Mobility Intro Lect I


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Mobility Intro Lect I

  1. 1. Manual Mobilization Of The Extremity Joint Introduction
  2. 2. Manipulation vs. Mobilization
  3. 3. Manipulation <ul><li>Orthopedic Sec. APTA </li></ul><ul><ul><li>Any manual procedure used for the purpose of examination , correction or modification of an articular or soft tissue dysfunction. </li></ul></ul><ul><li>Paris </li></ul><ul><ul><li>The skilled passive movement to a joint, either within or beyond its active limited motion. </li></ul></ul><ul><li>Maitland </li></ul><ul><ul><li>A sudden small amplitude thrust delivered at a speed which renders the patient powerless to prevent it </li></ul></ul>
  4. 4. <ul><li>Defined APTA </li></ul><ul><ul><li>The act of imparting movement, either actively or passively, to joints or soft tissue structures. </li></ul></ul><ul><li>Maitland </li></ul><ul><ul><li>Passive oscillatory movements or sustained stretch at the limit of range using graded amplitude movements. </li></ul></ul><ul><li>Kaltenborn </li></ul><ul><ul><li>Component of MT referring to any procedure that increases the mobility of joints or ST structures </li></ul></ul>Mobilization
  5. 5. History & School Of Thought <ul><li>James Cyriax </li></ul><ul><li>John Mennell </li></ul><ul><li>Freddie Kaltenborn </li></ul><ul><li>Geoffrey Maitalnd </li></ul><ul><li>Stanley Paris </li></ul>
  6. 6. James Cyraix <ul><li>Concept of end feel </li></ul><ul><li>Examination by selective tissue tension </li></ul><ul><li>Friction Massage </li></ul>
  7. 7. John Mennell <ul><li>Concept of joint dysfunction </li></ul><ul><ul><li>loss of accessory or joint play movement </li></ul></ul><ul><li>Jt. dysfunction as pain- producing entity, causing loss of movement </li></ul><ul><li>Jt dysfunction is detected by passive movement. Normal passive movement is pain free. </li></ul>
  8. 8. Freddy Kaltenborn <ul><li>Norwegian School- biomechanical model </li></ul><ul><li>Applied the works of MacConnell to joint mobilization </li></ul><ul><ul><li>Concave /Convex rule </li></ul></ul><ul><ul><li>Open/ Closed Pack Position </li></ul></ul><ul><li>Focus is on movement taking place within the joint capsule </li></ul>
  9. 9. Freddy Kaltenborn <ul><li>Brought into play the arthrokinematic and osteokinematic relationship of joint movement. </li></ul><ul><li>The osteokinematic and arthrokinematic at a specific joint may be the same, opposite direction. </li></ul><ul><ul><li>eg. Shoulder abduction </li></ul></ul>
  10. 10. Geoffrey Maitland <ul><li>Deviated from biomechanical model </li></ul><ul><ul><li>Advocating treatment of painful joints by oscillating passive movement that provide </li></ul></ul><ul><ul><ul><li>Neurophysiological therapeutic </li></ul></ul></ul><ul><ul><ul><li>Mechanical therapeutic </li></ul></ul></ul><ul><li>Implemented the grading system </li></ul>
  11. 11. Stanley Paris <ul><li>Focus is on Hypomobility </li></ul><ul><li>Define joint dysfunction as “ a state of altered mechanics either increased or decreased from the expected normal motion. </li></ul><ul><li>Grade scale from 0-7 </li></ul><ul><ul><li>0 no mobility </li></ul></ul><ul><ul><li>3 is normal </li></ul></ul><ul><ul><li>6 &7 unstable </li></ul></ul>
  12. 12. Terminology
  13. 13. Terminology <ul><li>Kinematics: </li></ul><ul><ul><li>Study of movement </li></ul></ul><ul><li>Osteokinematic: </li></ul><ul><ul><li>Overall movement of bone </li></ul></ul><ul><li>Arthrokinematic </li></ul><ul><ul><li>Movement of one articular surface in relation to it partner- roll, glide, spin </li></ul></ul>
  14. 14. Bone Rotation ( roll-gliding ) <ul><li>All bone movements occur around an axis. </li></ul><ul><li>From a mechanical viewpoint are considered to be rotation or spin </li></ul><ul><li>In normal joints all active movements produce joint roll-gliding </li></ul><ul><ul><li>Exception planar joints </li></ul></ul>
  15. 15. Roll, Slide , Spin <ul><li>Roll: Movement in which points at interval on the moving JT, surface contacts points at the same intervals on the opposite surface. </li></ul><ul><li>Slide. Movement in which a single point on the moving surface contacts various points on the opposing surface. </li></ul><ul><li>Spin. Type of slide that accompanies spin of a bone . 1/2 of the jt surface slides in one direction while the other 1/2 slide the opposite direction. </li></ul>
  16. 16. Distraction / Compression <ul><li>Distraction: Separation of joint surfaces </li></ul><ul><li>Compression: Approximation of joint surfaces- moving toward close pack position. </li></ul>
  17. 17. Accessory Movements <ul><li>Those movements which accompany the physiological movements and are necessary for normal function, but not under voluntary neuromuscular control </li></ul>
  18. 18. Categories Of Accessory Movements <ul><li>Joint Play </li></ul><ul><li>Component </li></ul>
  19. 19. Joint Play Movement <ul><li>Movement that can be produced passively at a joint but cannot be isolated actively. </li></ul><ul><li>Spin, roll, glide, compression, & distraction </li></ul><ul><li>Joint play movements are used when applying specific mobilization techniques to restore accessory movements so that full & painless osteokinematic movement may return. ( eg . Inferior distraction of the shoulder) </li></ul>
  20. 20. Component Motion <ul><li>A type of accessory movement that is directly associated with the production of osteokinematic movement or motion that takes place in a joint complex or related joint to facilitate a specific active motion </li></ul><ul><ul><li>Example: at glenohumeral Jt. </li></ul></ul><ul><ul><ul><li>Inferior and posterior glide of humeral head to produce flexion of the shoulder (humerus) </li></ul></ul></ul>
  21. 21. Closed & Open Pack Positions <ul><li>Closed Pack Criteria: </li></ul><ul><ul><li>Jt. Maximally congruent </li></ul></ul><ul><ul><li>Jt caps. & ligs. are twisted </li></ul></ul><ul><ul><li>Jt becomes locked in position </li></ul></ul><ul><li>Open Pack Criteria </li></ul><ul><ul><li>Lig & caps are slack </li></ul></ul><ul><ul><li>Jt surfaces distracted </li></ul></ul><ul><ul><li>Movements of roll slide are allowed </li></ul></ul>
  22. 22. End Feel <ul><li>Refers to the nature of movement limitation experienced by the examiner </li></ul><ul><ul><li>Assessment of joint play </li></ul></ul><ul><li>It is the sensation imparted to the examiner’s hands during passive movement of a joint at end range </li></ul>