Exmod PJM

• Joint mobilization, also known as manipulation, refers to manual therapy techniques that are used to modulate pain and treat joint impairments that limit range of motion (ROM) by specifically addressing the altered mechanics of the joint
• The altered joint mechanics may be due to pain and muscle guarding, joint effusion, contractures or adhesions in the joint capsules or supporting ligaments, or aberrant joint motion
• Joint mobilization stretching techniques specifically address restricted capsular tissue by replicating normal joint mechanics while minimizing abnormal compressive stresses on the articular cartilage in the joint
• True or False: Manipulation has a less aggressive connotation than mobilization (False)
• High-velocity thrust techniques, typically called manipulation
• True or False: When indicated, joint manipulative techniques are safe, effective means of restoring or maintaining joint play and can also be used for treating pain. (True)
• Mobilization and manipulation are two terms that have come to have the same meaning, and are, therefore, interchangeable
• Passive, skilled manual therapy techniques applied to joints and related soft tissues at varying speeds and amplitudes using physiological or accessory motions for therapeutic purposes (Mobilization/Manipulation)
• The varying speeds and amplitudes can range from a small-amplitude force applied at fast velocity to a large-amplitude force applied at slow velocity that is, there is a continuum of intensities and speeds at which the technique could be applied
• High-velocity, short-amplitude techniques performed at the end of the pathological limit of the joint and is intended to alter positional relationships, snap adhesions, or stimulate joint receptors (Thrust manipulation/high-velocity thrust)
• Pathological limit means the end of the available ROM when there is restriction
• Self-stretching techniques that specifically use joint traction or glides that direct the stretch force to the joint capsule (Self-Mobilization)
• Self-Mobilization is also known as Auto-Mobilization
• Concurrent application of sustained accessory mobilization applied by a therapist and an active physiological movement to end-range applied by the patient (Mobilization with Movement)
• MWM techniques are always applied in a pain-free direction and are described as correcting joint tracking from a positional fault.
• Movements the patient can do voluntarily (e.g., the classic or traditional movements, such as flexion, abduction, and rotation). The term osteokinematics is used when these motions of the bones are described (Physiological Movements)
• Procedure used to restore full ROM by breaking adhesions around a joint while the patient is anesthetized (Manipulation Under Anesthesia)
• MUA technique may be a rapid thrust or a passive stretch using physiological or accessory movements
• Use active contraction of deep muscles that attach near the joint and whose line of pull can cause the desired accessory motion (Muscle Energy)
• ME technique requires the therapist to provide stabilization to the segment on which the distal aspect of the muscle attaches
• Movements in the joint and surrounding tissues that are necessary for normal ROM but that cannot be actively performed by the patient; terms that relate to accessory movements are component motions and joint play (Accessory Movements)
• Motions that accompany active motion but are not under voluntary control; often used synonymously with accessory movement (Component motions)
• Motions that occur between the joint surfaces and also the distensibility or “give” in the joint capsule, which allows the bones to move; Tthe term arthrokinematics is used when these motions of the bone surfaces within the joint are described (Joint Play)
• In JP, movements are necessary for normal joint functioning through the ROM and can be demonstrated passively, but they cannot be performed actively by the patient
• In ovoid joints one surface is convex, and the other is concave
• In sellar (saddle) joints, one surface is concave in one direction and convex in the other, with the opposing surface convex and concave
• The movement of the bony lever is called swing and is classically described as flexion, extension, abduction, adduction, and rotation
• Motion of the bone surfaces in the joint is a variable combination of rolling and sliding, or spinning
• Roll/Slide/Spin: The surfaces are incongruent (Roll)
• Roll/Slide/Spin: There is rotation of a segment about a stationary mechanical axis (Spin)
• Roll/Slide/Spin: the surfaces must be congruent, either flat or curved (Slide)
• Roll/Slide/Spin: The same point on one surface comes into contact with the new points on the opposing surface (Slide)
• Roll/Slide/Spin: The same point on the moving surface creates an arc of a circle as the bone spins (Spin)
• Roll/Slide/Spin: New points on one surface meet new points on the opposing surface (Roll)
• Roll/Slide/Spin: results in angular motion of the bone (Roll)
• Roll/Slide/Spin: always in the same direction as the swinging bone motion whether the surface is convex or concave (Roll)
• Rolling, if it occurs alone, causes compression of the surfaces on the side to which the bone is swinging and separation on the other side
• In normally functioning joints, pure rolling does not occur alone but in combination with joint sliding and spinning
• Pure sliding does not occur in joints, because the surfaces are not completely congruent
• The direction in which sliding occurs depends on whether the moving surface is concave or convex