-
Passive joint mobs speed
- - they are done within the control of the pt- can be prevented by the pt
- - gentle oscillatory movements applied anywhere in range or sustained end-range stretches
- Grade 1-4
-
What are paasive mobs beneficial?
- - restricted passive jt for stiffness eg hypomobilt- restore ROM
- - pain reproduced on passive jt movement
- - pt collaboartion in decision making (edu and obtain consent)
- - used torelieve pain or ROM
-
Treatment
- 1. examine pt * = worse pain and what u reasess
- 2. treat tech
- 3. reasses = sub and obj thing. Reassess signs and symptoms
-
THings you need to consider when treating
- - progression of the disorder
- - stage of disorder
- - degree of stability of the disorder
- - degre of stability
- - irritability of the disorder
-
Dosage for non- irritable pt
- - select grade into R and possible P (treat R)
- - 2-5 reps (guided by reassessment)
- - long reps 30-60 sec
- - may perform into provocative position or direction
- - more rapid rhythm: 2-3 oscillation per sec
- - treat 2-3 times a week
-
Dosages of a highly irritable
- - treating pain. Want to touch pain not go into it
- - grade short of R1
- - 1-2 reps
- -short reps 20-30 sec
- - may select tech to ease resting pain ie easing postion or direction eg traction
- - slow, smooth rhythm: 1/2 - 1 oscil per sec
- - treated daily or 3x/ week
-
Things you need to consider when selecting treatment
- - impairment of nerve conduction
- - know pathology or syndrome (PF syndrome)
- - stretch or compressive component
- - movement impairment evident.. CJS- found in assessment movt impairment that is what you will use in treatment
-
Comparable jt sign (CJS)
- - passive movement which reproduces pts pain and is restricted in range
- - want this to corresponf with history ie function and with other physical examinations ie active movemets
- - consider the movement diagram in selecting the grade
-
Grades of movement
- 1- small amplitude movement at beginning of range rage
- 2- large amplitude within resitance- free range
- 3- large ampl movement into resistance and end range
- $- small amp movement into resistance and to end range
-
Treatement selection considerations
- - effects of past treatment
- - unilater vs central pain in the spine
- - biomechanics and coupling of movemnts
- - precautions and contraindications
-
Precautions for mobs
- - hypermobile
- -undaignosed pain (mechanical) eg weight loss
- - psychogenic pain
- - provocation of severe pain
- - protective spasm (dont push thru)
- - anticoagulant medication (bruisin)
- - post spinal surgery eg fusion dont treat in the first 6 weeks
- - VBI rare
- - radiological changes
- - neurological changes- decreased conduction
-
ontraindications of mobs- likely harms
- - neoplastic disease (malig or benign)
- - inflam disease (RA, ank spond) in anflam stage
- - infective conditions (eg osteomyelitis)
- - bone disease and fractures (eg OP)
- - jt instability (aim to stabilise)
- - cord or cauda equina lesions
- weakened tissues may be disrupted with PJM. Be aware of non-mechanical and constitutional symptoms
-
Treatment selections; Considerations
- - research evidence
- - past clinical experience
- - ease and control of performance
- - reassessment after physical examination
-
Reassessment: AIMS
- - to establish appropriateness of RX
- - to confirm source of symptoms
- - to determine when RX needs to be progressed
- - to demonstrate to patient an improvement in their condition (assists complance)
- - to enhance learning/ reasoning
-
When do you reassess?
- - after key physical examination components (PAIVMS)
- - whilst performing technique
- - following first Rx repetition
- - following completeion of technique
- - on presentation day 2 better?
-
Treatment progression
- SAME: cosider further Ax or increase grade/ reps or add home exercise or add technique
- Better: repeat Rx
- Worse: derease grade/ reps or discard tech (still good news source is comfirmed
-
Treatment progression
- - if non- irritable add tech rapidly eg 2-4 tech concurrently
- - if irritable better change technique 1-2
- - only make one Rx change per session as effects may be delayed ( also enhance learning) you dont know what is making them better/ worse
- One tech on the first day
-
Cerival unilateral pain / stiffness treatment options
- Rotation (rotate head away from side of pain: opening)
- PA unilat pressure(on side of pain: closing) no neuro or referred P
- Transverse (push towards side of pain: opening) (low C/S) make sure arms are para to ground
- Lateral flexion (Flex away from side of pain: opening )
-
Cervical bilateral pain treatmetn options
- PA central pressure(not if severe symptoms)
- Traction ( if any neurological symptoms, severe arm pain) (low cerv spine: in flexion)
-
Lumbar spine unilateral pian/ stiff treatment options
- Rotation (pain side up and rotate pelvis forward)
- PA unilateral (on side of pain) – normal back pain not highly irritable
- Transverse (push towards side of pain)(upper L/S)
-
Lumbar spine bilateral pain treatment
- PA central pressure
- Traction- referred pain
|
|
