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What type of thrust is a joint mobilization?
non-thrust
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What is the purpose of a joint mobilization?
passive procedure meant to restore normal joint play and reduce pain
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What is joint play?
straight lined (rectilinear), passive bone movements
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What are three types of joint play and what direction do they all need to be to the treatment plane?
- traction: perpendicular and away
- compression: perpendicular and toward
- gliding: parrallel
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What is a major indication for joint mobilization?
reverse hypomobility
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What happens if exercise and muscle stretching occurs prior to restoration of normal joint play?
articular surfaces are compressed further damaging the articular cartilage
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What are 2 methods to determine decreased joint play and their differences?
- direct method: physically feel joint in all directions
- indirect method: done through observation
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Why can't a person be physically examed if they are using the indirect method to determine joint play?
- severe pain
- little movement (symphysis)
- hypermobile
- examiner doesn't have the expertise to do so
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What is more important rolling or gliding?
gliding
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How do you grade joint play? (general)
- hypomobile (0-2)
- normal (3)
- hypermobile (4-6)
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What is the maximum loose packed position?
- maximum slack
- joint play is at the greatest
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What is the actual resting position?
similar to loose packed, but the position the patient adopts
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What is the closed packed position?
- maximum tension between joint capsule and muscle
- maximal congruency between 2 articular surfaces
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What position do you perform joint mobilizations in?
loose packed preferably, but if you can't then actual resting position gradually moving to loose packed position
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Where does the treatment plane lie?
with the concave joint partner whether it is movable or fixed
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What direction does rolling occur in?
always in the direction of the bone movement
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What occurs when CONCAVE moves on CONVEX, how do you mobilize?
- roll and glide in SAME direction
- mobilize in same direction
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What occurs when CONVEX moves on CONCAVE, how do you mobilize?
- roll and glide in opposite direction
- mobilize in direction of glide
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What are the Kaltenborn grades for Traction?
- grade I: nullify compressive forces
- grade II: take up slack
- grade III: stretch capsule
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What are the Kaltenborn grades for gliding?
- grade II: take up slack
- grade III: stretch
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What are grades I and II used for in traction?
treatment of pain
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What is grade III used for in traction?
treatment of capsular restriction
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What is three dimensional traction?
- can be very dangerous but effective
- and that's all i know...
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What are the grades for traction and gliding for Maitland oscillations?
- grade I: 0-25% (small oscillations)
- grade II: 0-50% (large oscillations)
- grade III: 50-100% (large oscillations)
- grade IV: 75-100% (small oscillations)
- grade V: high velocity thrust
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What are Maitlands Rules for oscillations?
- 2-3 per second for 2 minutes
- repeat 2-3 times
- treat pain then stiffness
- treat in loose/pain free position, moving to stiff/painful position
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What the two different "hands" of the PT when treating according to Kaltenborn?
- fixating hand: fixates one jt partner
- mobilizing hand: placed as close to jt as possible
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How do you treat pain according to Kaltenborn?
- with traction or oscillation
- 10 second intervals
- grades 1 or 2
- the goal here is NOT to stretch structures
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How do you treat hypomobility according to Kaltenborn?
- traction or gliding held for minimum of 5-7 seconds
- longer periods up to a minute better
- grade 1 traction should always be maintained during joint mobilization
- (15-18 seconds, 3-4 times?)
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What are some conditions that cause shortening of soft tissues?
- prolonged immobilization
- restricted mobility
- connective tissue or neuromuscular disease
- tissue pathology from trauma
- bony deformities
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What are you stretching, while stretching?
- contractile tissue
- non-contractile
- adhesions
- epimysium
- endomysium
- sacrolema
- muscle fiber
- origin and insertion
- nerve
- associated tendons
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What is the purpose of stretching?
- increase ROM to normal limits
- decrease pain
- increase strength
- improve function
- reduce injury
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Describe the load/stress- relaxation curve
- the length of muscle is held constant
- (i don't know how to explain this)
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Describe the idea of creep:
- load is held constant (keep moving into it)
- 15-18 seconds is when max deformation can occur
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What is the optimal number of passive stretch repititions?
4 (up to 80%)- much more than that deformation doesn't change
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What are some little facts about stretching from literature?
- no warm up required
- 4-6 reps optimal
- hold 15-18 seconds
- no signifcant difference from doing it 1 or 3 times a day
- retain gains for 2-4 weeks
- to maintain- stretch 1 time a week
- acute lasting effects lasts 24 hours
- effect on injury is inconclusive
- static stretching most researched
- 35% compliance
- intensity/force is very subjective
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What should be done before stretching?
- assess all joints the muscle crosses
- check muscle length
- check end feel
- stretch across larger more stable joints instead of smaller
- inform and instruct patient
- choose best method for you and pt
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What are different stretching techniques?
- static stretching
- hold relax
- hold relax- agonist contract
- agonist contract
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What do you do to stretch?
- preposition for protection
- elicit contraction or static stretch
- hold 15-30 seconds (avoid compression with grade 1)
- repeat 3-4 times
- stimulate antagonists
- gradual releast
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Who controls the direction, intensity, velocity, and duration in static stretching?
the therapist
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What do you do in hold relax?
- place involved muscle in lengthened position
- isometrically contract for 10 seconds
- patient relaxes
- lengthen passively and hold
- repeat 4-6 times
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What do you do in hold relax- agonist contract?
- place involved muscle in lengthened position
- isometrically contract for 10 seconds
- then contract muscle opposite the tight muscle
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What do you do in agonist contract?
- patient does everything- dynamically contracting the agonist (muscle opposite tight muscle)
- produces reciprocal inhibition
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What is the order of procedures?
mobilize --> stretch --> exercise --> functional exercise
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Why do you do exercises after stretching?
you have to show the body how to use this newly aquired motion from stretching
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What are acute effects of stretching?
active inhibition works well
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What are chronic effects of stretching?
low prolonged load techniques work well
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What are precautions to stretching?
- recent fracture
- recent soft tissue repair
- osteoporosis
- prolonged immobiliation
- pain greater than 24 hours post stretch
- edematous joints and tissue
- joint position sense or deep pressure dysfunction
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What are contraindications to stretching?
- bone block
- fracture or non-union
- acute inflammation or infection
- sharp pain
- hematoma
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