Mobilization for upper extremity (I)

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Mobilization for upper extremity (I)

1. Basic concept pp 119p127
2. Shoulder
3. Pp 165168
4. pp 194214

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Joint mobilization
Joint Stretching
Joint Range of Motion
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General Rules of Mobilization Techniques

• The patient must be relaxed
• The operator must be relaxed
• Body mechanics
• Do not move into or through the point of pain
• The mobilizing force should be
• as close to the operators center of gravity as
  possible
• Directed with gravity assistance, especially when
  treating larger joint

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General Rules of Mobilization Techniques

• Each technique is both an evaluative technique
  and a treatment technique.
• Assessment mobilization
• The resting position (Table 5-3)
• maximal joint traction and joint play
• Actual resting
• Neutral
• Loose-packed position
• Least painful
• Reassessment
• Before, during, and after treatment

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Peripheral jointThe direction of movement during
treatment

• Perpendicular or parallel to the treatment plane
• Fig. 5-3
• Perpendicular traction
• To separate the joint surface
• Parallel gliding

treatment plane A plane perpendicular to a line
running from the axis of rotation to the middle
of the concave articular surface
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Gliding mobilization

• Direct
• in the direction in which the mobility test has
  shown that gliding is actually restricted
• Indirect
• If the mobility test in the desired direction
  produced pain
• Hypomobile joint
• Little movement

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General Rules of Mobilization Techniques

• Treatment force close to the joint surface
• The contact surface
• Large
• Firm
• Finger tips to palpate
• stabilization
• Hand
• External
• Plinth
• The patients body weight
• Belt
• Close to joint space without pain

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General Rules of Mobilization Techniques

• Velocity of movement
• slow stretching for large capsular restriction
• faster oscillation for minor degree of
  restriction
• Amplitude of movement
• graded according to pain, guarding and degree of
  restriction
• Compare accessory joint movement to opposite side
  ( extremity)
• One movement is performed at a time, at one
  joint at a time

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In spinal joints

• In balance
• The occiput is in line with the coccyx
• The direction of mobilization
• Determined by provocation test
• Initially direction in which the pain and
  nociceptive reaction are diminished
• Traction (level I-II)
• to improved pain
• prior to applying the specific mobilization

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Each technique can be used as

• Examination procedure
• slack only to see accessory movement and pain
• Therapeutic procedure
• High-velocity, small-amplitude thrust or graded
  oscillation

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Indications

• Joint dysfunction
• Restriction of accessory joint motion
• Capsuloligamentous tightening
• Internal derangement
• Reflex muscle guarding
• bony blockage

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Contraindication

• Relative
• Joint effusion or inflammation
• Arthrosis ( e.g. degenerative joint disease) if
  acute, or if causing a bony block to movement to
  be restored)
• Rheumatoid arthritis
• Osteoporosis
• internal derangement
• General debilitation ( e.g. influenza, pregnancy,
  chronic disease)

• Absolute
• bacterial infection,
• neoplasm,
• recent fracture

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Grading of movement

• Rate
• Rhythm
• Intensity
• Acute
• Chronic
• According to the response of the patient to the
  technique

• The type of movement performed ultimately depends
  on the immediate effect desired
• Relief of pain
• Muscle guarding
• Stretching a tight joint capsule or ligament

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Manual traction

• Grade I, II
• Pain reduction
• Grade III
• Reduce pain
• Increase periarticular extensibility
• Other forms
• Oscillatory
• Inhibitory
• Progressive
• Adjustive high-velocity thrust
• Position
• Fig. 17-32, 20-45

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Three-dimensional traction (Kaltenborn)

• spine, positioned relative to all three cardinal
  planes (with relative position such as flexion,
  lateral flexion, and rotation)
• ExA painful joint may be positioned in a
  pin-free position

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Systems of Gliding mobilization

• Sustained joint-play (stretch) techniques
• Graded oscillation techniques

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Sustained joint-play (stretch) techniques

• Grade (stage) 13
• Loss of joint play and decreased functional range
• Direct technique
• Move the bony partner
• First available range of motion (resistance is
  felt)
• Then Stretch force against the resistance

