Presentation on theme: "Peripheral joint mobilization"— Presentation transcript:
1Peripheral joint mobilization Made by Sajida Mazhar
2Joint mobilizationJoint mobilization refers to manual therapy techniques that are used tomodulate pain andtreat joint dysfunctionsregain range of motion (ROM)addressing the altered mechanics of the joint.
3The altered joint mechanics may be due to painmuscle guardingjoint effusionContracturesadhesions in the joint capsulesAdhesions in supporting ligamentsMalalignmentsubluxation of the bony surfaces
4Joint mobilizationIt differ from stretching in that theyspecifically address restricted capsular tissue by replicating normal joint mechanicsminimizing abnormal compressive stresses on the articular cartilage in the joint.practitioner must knowanatomyarthrokinematics andpathology of the neuromusculoskeletal systemrecognize when the techniques are indicatedwhen other techniques would be more effective for regaining lost motion.False use of may lead to potential harm to the patient’s joints.
5Mobilization/Manipulation They are passive skilled manual therapy techniquesapplied to joints and related soft tissuesat varying speeds and amplitudes using physiological or accessory motions for therapeutic purposes.speeds and amplitudes could range froma small-amplitude force applied at high velocityto a large-amplitude force applied at slow velocity
6Self-Mobilization (Auto-mobilization) Self-mobilization refers to self-stretching techniquesspecifically use joint traction or glides that directthe stretch force to the joint capsule.
7Mobilization with Movement Mobilization with movement (MWM) isaccessory mobilization Applied by a therapistan active physiological movement to end range applied by the patientThe techniques are always applied ina pain-free direction anddescribed as correcting joint tracking from a positional fault
8Physiological Movements Physiological movements are movements the patient can do voluntarily(e.g., the classic or traditional movements,such as flexion, abduction, and rotation)term osteokinematics is used for these
9Accessory MovementsAccessory movements are movements in the joint and surrounding tissuesthat are necessary for normal ROMcannot be actively performed by the patient.Component motionsAccompany active motionbut are not under voluntary control.E.g. motions such as upward rotation of the scapula and rotation of the clavicle, which occur with shoulder flexion, ext rotation of the tibia in knee extension.
10Accessory Movements joint play. the motions that occur between the joint surfacesthe distensibility or “give” in the joint capsulenecessary for normal joint functioning through the ROMDemonstrated passivelybut they cannot be performed activelyThe movements includedistraction,Sliding,compression,rolling,spinning of the joint surfaces.The term arthrokinematics is used for these motions
11Thrust Thrust is a high-velocity, Is alter positional relationships short-amplitude motionthat the patient cannot prevent the motion.The motion is performed at the end of the pathological limit (end of the available ROM when there is restriction.)Is alter positional relationshipssnap adhesions,stimulate joint receptors.
12Manipulation Under Anesthesia is a medical procedureused to restore full ROMby breaking adhesions around a jointwhile the patient is anesthetized.The technique may be a rapid thrust or a passive stretchusing physiological or accessory movements
13Muscle Energy Muscle energy techniques use active contraction of deep muscles that attach near the joint andwhose line of pull can cause the desired accessory motion.The therapist stabilize the segment on which the distal aspect of the muscle attaches.A command for an isometric contraction of the muscle, that causes accessory movement of the joint
14BASIC CONCEPTS OF JOINT MOTION: ARTHROKINEMATICS Joint ShapesThe type of motion occurring between bony partners in a jointis influenced by the shape of the joint surfaces.
15Joint Shapes In ovoid joints In sellar joints, one surface is convex, theother is concaveIn sellar joints,one surface is concave in one directionand convex in the other,with the opposing surface convex and concave
16Types of Motion As a bony lever moves about an axis of motion, also movement of the bone surface on the opposing bone surface in the joint.The movement of the bony lever is called swingas flexion, extension, abduction, adduction, and rotation.measured in degrees with a goniometer and is called ROM.Motion of the bone surfaces in the joint is a combination of rolling and sliding, or spinning.These accessory motions allow greater angulations of the bone as it swings.For the rolling, sliding, or spinningThere must adequate capsule laxity or joint play.
17Types of MotionRollCharacteristics of one bone rolling on another are as follows.The surfaces are incongruent.New points on one surface meet new points on the opposing surface.Rolling results in angular motion of the bone (swing).Rolling is always in the same direction as the swinging bone motion whether the surface is convex or concave.
