Basic Introduction about Joint Mobilisation and Manipulation, This article gives clear notes for the students to understand the Mobilisation techniques.
The McKenzie Method is a classification system and treatment approach developed by Robin McKenzie for back, neck, and extremity pain. It involves assessing a patient's response to various movements and positions to determine the cause of their pain and develop an individualized exercise plan. The goals are to centralize or reduce pain. There are three main syndromes - postural, dysfunction, and derangement - each with different treatments like posture correction, mobilizing exercises, or movements to induce a directional preference. The McKenzie Method aims to actively involve patients to self-manage their pain.
The Faradic Galvanic (FG) test assesses lower motor neuron problems by stimulating muscles with different electric currents. A brief tetanic contraction indicates intact innervation, while a sluggish response suggests denervation. The test involves using faradic current to search for motor points and elicit fast contractions in innervated muscles. Galvanic current then produces slow contractions in denervated muscles. However, the FG test is inaccurate and unreliable, correctly interpreting muscle reactions in only 50% of cases.
The document discusses Kaltenborn manual mobilization techniques which use traction and gliding movements to reduce pain and increase joint mobility. It describes testing for restrictions in joint play, end feels, and functional movements to determine appropriate treatment grades of mobilization parallel or perpendicular to the treatment plane. Indications for treatment include restricted joint play or abnormal end feels while contraindications include various pathological bone and joint conditions.
The document discusses Mitchell's relaxation technique, which uses diaphragmatic breathing and isotonic muscle contractions based on reciprocal inhibition. It can be used to treat respiratory, orthopedic, post-natal, and psychiatric conditions. The technique promotes relaxation and reduces muscle tension and pain perception. It is effective for pre-labor Braxton Hicks contractions and realigning stress-related postures by moving to a new position and increasing awareness of body position. Mitchell's relaxation technique can also help conditions involving a high tone pelvic floor like painful bladder syndrome.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Joint mobilization refers to a technique of manual therapy by which a therapist applies a brief stretch of 30s or less through traction and gliding along a joint surface.
This document defines joint mobilization techniques and provides guidelines for their use. It describes mobilization as a manual therapy that uses passive joint movement to increase range of motion or decrease pain. Accessory joint movements like gliding and traction are explained. Precautions and contraindications for mobilization are outlined. A grading scale from I to V is presented to indicate the amplitude of oscillations used in different mobilization techniques.
Manual therapy techniques like joint mobilizations and manipulations can be used to safely restore normal joint mechanics and reduce trauma. Effective use requires knowledge of anatomy, arthrokinematics, and pathologies. Several concepts for manual therapy techniques were introduced, including Cyriax, Mulligan, Maitland, and McKenzie. Contraindications include inflammation, effusion, and hypermobility while indications include reversible hypomobility and functional limitations responding to mechanical treatment. Grading systems determine appropriate mobilization force and different joints require specific examination and treatment techniques.
Balance is the ability to control body position to maintain upright posture. It involves integration of sensory inputs and motor outputs. Balance training progresses from simple to complex tasks in positions like lying, sitting, kneeling, and standing static and dynamic exercises before walking, stairs, and community tasks. Assessment evaluates vision, sensation, vestibular function, range of motion, strength, and limits of stability. Treatment addresses sensory, strategy, musculoskeletal, and environmental factors through exercises, modifications, and assistive devices.
Dr. James Cyriax developed Cyriax techniques in the early 1900s as a systematic approach to soft tissue injuries. The techniques involve selective tissue tension testing to diagnose lesions, followed by treatments like deep friction massage, passive movements, and active exercises. Deep friction massage uses longitudinal or transverse forces to separate tissue fibers and relieve pain. Passive movements can be graded from low-force range-of-motion to high-velocity small-amplitude thrusts. Active exercises prevent immobilization effects and maintain tissue integrity. Together, Cyriax techniques aim to accurately diagnose and beneficially treat soft tissue disorders.
Kinetics and Kinematics of Gait summarizes gait terminology, phases, joint motion, determinants, and the kinetics and kinematics of the trunk and upper extremities during gait. It describes the six determinants of gait including pelvic rotation and tilting, knee flexion in stance, and foot and knee mechanisms which function to minimize center of gravity displacement. The document also outlines the muscle activity, internal joint moments, and energy requirements including potential and kinetic energy exchange during the gait cycle.
a detailed description on theory behind Strength duration curve, along with procedure for plotting SD Curve and measuring the Rheobase and Chronaxie of the plotted graph.
