Chapter 5 - PHT 1227 Therapeutic Exercise I
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Transcript Chapter 5 - PHT 1227 Therapeutic Exercise I
Peripheral Joint Mobilization
for Impaired Mobility
Chapter 5
Part II: Applied Science of Exercise and
Techniques
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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
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Definition of Terms
Mobilization/Manipulation
– Thrust manipulation/high-velocity thrust (HVT)
Self-Mobilization (Auto-Mobilization)
Mobilization With Movement (MWM)
Physiological Movements
– Osteokinematics
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Definition of Terms (cont'd)
Accessory Movements
– Component motion
– Joint play: arthrokinematics
Manipulation Under Anesthesia
Muscle Energy
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Basic Concepts of Joint Motion:
Arthrokinematics
Joint Shapes
– Ovoid
– Sellar (saddle)
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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
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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
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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
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Other Accessory Motions That
Affect the Joint
Compression
Traction: Longitudinal Pull
– Long axis traction
Distraction: Separation of Joint Surfaces
– Joint traction or joint separation
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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
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Indications for Joint
Mobilization/Manipulation
Pain, Muscle Guarding, and Spasm
– Neurophysiological effects
– Mechanical effects
Reversible Hypomobility
Positional Faults/Subluxations
Progressive Limitation
Functional Immobility
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Limitations of Joint Mobilization/
Manipulation Techniques
Cannot Change Disease Process
Cannot Change Inflammatory Process
Skill of the Therapist Affects the Outcome
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Contraindications
Hypermobility
Joint Effusion
Inflammation
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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
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Procedures for Applying Passive
Joint Techniques
Examination and Evaluation
– Quality of pain
– Capsular restriction (specific pattern)
– Subluxation or dislocation
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Procedures for Applying Passive
Joint Techniques (cont'd)
Documentation
– Use of standardized terminology
– Characteristics of documentation
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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
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
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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
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Comparison of Oscillation and
Sustained Techniques
Representation of Oscillation
Techniques
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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
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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
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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
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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
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Peripheral Joint Mobilization
Techniques
Shoulder Girdle Complex
Elbow and Forearm Complex
Wrist and Hand Complex
Hip Joint
Knee Joint Complex
Leg and Ankle Joints
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Independent Learning Activities
Critical Thinking and Discussion
Laboratory Practice
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