Joint mobilization & manipulation
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Joint mobilization and manipulation are passive techniques used by physiotherapists to increase range of motion (ROM) and decrease pain in joints. Mobilization involves small, rhythmic movements within a joint's available ROM, while manipulation is a sudden, forceful thrust beyond a patient's control. Both techniques work to move synovial fluid, maintain joint tissue extensibility, provide sensory input, and stimulate mechanoreceptors to reduce pain. Precautions are taken with patients having conditions like hypermobility, inflammation, or bone fractures.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Joint mobilization & manipulation
- 1. Joint Mobilization & Manipulation PRESENTED BY : MUHAMMAD ARSAL ROLL NO : 212 DPT-2 SUBMITTED TO : DR ABBAS JAMIL
- 2. Mobilization : Passive joint movement for increasing ROM or decreasing pain. Applied to joints & related soft tissues at varying speeds and amplitudes. “Small repetitive rhythmical oscillatory , localized , accessory or functional movements performed by the physiotherapist within availably ROM under patient’s control”
- 3. Uses of Mobilization : • Used to modulate pain • Used to increase ROM • Used to treat joint dysfunctions that limit ROM Factors that may alter Joint Mechanics: • Pain • Joint hypomobility • Joint effusion • Contractures or adhesions
- 6. Arthrokinematics : Types of joint motions -Rolling -Sliding -Spinning
- 7. Compressions : Decrease in space between two joint surfaces • Increases Joint stability Distractions : Two surfaces are pulled apart • Often used in combination with joint mobilizations to increase stretch of capsule
- 8. Joint Positions : Loose Packed Positions : Articulating surfaces are maximally separated. Closed Packed Positions : Joint surfaces are in maximal contact to each other Resting Positions : Positions in which joint capsules and ligaments are most relaxed
- 13. Effects of Joint Mobilization : • Moves synovial fluid • Maintains extensibility and strength of joint tissue • Provides sensory input • Stimulates mechanoreceptors to decrease pain
- 14. Precautions and Contradictions : • Hypermobility • Bone diseases • Inflammation • Joint effusion • Disk slip • Bone fracture • Congenital bone deformity
- 16. Manipulation : passive joint movement for increasing joint mobility It is a sudden, forceful thrust that is beyond the patient’s control
- 17. Manipulation of Joints by Physiotherapist : “ Accurately localized , single , quick decisive movements of small amplitude high velocity completed before the patient can stop it ”
- 18. Manipulation of Joints by Surgeon : “ The movements performed under anesthesia by a surgeon or physician to gain further range ” • Used to break joint adhesions • Stimulate joint receptors Point to be Noted : The increase in movement is maintained by Physiotherapist
- 19. Thrust Manipulation/ High-Velocity Thrust : • Small amplitude, high velocity • One repetition • Used to snap adhesion or to report a dislocated joint
- 20. Controlled sustained Stretching of Tightened Structures : Passive stretching of muscles and soft tissues is given to ROM. Movement can be gained in these structures by stretching adhesions .