This document discusses balance, fall prevention, and balance assessment and training. It defines balance as control of the center of mass over the base of support. Age-related changes and diseases that impact balance components are reviewed. Valid tools to measure balance include the Berg Balance Scale, Timed Up and Go test, and Functional Reach test. Balance training exercises discussed include calf stretches, heel/toe raises, soft surface stance, and exercises using movable surfaces like Swiss balls and tilt boards. Both hard and soft surfaces are used to challenge static and dynamic balance.
This document outlines the components of performing a coordination examination, including the purposes, relevant anatomy, testing protocols, and specific tests. It discusses testing coordination through non-equilibrium tests done in sitting and equilibrium tests of balance done standing. Tests examine abilities like finger-to-nose coordination, rapid alternating movements, and balance on one leg. Performance is graded on a scale of 1 to 5. Select tests are highlighted as useful for evaluating particular coordination impairments involving tremors, dysmetria, or other issues.
PNF is an exercise technique based on neurophysiological principles that uses resistance, manual contact, and stretching to facilitate muscle contraction and improve mobility through techniques like contract-relax, slow reversal, and rhythmic stabilization. It is commonly used in orthopedic and neurological rehabilitation to increase strength, flexibility, coordination and functional mobility through specific patterns targeting different areas of the body like the upper and lower extremities. Research has found PNF techniques are effective in rehabilitation of injuries to the knee, shoulder, and hip and its use has increased in ankle rehabilitation as well.
Myofascial release refers to the manual
technique for stretching the fascia and
releasing bonds between fascia and
Lintegument, musles,and bones, with the goal of
eliminating pain, increasing range of motion
and balancing the body.
The document provides an overview of coordination and its assessment. It defines coordination as the ability to execute smooth, accurate movements through integration of the motor, cerebellar, vestibular and sensory systems. Coordination involves appropriate speed, direction, muscle tension and synergist influences. Coordination deficits are often related to conditions involving the cerebellum, basal ganglia or dorsal columns. Common tests of coordination include finger-to-nose, heel-to-knee, rapid alternating movements and Romberg's test. Treatment focuses on techniques like PNF, balance exercises, and Frenkel's exercises to improve coordination.
The document describes the anatomy of the glenohumeral joint, or shoulder joint, including its ligaments, bones, and muscles. Key features include the glenoid fossa on the scapula articulating with the humerus, and ligaments like the coracoacromial, coracohumeral, and glenohumeral ligaments surrounding and supporting the joint. Muscles like the supraspinatus, infraspinatus, subscapularis, and teres minor originate on the scapula and insert on the humerus to allow shoulder movement.
Supraspinatus tendinitis is an inflammation of the supraspinatus tendon, which is one of the most commonly affected structures in the rotator cuff. It often results from repeated overhead arm motions or other activities that cause impingement beneath the coracoacromial arch. Symptoms include pain in the shoulder region that is worsened by motions like lifting the arm overhead. Treatment involves rest, exercises to strengthen the rotator cuff muscles, modalities like ultrasound to reduce inflammation, and manual therapy such as transverse friction massage to the tendon.
The document discusses principles of joint mobilization including using lower grades to reduce pain and higher grades to increase mobility. It outlines convex-concave rules for determining glide direction in different joints. Treatment glides are described to improve range of motion in various joints like the shoulder, knee, ankle and elbow. Open-packed positions and grades of movement are also defined. The goal of a joint mobilization treatment is to increase range of motion through appropriate gliding techniques.
This document discusses a construction project in Benghazi, Libya in the 1980s. The contractor was experiencing issues with soil settling after compacting backfill material in trenches for sewer pipes. Testing determined the soil contained montmorillonite crystals that caused it to expand when wet and shrink when dry, resulting in settling. A new testing process was implemented that fully rejected the excavated soil as unsuitable for backfilling due to this property.
This case study describes the physical therapy treatment of a 61-year-old male with a partially healed proximal humeral fracture and rotator cuff tear in his right shoulder. He had limited range of motion and pain with movement after 8 weeks of immobilization. The treatment plan involved joint mobilization techniques to increase shoulder range of motion, as well as strengthening exercises to improve muscular strength. The goals were to restore normal motion and strength without exacerbating pain.
The document discusses principles of mobilization treatment techniques from Maitland's text, including factors that govern passive movement, the method for selecting techniques, and eight principles for direction, patient/therapist position, force localization/application, and progression. It also covers grades, rhythms, and uses of movements like oscillations, distraction, and compression in treatment.
SELF- MOBILIZATION ( AUTO MOBILIZATION)-
Self stretching techniques that specifically used joint traction and glides that directs the stretch force to the joint force.