18Rolling Rolling, if it occurs alone, causes compression of the surfaces on the side to which the bone is swingingseparation on the other side.Passive stretching usingbone angulations alone may cause stressful compressive forces to portions of the joint surface,potentially leading to joint damage.In normally functioning joints, pure rolling does not occur alone but in combination with joint sliding and spinning
19Slide/Translation Slide/Translation Characteristics of one bone sliding (translating) across another include the following.For a pure slide, the surfaces must be congruent, eitherFlat or curvedThe same point on one surface comes into contact withthe new points on the opposing surface.
20Slide/Translation Pure sliding does not occur in joints because the surfaces are not completely congruent.The direction in which sliding occurs depends onwhether the moving surface is concave or convex.Sliding is in the opposite direction of the angular movement of the bone if the moving joint surface is convex.Sliding is in the same directionas the angular movement of the boneif the moving surface is concave.
21Combined Roll-Sliding in a Joint The more congruent the joint surfaces are, the more slidingThe more incongruent the joint surfaces are, the more rolling
22SpinThere is rotation of a segment about a stationary mechanical axisThe same point on the moving surface creates an arc of a circle as the bone spins
23Spinning rarely occurs alone in joints but in combinationwith rolling and sliding.Three examples of spin occurring in joints of the bodyare the shoulder with flexion/extension, the hip withflexion/extension, and the radiohumeral joint withpronation/supination
24Other Accessory Motions CompressionCompression is the decrease in the joint space betweenbony partners.weight bearing jtsWith muscle contration (stabilization)With rollinghelp move synovial fluid and thus help maintain cartilage health.Abnormally high loads may leadarticular cartilage changes and deterioration
25Traction/Distraction Traction isa longitudinal pull.Distraction is a separation, or pulling apartif traction is appliedto the shaft of the humerus, it results in a glide of the joint surface Distraction of the glenohumeraljoint requires a pull at right angles to the glenoid fossawhenever there is pulling on the long axis of a bone, the term long-axis tractionthe surfaces are to be pulled apart, the term distraction, joint traction, or joint separation is used.
26Open and close pack position Position patient in a relaxed, distracted, supported position so the joint capsule is lax (loose(open)-packed position).Close-packed position is one in which there is maximal contact of the articulating surfaces.
27Closed-packed Position Open-packed Position JointClosed-packed PositionOpen-packed PositionGlenohumeral90o ABD & Full ER combo55o flexion w/ 20-30o HABDElbowHumeroulnarHumeroradialRaduioulnarFull Extension90o flex w/ mid-pronationFull pronation or supination70o Flex w/ 10o supinationFull ext w/ full supination70o flex w/ 35o supinationDistal Radiocarpal JointFull extension & radial deviation or full flexNeutral positionMCP joints2-51Full flexionFull opposition20o flexionIP jointsHipFull IR, Ext & ABD55o flex w20-30o HABDKnee (tibiofemoral)Full Ext & ER20-25o flexionAnkle MortiseFull DF10o PFSubtalorFull EV or INVMidrange PF & DFForefoot1 MTP = 20o DF2-5 MTP = 20o PFIP’s = 20o PF
2910 simple steps Evaluation and Assessment Determine grades and dosage Patient positionJoint positionStabilizationTreatment forceDirection of movementSpeed and rhythmInitiation of treatmentReassessment
30Grades of Oscillations (Maitland) Grade I - small amplitude movement at the beginning of the range (pain and spasm)Grade II - large amplitude movement within the midrange of the movement (pain and spasm)Grade III - large amplitude movement at the end of the range (into restriction)Grade IV - small amplitude movement at end range when tissue resistance (not pain) is limitingGrade V - small amplitude, quick thrust manipulation at end range-
33INDICATIONS FOR JOINT MOBILIZATION Pain, Muscle Guarding, and SpasmPainful joints, reflex muscle guarding, and muscle spasm treated gentle joint-play techniques to stimulate neurophysiological and mechanical effectsneurophysiological and mechanical effectsstimulate the mechanoreceptorsInhibit nociceptive stimulimechanical effectsSynovial fluid motion provide neutrients to jts
34The small-amplitude joint techniques used to treat pain, muscle guarding, or muscle spasm should notplace stretch on the reactive tissues
35Reversible Joint Hypomobility joint-play stretching techniques to elongatehypomobile capsular and ligamentous connective tissuePositional Faults/SubluxationsMalposition / regain ROMrealign the bony partnersProgressive LimitationDiseases that progressively limit movement can be treated with joint-playFunctional ImmobilityPatient functionaly imobile
36CONTRAINDICATIONS AND PRECAUTIONS HypermobilityJoint EffusionInflammation
37Conditions Requiring Special Precautions for Stretching MalignancyBone disease detectable on radiographsUnhealed fractureExcessive painHypermobility in associated jointsTotal joint replacementsNewly formed or weakened connective tissueSystemic connective tissue diseases such as rheumatoidElderly individuals