Mobility Exercise

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Mobility Exercise

• David D. Wise, PT, Ph.D.

2
Mobility Continuum

• Hypomobile
• Contracture
• Tightness
• Normal
• Relatively hypomobile
• Normal
• Relatively hypermobile
• Hypermobile
• With muscular control assymptomatic
• Instability

3
Pathological Focus

• Joint hypomobility
• Joint capsule collagen shortness
• Menisci tears and loose bodies
• Intracapsular adhesions
• Apparent (not actual) joint shortness
• Intracapsular swelling
• Muscle guarding

4
Pathological Focus

• Muscle hypomobility
• Tenin
• Loss of sarcomeres in a series
• Collagen shortness in passive elastic component
  (PEC) or series elastic component (SEC)
• Terms referring to muscle shortness
• Common muscle tightness
• Myostatic contracture mod collagen shortness
• Irreversible contracture e.g., Volkmanns
  contracture
• Pseudomyotactic contracture - neurological

5
Pathological Focus

• Abnormal relative flexibility
• Joint or muscle shortness often affects the
  entire kinematic chain in which the hypomobile
  joint resides.
• The hypomobile joint will often cause excessive
  movement in the more freely moveable joints in
  the chain.

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Pathological Focus

• Collagenous Tissue Remodeling (effect of
  immobilization or movement restriction
  deprivation of normal elongation)
• Loss of GAGs separation of collagen fibers
• Serial Length remodeling registers taken off
  the ends. This is done because the fibrocytes
  are signalled that the current length is not
  necessary.

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Pathological Focus

• Secondary problems to Collagenous Tissue
  Remodeling
• Abnormal joint mechanics
• Excessive and poorly distributed compression
• Cross binding at pleats in the joint capsule
  leading to severe restriction.
• Stiff tendon or ligament pulls more sharply at
  periosteal attachment
• Stiff tendon or ligament rubs on periosteum

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Pathological Focus The use of mobility
exercises during inflammation and repair
Breaking Point
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Pathological Focus The use of mobility
exercises during inflammation and repair Acute
Inflammation
Breaking point
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Pathological Focus The use of mobility
exercises during inflammation and repair
Proliferative phase
Breaking point
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Pathological Focus The use of mobility
exercises during inflammation and repair Early
Remodeling
Breaking point
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Pathological Focus The use of mobility
exercises during inflammation and repair Late
Remodeling
Breaking point
13
Pathological Focus

• Other collagenous tissue problems
• Normal (Collagen and GAG ratio normal)
  remodeled short e.g., frozen shoulder
• Scars
• From burns and wounds
• An entire branch of PT
• Adhesions
• Between collagenous tissues - Fascia
• Between collagenous tissues and other types of
  tissue, e.g., nerve

14
Impairment or Clinical Focus

• Units of measure
• Joint ROM
• ROM c muscles slack
• Levels tightness contracture
• Muscle ROM
• ROM of one or several joints in the direction
  opposite all the action of the muscle.
• Levels Tightness Contracture
• SLR, 90o-90o test, Thomas test,

15
Impairment or Clinical Focus

• Nerve excursion or extensibility
• SLR ULTTs
• Tendon gliding or excursion
• Bunnells test

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Functional Focus

• BADLs
• ROM sufficient to do BADL movement S lt -- gtS
  gait, transfers,
• ROM sufficient to do functional postures lying,
  sitting, standing.
• IADLs
• Work
• Sports
• Tightness pt can often accommodate but may
  cause secondary problems or problems over time.
• Contracture pt cant compensate severe
  deficits

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Intensity
SI