MOBILIZATION WITH MOVEMENT (MWM)- Concurrent application of a sustained accessory mobilization applied by a clinician and an active physiological movement to end range applied by the patient.
Applied in a pain free direction
Peripheral joint mobilization and manipulation are manual therapy techniques used to treat joint impairments and limit pain by addressing altered joint mechanics. They involve passive movement of joints using physiological or accessory motions at varying speeds and amplitudes. Self-mobilization refers to self-stretching techniques using joint glides directed at the joint capsule. Mobilization with movement applies sustained accessory mobilization by the therapist during an active physiological movement by the patient. Joint shapes and types of motion between bones are influenced by the surfaces of articulating bones.
Peripheral joint mobilization and manipulation refers to manual therapy techniques used to treat joint impairments and range of motion limitations. Techniques include passive movements, self-mobilization exercises, and mobilization with movement performed by a therapist. Variables like speed, amplitude, and direction are used. Mobilization techniques are classified by grade based on factors like oscillation rate and amplitude. Precautions are taken with certain conditions, and techniques are selected based on a patient's examination and evaluation.
This presentation will give an basic insights about the spinal mobilisation and various manual therapy techniques used on Lumbar spine especially Maitland & Mulligan techniques.
1) Lumbar spine mobilisation involves skilled passive movement of the spinal joints performed by a physical therapist to decrease pain and increase mobility. It includes techniques like joint mobilisation and manipulation.
2) Mobilisation techniques for the lumbar spine include central and unilateral posteroanterior glides, lateral/transverse glides, longitudinal glides, and anterior pressure to improve flexion, extension, lateral flexion and rotation.
3) Mobilisation techniques described include Maitland oscillatory techniques and grades as well as Mulligan techniques like natural apophyseal glides, sustained natural apophyseal glides, mobilisation with movement, and spinal mobilisation with leg movement.
This document discusses joint mobility assessment in physical therapy. It begins by stating the learning objectives, which are to explain concepts of joint mobility assessment, state principles and guidelines, identify indications and precautions, demonstrate techniques, and communicate results. It then reviews relevant concepts such as range of motion, limitation of motion, and hypermobility versus instability. The document outlines the assessment procedures including pain assessment, active and passive motion tests, and accessory mobility tests. It provides guidance on patient positioning, use of glides and distraction/compression. The document concludes by describing how to interpret test findings and documenting the results.
Manual mobilization of extremity joints involves passive movements applied to increase joint mobility. There are different schools of thought on mobilization, including focusing on neurophysiological effects, treatment of painful joints, and restoring normal accessory movements. Terminology includes types of bone movement like roll and slide, as well as concepts like closed and open pack positions and end feel.
This document discusses passive range of motion exercises. It defines passive movement as movement produced by an external force with little voluntary muscle contraction. It describes different types of passive movements including relaxed manual movements, forced movements like joint mobilization/manipulation, and mechanical movements like continuous passive motion. Key goals of passive movements are to maintain joint mobility and flexibility while preventing contractures. The document provides guidelines for different passive techniques as well as indications, contraindications, and precautions.
Passive movement involves moving a body part without active muscle contraction. There are several types: relaxed passive movements where a therapist smoothly moves a joint within its pain-free range; accessory movements which are small rotational or gliding motions in a joint; and passive manual techniques like joint mobilizations and manipulations. Controlled stretching can also be applied to tight muscles and tissues. Passive movements help maintain range of motion, prevent adhesions, reduce swelling, and stretch contracted structures. They are important for patients who cannot actively move due to injury or condition.
The document discusses peripheral joint mobilization and manipulation techniques. It defines these techniques as passive manual therapy applied to joints to address range of motion limitations from altered joint mechanics. The techniques can be non-thrust oscillations or sustained distraction, or high-velocity thrusts applied at the end of available motion. Proper positioning, stabilization, and application of specific sliding forces are described to safely stretch tight joint capsules while avoiding compression. The effects of increased motion on joint health are also summarized.
Dr Pooja Joshi presented on motor control in ankle instability. The ankle is a stable hinge joint made unstable by injury or repeated trauma. Assessment of ankle instability includes history, physical exam testing ranges of motion and ligaments, and evaluating proprioception and neuromotor control. Treatment focuses on reducing pain and swelling followed by motor control training using techniques like motor imagery, mirror therapy, and bracing to prevent further injury and give closed loop feedback to the central nervous system.
1) The document discusses spasticity, specifically the pathophysiology and assessment of spasticity. It covers topics like the stretch reflex, muscle spindles, golgi tendon organs, spinal interneurons, and supraspinal influences on spasticity.
