Joint Mobility

Question 1

Provide 3 examples when AROM would be more indicated than PROM.

Answer 1

1. Person can perform full or near full PROM with no pai
2. If they are not bedridden or have neurological issues that limits their ability to move
3. To strengthen the muscle

Question 2

What are the potential reasons if someone has decreased AROM in knee flexion?

Answer 2

1) Tight knee extensors are limiting the range (Prescribe stretching)
2) Problems with the Accessory movements (Prescribe joint mobilization)

Question 3

What are the three types of joints that can be found in the human body?

Answer 3

Arthroses = joints

Synarthroses = immovable, fixed/ fibrous.

Eg., Sutures of the skull —irregular bones interlocks and are bound tightly together by fibrous connective tissues. Eg., Syndesmosis: distal tibiafibular

Amphiarthroses = slightly moveable/ cartilaginous

Eg, pubic symphysis, Interosseous membrane: the sheet of connective tissue joining neighboring bones. These joints are connected by fibrocartilage that adhere to the ends of each bone.

Diathroses = movable. Synovial joints: plane, hinge, pivot, saddle, ball-in-socket, ellipsoid

Question 4

Could performing Passive ROM (Including stretching) help with preventing muscle contractures and decrease pain?

What are the contraindications ?

Answer 4

Yes.

Contraindications:

• acute injury to the joint, ligaments or muscles
• Early fractures

Question 5

Describe the structure of joints

Answer 5

Components of joint

• Bones: articular surface
• Cartilage: cover the bone articular surfaces → articular cartilage
• Joint capsule: tissues covering joints
• Synovial membrane: inner lining of capsule → secrete synovial fluid (reduce joint friction)
• Ligaments: by stability by connecting structures

Other Structures:

• disc/ minisci - structural integrity and shock absorption
• labra/ fat pad - increase joint surface area → increase stability, shock absorption

* bursa - reduce friction between rubbing surfaces

Question 6

What are the factors that facilitate normal joint range of motion?

Answer 6

1. Bone shape (concave, convex) → the surface area for the joint to move
2. Accessory movement will help increase the available rom of the joint
3. Hyaline cartilage → a) provide a smooth surface over the bone to occur… allow for spin/ glide/ roll w/out damaging friction, b) thus protect joint from wear and tear
4. Synovial membrane - produce synovial fluid that runs over the joint surfaces (reduce friction when movement occur, shock absorption, nutrition) and enhance the function of the hyaline cartilage
5. Joint capsule - most of the capsule surrounding joints are laxed → ease of ROM
6. Additional structure - menisci in the knee, labrum in the shoulder, hip → increase joint surface, congruity or affecting stability within the joint
7. Neuro-system
8. muscle strengthn (help produce movements and stabilize the joint)

Question 7

List and describe 4 factors that can decrease range of motion.

Answer 7

Factors:

1. Tearing or displacements of intracapsular structures, eg. meniscus tear
2. soft tissue lesions, eg., frozen shoulder
3. immobilization: muscle shortens around the joint
4. Pain: may lead to muscle guarding and lack of movement are factors that lead to hypomobility
5. Neurological impairment can change muscle control, eg, spaticity

Question 8

What plane of movement occurs along the vertical axis?

What plane of movement occurs along the anteroposterior axis? Transverse axis?

Answer 8

Vertical axis: Transverse plane (rotational movements)

Transverse axis - sagittal plane (flexion and extension)

Anterioposterior axis (aka sagittal) frontal plane, adduction and abduction

Question 9

How do hyaline cartilage and synovial membrane helps faciliate normal joint movement?

Answer 9

• Hyaline cartilage → a) provide a smooth surface over the bone to occur… allow for spin/ glide/ roll w/out damaging friction, b) thus protect joint from wear and tear
• Synovial membrane - produce synovial fluid that runs over the joint surfaces (reduce friction when movement occur, shock absorption, nutrition) and enhance the function of the hyaline cartilage

Question 10

How do we assess ROM?

Answer 10

By using a device to calculate the angle of that joint, refer to as the goniometry. AROM, PROM, end feel or other ways physical therapist used to assess ROM.

With AROM, we could note how much movement is present compared to the normal ROM for the specific joint.

PROM: we could determine the end feel of a joint, it is how the joint feel at the end of the passive range. It is important to determine the normal and abnormal end feels as it would give you info about the joint

Question 11

What are accessory movements? role?

Answer 11

Accessory movements are the spin, glide, rotation movements that we cannot see that occurs during physiological movements.

Accessory movements could increase joint surface contact (closed pack position) ensuring joint congruity/stability. Alternatively, accessory movements help to improve joint range of motion.

Question 12

Describe the four types of passive passive range of motion.

When do you use one versus the other?

If someone has muscle weakness, what technique would you select?

Answer 12

1. Relaxed passive ROM: an external force is applied without muscle contraction and performed within available ROM. It is used when full active ROM is not possible due to weak muscle, neurological problem, pain, spinal injury, unconsiousness. (Either performed by the therapist, by the patient or by a machine)
2. Stretching: an external force is applied by the individual that takes the joint beyond available physiological range of motion and result in a change in soft tissue length.
3. Mobilization: is a PROM technique performed within the joint available range by the therapist to test or restore accessory movements of the joint. It is used to treat capsule and ligament tightness. Eg., a shoulder capsule stretch

4. Manipulation: is a PROM technique that uses small amplitude forceful movements to move the joint beyond its physiological range. Eg., traction, backcracking.

