Joint mobilizations and manipulations Flashcards Preview

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Flashcards in Joint mobilizations and manipulations Deck (24)
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1
Q

Indications for a joint mobilization

A
  • decreased passive movement of joint
  • early capsular EF
  • mechanical pain
2
Q

Contraindications to joint mobilizations

A
  • #
  • neoplasm
  • acute inflamm process
  • apparent hypermobility or instability in direction of technique
  • bone/joint infection
  • spinal cord signs or symptoms
  • spasm or bony end feel
3
Q

Precautions for joint mobilizations

A
  • impaired circulation or sensation
  • osteoporosis or compromised health
  • haemophiliacs
  • poor skin condition
  • open wounds
  • discomfort in treatment position
  • marked skeletal deformity
4
Q

What do you base the grade of a mobilization on?

A

on palpation findings, PIVMs, PAVMs, quality of movement and EF *

5
Q

What type of end feel do you never mobilize through

A

never mobilize through a spasm EF

6
Q

Maitland grades?

A

Grades I-V

  • I - small amplitude movement at beginning of range: with pain before resistance or at resistance (or use traction)
  • II - large amplitude movement from beginning to middle of range (before resistance) usually into R1 when tissues start to tighten (when pain before resistance or at resistance)
  • III - large amplitude movement from middle to end of available range (into resistance) R2 where limitation is usually due to a tight capsule (when you get resistance before pain)
  • IV - small amplitude movement at end of available range into resistance (when you get resistance before pain or resistance and no pain)
  • V - small amplitude high velocity movement at end of available range (when you have resistance and no pain)
7
Q

Kaltenborn grading system

A

Sustained

i. small amplitude distraction
ii. distraction or glide to take up the slack
iii. distraction or glide to stretch the tissues
- cycle 6-10 second hold

8
Q

Rx using mobilizations

A
  • 3x 10 second bouts, checking in with patient
  • then re-ax active movement, passive (PIVM or PAVM)
  • then repeat 2 more times; always re-ax
  • warn patient about treatment soreness and temporary after effects
9
Q

Effects of a grade 1-2 mobilization

A
  • neurophysiological (dec muscle tone, endorphin and enkaphaline release)
  • mechanoreceptor stimulation (pain gaiting)
  • vascular effect (joint nutrition)
  • mechanical effect (mobilize collagen and neuromeningeal tissue, joint lubrication)
10
Q

Effects of grade 3-4 mobilization

A

same as grade 1 and 2 plus: greater mechanical effect and enhanced joint lubrication, elongate shortened capsuloligamentous tissue

11
Q

Effect of grade 5 mobilization

A

same as pervious grades but with greater neurophysiological and more mechanical effects, joint cavitation

12
Q

Indications for joint manipulations

A
  • to restore full ROM at end range of DF and PF when the progressive mobilizations are no longer effective (last 5 degrees)
  • to gain last few degrees of DF and PF when a non-capsular limitation of motion is present *
13
Q

What must you always suspect when doing a joint manipulation

A

ALWAYS SUSPECT AN UNDERLYING HYPERMOBILITY AND RE-AX STABILITY

14
Q

Joint manipulation effects

A
  • tearing of the scar tissue
  • quick stretch to joint capsule
  • stim of mechanoreceptors- neurophysiological effects
15
Q

Contraindications to joint manipulations

A
  1. fracture
  2. joint instability in direction of manipulation
  3. inflammatory joint disease
  4. malignancy
  5. bone disease
  6. osteoporosis
  7. open wound or skin lesion in area
  8. poor circulation or sensory deficit in the area
  9. spasm or increased pain with test pull
  10. unsure of health or diagnosis
  11. patient doesn’t want to be manipulated (informed consent)
  12. patient is on anticoagulants
  13. haemophiliacs
  14. inability of patient to relax
  15. physio factors
16
Q

Cautions and contraindications for novice maniopulators

A
  1. pain or instability proximally in the lower kinetic chain
  2. uncertainty about indications of technique
  3. children (skeletal maturity)
  4. diabetics
  5. elderly
  6. positive straight leg raise (for talocrural manip) on effected side
17
Q

Follow up Rx for manipulations

A
  • ROM exercise (assuming joint is stable)
  • post – treatment soreness can occur (suggest use of ice)
  • balance, proprioception, strength
  • protected function
  • taping/bracing if joint is unstable
18
Q

DTFM Purpose

A
  • To maintain/regain mobility
  • prevent scar tissue adhesions
  • create hyperemia (inc blood flow)
  • create analgesia
19
Q

DTFM Effects

A
  • Hyperemia
  • mechanical stress to break adhesions and align collagen
  • mechanoreceptor stim and dec pain
20
Q

DTFM Rx

A

2-3 cycles per second, at least 3 minutes (or until numbing effect occurs) for 5 minutes, literature says 10-20 minutes, find lesion, friction perpendicular to tissue

21
Q

When do you DTFM muscle?

What position is it in?

What do you do following Rx?

A

only when sub-acute or chronic 5-10+ days

Have muscle belly in relaxed position - Follow with active contractions in inner range

22
Q

When do you DTFM tendon and ligament

What position do you DTFM them in

What do you do following Rx?

A

acute or chronic stage

On pain free stretch

Follow up with exercise

23
Q

DTFM Contraindications

A
  • Infection
  • skin breakdown
  • ossification/calcification
  • CT or inflammatory joint disease
  • neural irritation
  • Bursitis, recent local injection
  • long term steroid
  • anticoagulant or anti inflammatory drug use
24
Q

DTFM Precautions

A
  • Elderly
  • Children
  • Diabetes (decreased sensation)