2) Key points include that spasticity is a velocity-dependent increase in muscle tone caused by hyperexcitability of the stretch reflex. It can be assessed by measuring the exaggeration of the stretch reflex at different velocities.
3) Spasticity is caused by abnormal processing in the spinal cord that leads to excessive reflex activation of motor neurons in response to input from muscle spindles. Supraspinal pathways like the reticulo
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.
The document discusses the neural control of human locomotion. It states that locomotion requires progression, postural control, and adaptation. It is controlled by the coordinated actions of the neurologic, muscular and skeletal systems through various chains including sensorimotor chains. The nervous system generates locomotor patterns and coordinates multi-limb movements while accounting for environmental factors. Both lower motor neurons and supraspinal centers receive convergent input which allows locomotion to be adapted based on context.
;Passive movements are those which are performed by therapist. It is also called Passive Range of motion (PROM). It is divide into Five types .Also passive movements can be done by mechanically.
1. Passive movement involves moving a joint through its range of motion without active contraction of the muscles around the joint. It is done by a therapist or machine when a patient cannot actively move on their own or has a reduced range of motion.
2. There are two main types of passive movement - relaxed passive movements and passive manual mobilization techniques. Relaxed passive movements are smooth movements done by a therapist through a patient's full available range, while manual techniques include joint mobilization, manipulation, and controlled stretching.
3. Continued passive motion devices are used after limb or joint surgery to maintain movement and limit stiffness and pain. They move the joint through its full range while the patient is in bed to prevent immobil
This document discusses passive movements in physical therapy. It defines passive movements as smooth, rhythmic movements performed by a therapist or device on a patient, within their pain-free range of motion, to help increase range of motion when muscles cannot move a joint on their own. It describes different types of passive movements including manual techniques by therapists and mechanical techniques using devices, and provides guidelines for properly performing passive movements.
The document summarizes the Mulligan technique, an evidence-based manual therapy developed by Brian Mulligan. It was founded on the concept of mobilizing joints with movement to reduce pain and improve range of motion. The technique uses sustained natural glides applied by a therapist concurrently with an active movement by the patient. It aims to correct minor positional faults in joints that cause pain and stiffness. The document outlines the technique's mechanisms of action, principles, indications, contraindications and specific mobilization techniques such as SNAGs, MWMs, and SMWLMs.
NASM Integrated Flexibility Continuum
Corrective Flexibility: This phase is designed to correct common postural dysfunctions, muscle imbalances, and joint dysfunction. It includes: SMR and static stretching (and neuromuscular stretching if trained in technique). ... This includes SMR and dynamic stretching.
Similar to Manual Therapy, Joint Mobilisation (20)
21. Alignment for Advanced Yoga Asana
The advance asanas that are taught during various asana classes throughout the duration of the teacher training are brought up for analytical discussions and practical sessions of methods to adjust advance postures with both verbal cues and hands-on adjustments. Learning revolves around demonstrations, observation and practicums by assisting the lead instructors during some advanced yoga classes. Students will demonstrate observe and assist lead instructors in adjusting in a basic yoga class.
Learning Objective
Be able to identify misalignments of advance postures. Be able to observe student’s capacity during adjustments. Be able to safely and gently adjust advance postures with verbal cues and with hands-on adjustments. To provide adjusting and assisting techniques of yoga asana class.
The Importance of Gratitude in Daily Life.pptxMartaLoveguard
Prezentacja - The Importance of Gratitude in Daily Life
Slide 1: Introduction
Welcome to the presentation on the importance of gratitude in daily life. Today, we'll explore how cultivating gratitude can significantly impact our mental, emotional, and physical well-being.
Slide 2: What is Gratitude?
Gratitude is the practice of acknowledging and appreciating the good things in our lives, big and small. It involves recognizing the positive aspects of our experiences, relationships, and circumstances rather than focusing solely on what's lacking or negative. Cultivating gratitude involves a mindset shift towards abundance and appreciation.
Slide 3: Psychological Benefits
Gratitude plays a crucial role in enhancing mental health by reducing negative emotions such as envy, resentment, and frustration. Research indicates that practicing gratitude promotes more positive emotions like happiness and satisfaction with life. Studies have shown that gratitude can lead to improved overall well-being and a greater sense of fulfillment.
Slide 4: Emotional Resilience
Gratitude fosters emotional resilience by helping individuals cope with stress and adversity more effectively. It encourages a mindset that focuses on solutions and growth rather than dwelling on problems. By finding reasons to be grateful even in challenging times, individuals can develop resilience and maintain a positive outlook.