It is used to increase ROM due to end range blockage by loose bodies or a period of immobilization. - break down adhesions, clearing blockage that has been formed through the healing process.

Question 13

What are the methods to treat abnormally limited ROM?

Answer 13

1. Passive ROM
2. Stretches
3. Mobilizations
4. Manipulation
5. Active ROM

Question 14

In what case would you prescribe stretching?

Would you prescribe stretching if someone has muscle spasmS?

Answer 14

1. If they have pain caused by muscle spasms
2. person is susceptible to muscle contractures
3. Person do not have joint hypermobility, bone fractures or soft tissues damage and they want to improve their flexibility.

Question 15

What is the interaction between muscle and joints?

Answer 15

Muscles are attached to bones via tendons. Muscle contraction create forces on bones (pull). In order for movement to occur the bones have to be able to move freely.

Question 16

What are the potential causes of hypomobility?

Answer 16

1. Destruction of bone and/or cartilage. Eg., fracture, osteoarthritis, rheumatoid arthritis.
2. Scar tissue
3. Tearing (or displaced) intracapsular structures, e.g., meniscus tear
4. Immobilization
5. Neurological impairment - change in muscle control, eg, spasticity or flaccidity

Question 17

What are the effects of passive ROM?

Contraindications?

Answer 17

Effects:

1. Maintain or increase ROM
2. Prevent muscle contractures
3. Increase circulation
4. Increase synovial fluid production and cartilage nutrition
5. Decrease pain
6. Maintain function

Contraindications:

• acute injury to the joint, ligament or muscles, fracture

Question 18

What structures of the joint could limit or contribute to its normal movement ?

Give 4 factors that contribute to normal ROM. Describe how they facilitate ROM

Answer 18

Normal bony structures prevents further movement. Eg, in elbow extension, the joint is prevented to extend past 180 deg by the olecranon of the ulna impinging on the humerus.

Approximation of soft tissue. Eg, In elbow flexion, the joint rom is limited by the bulk of the biceps brachii pressing against the forearm

Ligaments and tendons extensibility - white fibrous collagen = relatively inelastic, no room pass end range. Eg., internal and external rotation of the GH joint is limited by the 3 ligaments that also acts as the fibrous outer layer of the joint capsule.

Muscular extensibility - Despite it’s limitation to be stretched, muscles offer the opportunity of more stretch. — the rom it can perform is affected magnified when stretched over 2 joints.

Eg., the hamstring muscles crosses 2 joints. When the hip is flexed, the amount of knee extension is limited as the muscle is already near its maximum possible length. But if the hip joint is extended, the muscle can stretch more and go into deeper knee flexion.

Question 19

What are the degrees of freedoms of a joint?

Answer 19

Degrees of freedom is used to describe the movements a joint can perform about an axis.

A joint could be

uniaxial: 1 DOF; elbow flexion & extension.
biaxial: 2 DOF; flex & ext, & wrist deviation
multiaxial: 2+ DOF shoulder and hip joint

Question 20

When would you not use prescribe mobilization ?

Answer 20

Contraindications:

1. Acute injury to the joint, ligament, muscles
2. Early fractures
3. Joint hypermobility

Question 21

Describe the technique of Manipulations

Answer 21

Manipulation:

is a PROM technique that uses small amplitude forceful movements to move the joint beyond its physiological range.

Eg., traction, backcracking.

Indication:

to increase ROM due to end range blockage ( by loose bodies or a period of immobilization)

The technique helps to break down adhesions, clearing blockage that has been formed through the healing process.

Effects:

1. Increase ROM
2. regain normal physiological ROM - hypomobile, adhesion
3. Decrease pain
4. Increase synovial fluid production and cartilage nutrition

Contraindications

Acute injury to the joint, ligament or muscles

Question 22

What are the potential factors resulting in a decreased passive range of motion of a joint?

For example, limited dorsiflexion

Answer 22

1. limitation in the joint (eg, accessory movement)
2. antagonist muscles tightness (eg, tight gastrocnemius)

Question 23

What could be limiting the mobility of the joint?

If someone has decreased AROM in a particular joint but accessory movements are normal, what could you assume?

If someone has decreased AROM but accessory movements are abdnormal.

Answer 23

1) we can assume that what is limiting the jont mobility is the contractile tissues, ie, muscle tightness. Therefore, stretching should be prescribed.
2) we can assume that what is limiting joint mobility is the joint itself, therefore mobilization might be best

Question 24

Define stretching.

Would stretching help improve accessory movements?

Answer 24

No

Stretching: an external force is applied by the individual that takes the joint beyond available physiological range of motion and result in a change in soft tissue length.

Question 25

What is mobilization ?

Answer 25

is a PROM technique performed within the joint available range by the therapist to test or restore accessory movements of the joint. It is used to treat capsule and ligament tightness. Eg., a shoulder capsule stretch