Therapeutic Exercise: Foundations and Techniques, 6th Edition

Therapeutic Exercise: Foundations and Techniques, 6th Edition

Peripheral Joint Mobilization for Impaired Mobility Chapter 5 Part II: Applied Science of Exercise and Techniques Copyright 2013. F.A. Davis Company Joint Mobilization/Manipulation Manual therapy techniques that are used to modulate pain and treat joint impairments that limit ROM by specifically addressing the

altered mechanics of the joint Copyright 2013. F.A. Davis Company Definition of Terms Mobilization/Manipulation Thrust manipulation/high-velocity thrust (HVT) Self-Mobilization (Auto-Mobilization) Mobilization With Movement (MWM) Physiological Movements Osteokinematics

Copyright 2013. F.A. Davis Company Definition of Terms (cont'd) Accessory Movements Component motion Joint play: arthrokinematics Manipulation Under Anesthesia Muscle Energy Copyright 2013. F.A. Davis Company

Basic Concepts of Joint Motion: Arthrokinematics Joint Shapes Ovoid Sellar (saddle) Copyright 2013. F.A. Davis Company Basic Concepts of Joint Motion: Arthrokinematics (cont'd) Types of Motion

Swing: Movement of the bony lever about an axis of motion Motion of the bone surfaces in the joint Roll Slide/translation Combined roll-sliding in a joint (glide) Spin Copyright 2013. F.A. Davis Company Convex-Concave Rule Basis for determining the direction of the mobilizing force when joint mobilization

gliding techniques are used Sliding is in the opposite direction of the angular movement of the bone if the moving surface is convex Sliding is in the same direction if the moving surface is concave Copyright 2013. F.A. Davis Company Passive-Angular Stretching Versus Joint-Glide Stretching Passive-angular stretching may cause

increased pain or joint trauma Joint-glide is safer and more selective Controlled Replicates normal joint mechanics Force is specific to target tissues Copyright 2013. F.A. Davis Company Other Accessory Motions That Affect the Joint Compression Traction: Longitudinal Pull

Long axis traction Distraction: Separation of Joint Surfaces Joint traction or joint separation Copyright 2013. F.A. Davis Company Effects of Joint Motion Helps move synovial fluid to maintain cartilage health Maintains extensibility and tensile strength of articular and periarticular tissues

Provides sensory input for proprioceptive feedback important for balance response Copyright 2013. F.A. Davis Company Indications for Joint Mobilization/ Manipulation Pain, Muscle Guarding, and Spasm Neurophysiological effects Mechanical effects Reversible Hypomobility

Positional Faults/Subluxations Progressive Limitation Functional Immobility Copyright 2013. F.A. Davis Company Limitations of Joint Mobilization/ Manipulation Techniques Cannot Change Disease Process Cannot Change Inflammatory Process Skill of the Therapist Affects the Outcome Copyright 2013. F.A. Davis Company

Contraindications Hypermobility Joint Effusion Inflammation Copyright 2013. F.A. Davis Company Conditions Requiring Special Precautions for Stretching Malignancy Bone Disease Detectable on Radiograph

Unhealed Fracture (With Limitations) Hypermobility in Associated Joints Total Joint Replacements Newly Formed or Weakened Connective Tissue Elderly Individuals Copyright 2013. F.A. Davis Company Procedures for Applying Passive Joint Techniques Examination and Evaluation Quality of pain

Capsular restriction (specific pattern) Subluxation or dislocation Copyright 2013. F.A. Davis Company Procedures for Applying Passive Joint Techniques (cont'd) Documentation Use of standardized terminology Characteristics of documentation

Rate of application of movement Location of range in the available motion Direction of force applied by the therapist Target of force Relative structural movement Patient position

Copyright 2013. F.A. Davis Company Non-Thrust Oscillation Techniques Grade I: Small Amplitude at Beginning of Range Pain inhibition and fluid movement Grade II: Large Amplitude Within the Range Pain inhibition and fluid movement Grade III: Large Amplitude Up to the Limit into Resistance Stretching maneuver

Grade IV: Small Amplitude at the Limit into Resistance Stretching maneuver Copyright 2013. F.A. Davis Company Non-Thrust Sustained Joint-Play Techniques Grade I: Loosen: Small Amp Distraction Pain relief Grade II: Tighten: Distraction or Glide to Tighten Tissue

Pain relief, assess joint sensitivity, maintain joint play Grade III: Stretch: Distraction or Glide Increase joint play Copyright 2013. F.A. Davis Company Comparison of Oscillation and Sustained Techniques Representation of Oscillation Techniques

Copyright 2013. F.A. Davis Company Representation of Sustained Joint-Play Techniques Thrust Manipulation/High-Velocity Thrust (HVT) Application Small-amplitude, high-velocity Performed only once Indications

Snap adhesions Reposition joint surfaces Copyright 2013. F.A. Davis Company Procedures for Applying Passive Joint Techniques Positioning and Stabilization Direction and Target of Treatment Force Treatment plane Initiation and Progression of Treatment

Patient Response Total Program Copyright 2013. F.A. Davis Company Mobilization With Movement (MWM): Principles of Application Principles and Application of MWM in Clinical Practice Comparable sign Passive techniques Accessory glide with active comparable sign

No pain Repetitions Description of techniques Copyright 2013. F.A. Davis Company Mobilization With Movement (MWM): Principles of Application (cont'd) Patient Response and Progression Pain as a guide Self treatment Total program

Theoretical Framework Brian Mulligan Copyright 2013. F.A. Davis Company Peripheral Joint Mobilization Techniques

Shoulder Girdle Complex Elbow and Forearm Complex Wrist and Hand Complex Hip Joint Knee Joint Complex Leg and Ankle Joints Copyright 2013. F.A. Davis Company Independent Learning Activities

Critical Thinking and Discussion Laboratory Practice Copyright 2013. F.A. Davis Company

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