Slide 5: Social Benefits
Expressing gratitude strengthens relationships by fostering feelings of connection and appreciation. When we show gratitude towards others, it deepens our bonds and encourages reciprocity in kindness and support. Gratitude also enhances empathy and compassion, leading to more meaningful social interactions.
Slide 6: Physical Health Benefits
Gratitude isn't just beneficial for mental and emotional well-being; it also impacts physical health. Research suggests that grateful individuals may experience better sleep, reduced inflammation, and improved immune function. Adopting a grateful mindset can contribute to overall holistic health and well-being.
Slide 7: Cultivating Gratitude
There are practical ways to cultivate gratitude in daily life. Keeping a gratitude journal, where you write down things you're thankful for each day, can help reinforce positive emotions. Additionally, expressing gratitude to others through thank-you notes or verbal appreciation can strengthen relationships and increase overall happiness.
Slide 8: Conclusion
In conclusion, integrating gratitude into our daily routines can lead to profound positive changes in our lives. By focusing on what we are thankful for, we shift our perspective towards abundance and possibilities. Embracing gratitude empowers us to live more fully and joyfully, enhancing both our personal well-being and the quality of our relationships.
Etiologies of Bipolar disorders. Power Point Presentation ptxseri bangash
www.seribangash.com
Bipolar disorder, formerly known as manic-depressive illness, is a complex psychiatric condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). The etiology of bipolar disorder involves a combination of genetic, biological, and environmental factors. Here's a breakdown of these etiologies:
Genetic Factors:
Family History: Bipolar disorder tends to run in families, suggesting a genetic component. Studies indicate that having a close relative with bipolar disorder increases the risk.
Genetic Studies: Research has identified specific genetic variations associated with bipolar disorder. These include genes involved in neurotransmitter signaling, ion channel function, and circadian rhythms.
Neurobiological Factors:
Neurotransmitter Imbalance: Imbalances in neurotransmitters such as dopamine, serotonin, and norepinephrine are implicated in bipolar disorder. For example, elevated dopamine levels during manic episodes and decreased levels during depressive episodes.
Neuroendocrine Factors: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and abnormal cortisol levels have been observed in individuals with bipolar disorder.
Neuroanatomical Factors:
Brain Structure and Function: Structural and functional abnormalities in certain brain regions are linked to bipolar disorder. These include the prefrontal cortex, amygdala, and hippocampus, which are involved in emotional regulation and cognition.
Environmental Factors:
Stress: Stressful life events, such as trauma, loss, or significant life changes, can trigger or exacerbate episodes of bipolar disorder.
Substance Abuse: Substance use, particularly stimulants or drugs that affect neurotransmitter systems, can precipitate manic episodes or worsen the course of the disorder.
Developmental Factors:
Early Life Experiences: Adverse childhood experiences, including abuse, neglect, or chronic stress, may increase susceptibility to developing bipolar disorder later in life.
Trajectories: Some individuals may have a prodromal phase marked by subthreshold symptoms or other behavioral indicators before full-blown episodes manifest.
5 Must-Have’s in ePCR Software for a More PROFITABLE and EFFICIENT EMS, NEM...Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS & NEMT organization, not just certain groups of people or certain departments.
It should benefit EMS crews – making it convenient to enter data and have the tools to increase document accuracy.
It should benefit the back-office by streamlining documentation and billing processes internally and with health facilities.
It should benefit the entire organization by improving workflow efficiency, comply with regulations, reduce costs, and contribute to generating data-driven reports.
To achieve those benefits, ePCR software must have these 5 functions.
📞Call Us 🔼((((8 6 0 7 5 7 5 4 8 3)))🔼 100% Trusted Independent "Call "Girls Service in Kolkata
A nutshell review for Hot "Call "Girls in Kolkata((West Bengal)) . MY experience was superb with them this is the only recommended "Call "Girls service in Kolkata"Call "Girls and again then Russian. so overall my practice was magnificent. The price is also moderate per hour. 0
CHAPTER THREE: MUDRA AND BANDHA
Chapter 3 Verse 1 Kundalini is the support of yoga practices
As the serpent (Sheshnaga) upholds the earth and its mountains and woods, so kundalini is the support of all the yoga practices.
Chapter 3 Verse 2 Guru’s grace and opening of the chakras
Indeed, by guru's grace this sleeping kundalini is awakened, then all the lotuses (chakras) and knots (granthis) are opened.
Chapter 3 Verse 3 Sushumna becomes the path of prana and deceives death
Then indeed, sushumna becomes the pathway of prana, mind is free of all connections and death is averted.
