Effects of joint mob techniques
Neurophysiological: Reduces muscle spasm and guarding; Stimulates mechanoreceptors to decrease pain; Afferent nerve impulses allow for increased awareness of position and motion. Mechanical: Improves mobility of hypomobile joint. Nutritional: Synovial fluid movement improves nutrient exchange.
Indications
Pain; Muscle guarding; Deformity ex.) frozen shoulder.
Limitations
These include thing like rheumatoid arthritis that we can’t take away but we can: Minimize pain; Maintain joint play; Reduce mechanical limitations.
Contraindications and precautions
Contraindications: Hypermobility; Acute inflammation; Rheumatoid arthritis flare; Injury; Spinal cord injury. Precautions: Pregnancy and post partum; Neurological defect; Rheumatoid arthritis; Osteoarthritis; Spondylolisthesis.
Osteokinematic movements
The result of concentric or eccentric active muscle contractions; Bones move about an axis through flex, abd, add, ext, and rot; Can be measured by goniometer; Performed active or passive.
Arthrokinematic movements
Movements in a joint and surrounding tissues that are necessary for normal ROM but cannot be done actively.
Movements
Roll: As the joint moves through its ROM, a new portion of the joint meets the opposite joint surface; Glide: One part of the moving joint is in contact with multiple points on the opposing surface; Spin: The joint surface spins along the joint surface.
Fixed convex and concave rule
Fixed concave, moving convex: Gliding movement occurs in the opposite direction of the bone movement. Fixed convex, moving concave: Gliding occurs in the same direction as the bone movement.
Grades of mobility
Grade 0- no motion between joint surfaces. Mobilizations not indicated. Grade 1- considerable limitation between the joint surfaces. Mobilization indicated. Grade 2- slight limitation. Mobilization indicated. Grade 3- normal amount of movement between the joint surfaces. Mobilization not indicated. Grade 4- slight increase in mobility above normal movement. Stabilization exercises required. Grade 5 - considerable increase in mobility. Stabilization plus taping or bracing required. Grade 6- unstable joint. Medical intervention.
Pain with hypermobile and hypomobile joints
Hypomobility: With pain: May indicate adhesion or contracture; Mobilization tech are indicated with pain free accessory movement. Without pain: Chronic adhesions or contracture; Mobilizations possibly indicated. Normal mobility: With pain: Mild sprain without disruption of capsular fibers; May benefit from gentle mobs to decrease pain and promote normal alignment forming new collagen fibers. Without pain: Joint mob not indicated. Hypermobility: NO JOINT MOB.
End feel of hypermobility and hypomobility
Bony end feel: Tissue resistance is felt as an abrupt change in joint extensibility; Might be painful; Indicates bone hypertrophy in the joint blocking movement; Restriction in joint capsule causing two surfaces to jam together; JOINT MOB NOT INDICATED. Firm: End feel is less abrupt; Feels thicker than the tissue stretch; Indicates capsular tissue limitation; If with hypomobility can do joint mob.
Joint positioning
Open/ loose packed: Articular surfaces are barely touching; Supporting structures are more lax; Greatest mobility here. Closed packed: Maximum contact; Maximum mobility; Maximum stability.
Traction and distraction and compression
Traction: a longitudinal pull; Distraction: a separation or pulling apart; Compression: A decrease in joint space; Happens in spinal joint often; Helps move synovial fluid and maintain cartilage health; If there’s too much compression: can lead to articular changes or deterioration.
Oscillations in Joint mobs
Grade I: Small amplitude rhythmic oscillation performed at beginning of range. Grade II: Large amplitude oscillation performed within range, not reaching limit. Grade III: Large amplitude oscillation performed up to the limit of motion and is in tissue resistance. Grade IV: Small amplitude oscillation performed to limit and in tissue resistance. Important to know: Grades I and II: reduce pain, reduce muscle guarding; Grades III and IV: stretch joint capsule, increase ROM.
