contraindications to joint mob? (7 things)

1. Joint effusion or inflammation 2. Rheumatoid arthritis not in exacerbated state 3. Presence of neurologic signs 4. Osteoporosis 5. Pregnancy, if a technique is to be applied to the spine 6. Dizziness 7. Steroid or anticoagulant therapy

Joint Play Assessment and Joint Mobilization are different in what 2 ways? also when is joint play assessment and joint mobilization done?

1. Joint play assessment IS NOT a treatment, it is part of an evaluation. 2. Joint mobilization IS a treatment technique and as such implies that assessment has already been completed. It is performed after evaluation.

what are the 7 considerations for joint play assessment?

1. Patient and Therapist must be relaxed 2. The assessment should not be painful, do not push through pain 3. Specific and localized - with gravity assistance if possible 4. The joint should be positioned in loose packed, or as close as possible, to reduce the possibility of compression. 5. Force applied as close to the joint surfaces as possible 6. One hand stabilizes, one hand mobilizes 7. Palpate the joint whenever possible

what are the 4 characteristics of applying join mob?

1. ROM 2. type of movement 3. velocity of movement 4. amplitude of movement

what are the 2 Potential therapeutic effects of joint mobilization techniques: (mechanical)

1. Reduce capsular or ligamentous restriction of accessory joint motion via mechanical tissue deformation to induce permanent changes. 2. Prevent adhesions.

what are the 14 absolute contraindications to joint mobilizations? (grade 3 and 4)

1. Systemic or localized infection 2. Acute circulatory condition 3. Malignancy 4. Open wound or sutures at treatment site 5. Recent fracture 6. Hematoma 7. Hypersensitivity of the skin 8. Inappropriate end feel, (spasm, empty, boney) or evidence of hypermobility or ankylosis (may be relative contraindication in some cases depending on technique) 9. Advanced diabetes 10. Rheumatoid arthritis in exacerbated state 11. Cellulitis 12. Constant severe pain, including pain at rest or that disturbs sleep, indicating that the condition is likely to be very irritable or in the acute stage of healing (may be relative in some cases depending on technique) 13. Extensive radiation of pain 14. Any condition that has not been fully evaluated

Joint Play Assessment may also be called: (3 things)

1. Testing accessory motion at a joint 2. Passive articular mobility testing 3. Specific Mobility Testing

Type of mobilization also related to stage of healing: (describe acute, sub acute, and chronic)

Acute: Distractions, grade I or II glides (Dutton p. 336) Sub Acute: grade II (Dutton p. 338) Chronic or Advanced: grade III or IV

what does grading of movement attempt to do with joint mob?

Attempt to describe where in the range and in some cases the amplitude and type of movement

what are the ways you can apply joint mobilization for range of movement? (3 ways)

Beginning, middle, or end of arthrokinematic range

what are the maitland 5 grades of joint motion?

Grade 1 - small amplitude mvt. beginning of range Grade 2 - large amplitude in the middle of range Grade 3 - large amplitude movement towards end of range Grade 4 - small amplitude movement towards end of range Grade 5 - small amplitude high velocity thrust applied at the physiologic limit of range

how do you make sure the pt and therapist are relaxed? (3 things)

Positioning, draping, confidence

what are the Potential therapeutic effects of joint mobilization techniques: (Neurophysiologic- 3 things)

Reduce pain, guarding, increase proprioception.

how should you perform the glide in joint play assessment? why do you perform it this way?

The glide should be slow and controlled, and sustained at the end of range, if possible, long enough to allow for creep and an assessment of end feel.

what should you test first in joint play assessment?

The non-symptomatic contralateral joint should be tested first when possible.

what are the 2 main schools of thought with joint mob?

Two main schools of thought proposed by Kaltenborn and Maitland.

define distraction

a motion that occurs at 90 degrees to the joint plane

how do you mob for preventing adhesions - mechanical effects?

all ranges

distraction provides a general assessment of what?

amount of joint play available at a given joint in all directions

what does maitlands grades assume?

assume that oscillations are being performed, and the range described by the grade is the range through which the oscillation is occuring.

maitland grades include what 2 things?

both a point in the arthrokinematic range and the type of motion.

joint plane is determined by what?

concave surface

Joint Mobilizations are applied differently according to the _______ ______

desired effect

if the joint play assessment is perpendicular to the plane what is this called?

distraction

Joint play assessment usually includes what at the beginning? then what at the end?

distraction at the beginning of the assessment when relevant, followed by assessing translatory glides in specific directions

what do the 3 grades of motion for kaltenborn describe?

grades describe only the arthrokinematic range in which the joint is moved.

how do you mob a Restriction of accessory joint motion, usually capsular or ligamentous

hold at end range

what are the 2 ways you apply joint mobilization for type movement?

hold or oscillate

After assessment, joint play is usually described as what 3 things?

hypomobile, normal, or hypermobile.

what are the Potential therapeutic effects of joint mobilization techniques: (hydrodynamic effects)

increase nutrition

The same techniques used for assessing joint play (arthrokinematic glides) may also be used as _____ ___________ techniques.

joint mobilization

define osteokinematic motion

motion of a limb through space in an arc around a fixed point.

define arthrokinematic motion

motions that occur between the joint surfaces during Osteokinematic motion.

The test is carried out by gliding in a specific direction from what point?

neutral

what must be present in order for full range osteokinematic motion?

normal arthrokinematic motions

what osteokinematic motion sometimes called?

normal physiological motion

how do you mob for Pain relief - Neurophysiologic effects

oscillate beginning to mid range

how do you mob for nutrition - hydrodynamic effects?

oscillate, beginning to mid range

what 2 things must you assess in order to correctly treat movement dysfunction?

osteokinematic and arthrokinematic motion at a joint

A patient may be hypomobile for a variety of reasons other than adaptive shortening, for example what 3 things?

pain and guarding or swelling.

grading of movement with joint mob is influenced by what 3 things?

region, history and training

If the limitation occurs when convex surface is moving during joint mob what is the restriction?

restriction of the convexity moving into the capsule (leading portion)

what 3 things does arthrokinematic motions consist of?

roll, glide, and spin

how do you apply the amplitude of movement with joint mob?

small or large amplitude

how do you apply the velocity of movement with joint mob?

speed at which it is applied

If the limitation of motion during joint mob occurs when concave surface is moving what is the restriction?

trailing capsule

Arthrokinematic motion at a joint can be determined by assessing the ? (2 names)

translatory component or joint play

if the joint play assessment is parallel to the plane what is this called?

translatory glide

what kind of motion is a glide? (3 names)

translatory motion, AKA accessory motion, sometimes also called joint play.