Chapter 3 Verse 4 Names of sushumna
Sushumna, shoonya padavi, brahmarandhra, maha patha, shmashan, shambhavi, madhya marga, are all said to be one and the same.
Chapter 3 Verse 5 Sleeping goddess is awakened by mudra
Therefore, the goddess sleeping at the entrance of Brahma’s door should be constantly aroused with all effort by performing mudra thoroughly.
Attitude and Readiness towards Artificial Intelligence and its Utilisation: A...ShravBanerjee
AI is a hot topic in recent days... We students of IPGME&R, Kolkata, India have done a study on Attitude, Readiness and Utilization of AI by medical students.
Artificial Intelligence (AI): The theory and development of computer systems able to perform tasks normally requiring human intelligence, such as visual perception, speech recognition, decision-making, and translation between languages.
Our study showed that:
1. Nearly half of the study participants showed a favorable attitude towards role of AI in healthcare
2. Around three-fifth of the participants could define basic concepts of data sciences and AI and were ready to choose AI based applications for healthcare; they were willing to accept AI usage despite feeling a lack of cognitive skills
3. Most of them used AI-based applications for studying (ChatGPT), however, some of them faced difficulties in using them
Thank you!
INSULI THERAPY.pptx. All about Insulin, Mode of ation, doses.
Manual Therapy, Joint Mobilisation
1. 11/26/2008
DEFINITION
• Mobilizations: these are passive movements
performed by therapist at a slow speed enough
that the patient can stop the movement.
• Manipulations: these are sudden movements
performed with a high velocity, short amplitude
motion such that the patient cannot prevent the
B.ARUN.,MPT,CMPT,COHS motion.
ORTHOPEDIC PHYSIOTHERAPY
26-11-2008 2
Terminology Terminology
• Mobilization – passive joint movement for
increasing ROM or decreasing pain • Self-Mobilization (Automobilization) –
– Applied to joints & related soft tissues at varying self-stretching techniques that specifically use
speeds & amplitudes using physiologic or accessory joint traction or glides that direct the stretch
motions force to the joint capsule
– Force is light enough that patient’s can stop the
movement • Mobilization with Movement (MWM) –
concurrent application of a sustained
accessory mobilization applied by a clinician
• Manipulation – passive joint movement for & an active physiologic movement to end
increasing joint mobility range applied by the patient
– Applied in a pain-free direction
– Incorporates a sudden, forceful thrust that is beyond
the patient’s control
Terminology Terminology
• Physiologic Movements – movements done • Arthrokinematics – motions of bone surfaces within the
voluntarily joint
– 5 motions - Roll, Slide, Spin, Compression, Distraction
– Osteokinematics – motions of the bones
• Muscle energy – use an active contraction of deep
muscles that attach near the joint & whose line of pull can
• Accessory Movements – movements within the cause the desired accessory motion
joint & surrounding tissues that are necessary for – Clinician stabilizes segment on which the distal aspect of the
normal ROM, but can not be voluntarily performed muscle attaches; command for an isometric contraction of the
muscle is given, which causes the accessory movement of the joint
– Component motions – motions that accompany active
motion, but are not under voluntary control • Thrust – high-velocity, short-amplitude motion that the
• Ex: Upward rotation of scapula & rotation of clavicle that occur patient can not prevent
with shoulder flexion – Performed at end of pathologic limit of the joint (snap adhesions,
stimulate joint receptors)
– Joint play – motions that occur within the joint – Techniques that are beyond the scope of our practice!
• Determined by joint capsule’s laxity
• Can be demonstrated passively, but not performed actively
1
2. 11/26/2008
Joint Surfaces of Ovoid
and Sellar Joints KINEMATICS
• Physiological Movements & Accessory
movements.
• Also called as
• Osteokinematics (Physiological
movements)
• Arthrokinematics. (Accessory movements
26-11-2008 8
Osteokinematics ARTHROKINEMATICS
• Deals about the movement present in the joint • Also termed as Accessory movements
• Helps to find out the amount of Motion • Movements occurs inside the joint.
available in particular joint
• Responsible for improving Physiological
• Can be visualized
movements.
• Can be measured
• Restriction in accessory motion results in
• Also called as Physiological movements
decrease of physiological movements.
26-11-2008 9 26-11-2008 10
Arthrokinematics Roll
• Roll
• Glide / Slide
• Spin
• Compression
• Distraction
26-11-2008 11
2
4. 11/26/2008
Maitland Joint Mobilization
Grades of Movement in a
Grading Scale
Normal and a Restricted Joint • Grading based on amplitude of movement &
where within available ROM the force is applied.