• For restricted joints
• A minimum of a 6-second stretch force
• Partial release to grade 1 or 2
• Repeat at 3- to 4-second intervals

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Graded oscillation techniques

• Grade 15
• Recommended for pain or high tone
• Gr 13
• Irregular rhythm to trick muscle
• Usual methods
• Small-or large-amplitude movement at a rate of
  23 seconds within the range
• Combined with sustained stretch as
  small-amplitude oscillations applied at the limit
  of the joint range

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Tips

• To inhibit pain
• Low-amplitude, high speed
• To relax muscle guarding
• Slow speed
• Depends on the patient response
• Grade 1of 2 systems no tension placed on the
  joint capsule or surrounding tissue
• Traction is always the first procedure

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Glenohumeral joint

• Peripheral mobilization

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General techniques for elevation and relaxation
(fig. 9-28)

• Distraction
• in flexion (A)
• With lateral glide (B)
• With Inferior glide (C) in flexion
• Inferior glide
• At side (D)
• With halter (E)
• Progressive long-axis extension moving abduction

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Inferior glide techniques for elevation fig. 9-29

• Resting position (A)
• Moving toward flexion (B)
• In abduction (C)
• About 90º
• Guided by the ease with a relaxed movement
• To increase abduction
• Avoiding impingement
• In more than 90º elevation (D)
• Stretching
• A few degree of elevation are restricted

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Internal rotation (fig. 9-30)

• Posterior glide
• Arm in various degrees of abduction (10 º -55 º)
  (A)
• Arm close to the limits of internal rotation (B)
• Arm close to 90º abduction (C)

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External rotation (fig. 9-31)

• Anterior glide
• Arm at side (A)
• Prone (B)
• Near the limits of external rotation (C)
• Arm close to 90º abduction (D)

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General capsular stretch and techniques for
horizontal adduction (Fig. 9-32)

• Posterior glide or shear (A)
• Lateral glide
• at side (distraction) (B)
• In flexion (C)
• And backward in flexion (D)
• With belt (E)

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Anteroposterior glide for the last few degrees of
elevation (Fig. 9-33)

• Anterior glide
• in supine (A)
• In sitting (B)

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Sternoclavicular joint

• Distraction (fig. 9-34A)
• Superior glide (fig. 9-34B)
• Inferior glide (fig. 9-34C)
• Posterior glide (fig. 9-34D)

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Acromioclavicular joint

• Distraction (fig 9-35A)
• Anteroposterior glide (fig 9-35B)
• Posteroanterior glide (fig 9-35C)
• Clavicle
• Inferior glide

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Scapulothoracic joint

• Distraction of the medial border of the scapula
  (fig 9-37A)
• Distraction or inferior glide of the scapula (fig
  9-37B)
• Scapulothoracic articulations (fig 9-38)
• Medial-lateral glide
• Superior-inferior glide
• rotational and diagonal pattern

• The soft tissue is stretched to obtain normal
  shoulder-girdle motion
• Prone
• Side-lying

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Self-mobilization
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Inferior glide

• Long-axis extension (fig. 9-39)
• Shoulder adduction with distraction (fig. 9-40)
• Glenohuumeral abduction when patient has been
  less than 90º abduction(fig. 9-41A)
• Glenohuumeral abduction when patient has been
  less than 90º abduction (fig. 9-41B)
• Glenohuumeral abduction when patient has been
  less than 90º flexion (fig. 9-42A)
• Glenohuumeral abduction when patient has been
  less than 90º flexion (fig. 9-42B)

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• Anterior glide (fig. 9-43)
• Shoulder extension
• Shoulder internal rotation (fig. 9-44)
• Shoulder external rotation (fig. 9-45)

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Self capsular stretches

• Anterior capsular stretch (fig. 9-46A)
• Inferior capsular stretch (fig. 9-46C)
• Posterior capsular stretch (fig 9-46D)

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Self range of motion - shoulder

• flexion
• Sitting (fig. 9-47)
• Standing (fig. 9-48)
• extension (fig. 9-49)
• abduction
• Sitting (fig. 9-50)
• Standing (fig. 9-51)
• Internal rotation (fig. 9-52)
• External rotation
• Sitting (fig. 9-53)
• Standing (fig. 9-54)