• Grade I
– Small amplitude rhythmic oscillating movement at the
beginning of range of movement
– Manage pain and spasm
• Grade II
– Large amplitude rhythmic oscillating movement within
midrange of movement
– Manage pain and spasm
• Grades I & II – often used before & after treatment
Adapted by permission from G. Maitland 1991.
with grades III & IV
• Grade III
– Large amplitude rhythmic oscillating movement up to OSCILLATION MOBILIZATION
point of limitation (PL) in range of movement
– Used to gain motion within the joint
– Stretches capsule & CT structures
• Grade IV
– Small amplitude rhythmic oscillating movement at very
end range of movement
– Used to gain motion within the joint
• Used when resistance limits movement in absence of pain
• Grade V – (thrust technique) - Manipulation
– Small amplitude, quick thrust at end of range
– Accompanied by popping sound (manipulation) Beginning Pathologic Normal
– Velocity vs. force range of al limit of limit of
– Requires training movement movement movement
26-11-2008 22
Kaltenborn Traction
Grading SUSTAINED MOBILIZATION
• Grade I (loosen)
– Neutralizes pressure in joint without actual surface
separation
– Produce pain relief by reducing compressive forces
• Grade II (tighten or take up slack)
– Separates articulating surfaces, taking up slack or
eliminating play within joint capsule
– Used initially to determine joint sensitivity
• Grade III (stretch)
– Involves stretching of soft tissue surrounding joint
– Increase mobility in hypomobile joint
26-11-2008 24
4
5. 11/26/2008
CONTRAINDICATION
INDICATIONS • Inflammatory arthritis ( RA, AKS)
• Pain • Malignancy
• Muscle spasm • Bone disease
• Decreased ROM • Bone Fracture
• Hypomobile Joints • Vascular disorder
• Reduce Functionally Mobility. • Unskilled manipulator
26-11-2008 25
• Joint effusion 26
• Pregnancy • Rubbery end feel of the CAUSES FOR COMPLICATIONS
• TKR, THR joint.
• Practioner — Related complications
• Closed pack position • Evidence of involvement
of 2 adjacent nerve root
Diagnostic error
• Cauda equina lesion.
• Undiagnosed pain
in lumbar spine Lack of skill
• Lower limb neurological Lack of interprofessional consultation
• Protective muscle
symptoms due to
spasm
cervical or thoracic
• Inability of the patient
dysfunction.
to relax. 27 26-11-2008 28
Patient — Related complications • Patient in whom uncomplicated sciatica
becomes a unilateral radiculopathy with distal
Patient with psychological intolerance of pain.
paralysis of limb, sensory loss.
Patient involved in litigation
• These patients usually doesn’t respond to
Patient recently undergone treatment to any
manipulation & should be considered as
practioners.
surgical emergency.
Patient develop psychological dependence on
manipulation.
26-11-2008 29 26-11-2008 30
5
6. 11/26/2008
JOINT POSITIONS RESISTING POSITION:
• The position in which the joint capsule &
JOINT PLAY
ligaments are relaxed.
• Each joint in the body has positioned to
• Helps in evaluation of the joint
make maximum amount of motion.
• Treatment done for hypomobile joints
• Joint should be positioned in a Relaxed
position. • Placing the joint in resting position allows the
joint to assumes a Loose pack position
26-11-2008 31 26-11-2008 32
TREATMENT PLANES
Closed pack position:
• Direction of movement is either parallel or
• Here maximal contact of articular surface of
Perpendicular to the treatment planes.
bones with capsule & ligaments are tense or
• Joint traction – Perpendicular to the
tight.
treatment plane
• No movement is seen.
• Glides — Parallel to the
treatment planes.
26-11-2008 33 26-11-2008 34
TREATMENT FORCE SPEED
OSCILLATIONS:
• It should be close to the opposing joint surface,
• Grade I & IV are usually rapid oscillations
• Either Gentle or Strong.
• Grades II & III are smooth, regular oscillations at
• Large contact area will be more comfortable than
two or three per second for 1 to 2 minutes.
small surfaces..
• Vary the speed of oscillation for different effects
• Like use of Hand is advised than Thumb for
such as low amplitude and high speed to inhibit
mobilizing larger joint or Surface.
pain or slow speed to relax muscle guarding.
26-11-2008 35 26-11-2008 36
6
7. 11/26/2008
Sustained: LIMITATION
• Painful joints : Apply intermittent distraction 7—10 sec
• Few seconds of Rest in-between. 1. Can’t change the disease process of Disorders.
• If no response Repeat correctly or Discontinue. 2. Like OA,RA manual therapy helps in Reducing
• Resisted Joints : pain & mobilize joints.
• Apply for 6 sec stretch force 3. Skill of therapist affects outcome.
• Followed by partial release
• Repeat with intermittent stretches for 3—4 sec intervals.
37 26-11-2008 38
PRINCIPLES OF MANUAL 5. All pain arise from lesion, so treatment should
THERAPY focus on the lesion.
• The principles are summarize by clinicians such as
6. Constant reassess to determine the effect of the
Grieves, Maitland, Cyriax ect..
technique being used.
1. Remember the contraindications & conditions
7. Progress is governed by the response to previous
require extra care.
treatment.
2. Don’t harm the patient or yourself
8. Discontinue technique that are not productive
3. A through examination is necessary
9. Make the patient to relax, reduce anxiety & fear.
4. Make an accurate diagnosis as possible based on
10.Don’t force the protective muscle spasm.
39 40
solid knowledge of anatomy.
Causes of Limited Range of
11. A slight alteration of joint position or angle of
thrust often allows a technique much more
Motion
effective. • Loss of Extensibility of periarticular connective
12. Warm up patients of the potential for post tissue structures, ligaments, capsule & fascia.
treatment soreness. • Deposition of Fibrofatty infiltrates acting as
13.Don’t over treat. intraarticular “Glue”.
14.Aim for restoration of normal , painless • Adaptive shortening of Muscles.
technique.
• Breakdown of articular cartilages.
41 42
26-11-2008
7
8. 11/26/2008
EFFECTS
Pain & Muscle guarding
• Mobilization showed that it helps in break down of
Muscle shortening and reduce the fibroblastic • Wyke’s explained that Receptors nerve
proliferations inside the joints. endings present in various periarticular
• Forceful passive movements has shown to structures.
rupture of intra-articular adhesion that forms
during immobilization.
26-11-2008 44
26-11-2008 43
• Type I (postural) & Type II (dynamic)
mechanoreceptors are located in joint capsule. • Type IV, (Pain receptors), are found in capsule,
ligaments, Fat pads and Blood vessel walls.
• They have low threshold and excited by repetitive
movements including oscillations. • These receptors are fired by noxious stimuli as
in trauma and have a relatively high threshold.
• Type III mechanoreceptors are found in joint
capsules and extracapsular ligaments. • Type IV are Slow conducting fibers,
• They are excited in stretching & thrust • Type I & II are Fast conducting fibers.
maneuvers.
26-11-2008 45 26-11-2008 46
EFFECT OF MANUAL EFFECTS OF MANUAL
THERAPY THERAPY
PAIN REDUCTION Pain Reduction
• During Oscillatory glides, faster impulses Small amplitude
Stimulate
distraction,
Oscillatory mechanorece
overwhelm the slower impulses. movement ptors
• It helps in closing of gate at spinal level.
• Release of Endorphins from CNS.
Inhibit
Transmission
Melzack R, Torgerson WS: On the language of pain, Anesthesiology, of Nociceptive
stimuli
1971
26-11-2008 48
Wyke B: Articular neurology—a review, physiotherapy, 1958
8
9. 11/26/2008
Small
Amplitude
Muscle Relaxation
Distractions
& Glides
• Type III receptors in joint & golgi tendon organ
Stimulates
Gentle Joint Synovial fire by stretching or thrusting of a joint result in
play helps in Fluid
maintain motion temporary inhibition or relaxation of muscle.
Nutrient
exchange
• This itself cause an increase Range of motion
Brings nutrition
to Avascular and helps prepare the joint for further
Articular
cartilage stretching & mobilization.
Prevent
Painful
Degenerati Paris SV: extremity dysfunction and mobilization . Institute Press, Atlanta
49 1980
on Wyke B: Articular neurology—a review, physiotherapy, 1958
IMPORTANT RULES FOR 3) Protect neighboring hypermobilities. If patient
MOBILIZATION is having shoulder dislocation, following a
Described by Stanley. V. Paris. anterior laxity, mobilization focused on
1. Identify the location and direction of the improving abduction and rotation.
limitation. for e.g Ankle stiffness, posterior glide
4) Communicate with the surgeon, find out which
of talus is restricted.
tissue have been cut or scarified, and what
2. Prepare the soft tissue, (i.e) first reduce the
motions should be avoided initially.
swelling, pain, muscle guarding or tightness.
26-11-2008 51 26-11-2008 52
9