Evaluation of arthrokinematic movement
Arthrokinematic disfunction by scale:
0 - ankylosis
1 - high hypomobility
2 - medium hypomobility
3 - normal movement
4 - medium hypermobility
5 - high hypermobility
6 - total instability
Quality of tissue resistance on end of movement:
softly elastic - muscle
rigid elastic - ligament
rigid clash - bone
abnormal end feeling - appears too early
firmly feeling - periarticular structures
more elastic - muscle tension
feeling of emptiness - without resistance
feeling of fall through - intraarticular resistance
quick limitation of movement without elasticity - bone block
feeling of laxity - hypermobility that routes to laxisity
physiologic - resistance at the end of motion
anatomic - pasive stretch over physiologic barriere
restrictive - limits of normal movement
Maitland Concept - way of gradation of motion
The Maitland Concept of Manipulative Physiotherapy as it became to be known, emphasizes a specific way of thinking, continuous evaluation and assessment and the art of manipulative physiotherapy (“know when, how and which techniques to perform, and adapt these to the individual Patient”) and a total commitment to the patient.
Maitland’s Concepts (often also referred to as the Maitland Technique) involve the application of passive and accessory oscillatory movements to spinal and vertebral joints to treat pain and stiffness of a mechanical nature. The techniques aim to restore motions of spin, glide and roll between joint surfaces and are graded according to their amplitude.
Grade I is a small amplitude movement performed below the range of resistance and is suitable for treating highly irritable conditions. Use of Grade I enables the slack in collagen to be taken up when connective tissue is not under load and can relieve pain by working on neural structures.
A Grade II mobilisation is wider in amplitude but still below resistance. Use of Grade I and II are appropriate when palpation elicits pain before restriction of movement.
Grade III and IV are used when resistance to movement is encountered before pain. A Grade III is a large amplitude movement performed within resistance and generally used to improve range of motion.
Grade IV is a small amplitude movement performed within resistance used for chronic aches of low irritability.
Grade V is a high velocity thrust used in manipulation.
Application of Maitland techniques to the vertebrae is along an anterior-posterior axis or transverse irrespective of the angle of the joint. Peripheral joints are similarly treated with Maitland techniques on planes appropriate to the condition, usually on the plane where there is pain or restriction. These may be anterior- posterior, transverse or longitudinal.
Cyriax concept of gradation
Dr, J.H.Cyriax was the first to study thorougly and systematiclly soft tissue lesions of the locomotor system. Cyriax decided to devote his life to this problem and started by rejecting all the old "non-system" of examination. He relegated palpation to a merely confirmatory role once the correct tissue had been incriminated, and set to work to develop a system of examination based on testing the function of all the components of the soft-tissue moving parts.
Cyriax started with the simple assumption that if a damaged tissue was pulled it would hurt... tension on the structure would give rise to pain, wherever that pain might be felt. If each structure acting on or around a joint could be put under tension independently and in turn, then the structure at fault could be identified. This simple postulate turned out to be extremely effective.
He worked out that some tissues (the contractile tissues, the muscles with their associated tendons, nerve and bony insertion) could be made to apply tension to themselves by a simple strong isometric contraction. The inert structures (joint capsule, ligaments, bursae) would not have been moved during this contraction, but could, by contrast, be put under tension by being stretched passively.
Accurate clinical observation next showed him that when inflammation of a joint was present (synovitis or capsulitis), not only would passive stretching of the capsule be painful but limitation of range was always in a specific pattern; this pattern was always similar for that particular joint, although each joint has a different and instantly recognisable capsular pattern.
Cyriax had three principles for examination by Selective Tissue Tension:
1. Isometric contractions test the function of the contractile tissues.
2. Passive movements test the function of the inert structures.
3. Capsular patterns differentiate between joint conditions and other inert structure lesions.
- passive movement through painless range of motion (commonly its about oscillation motions for acute phases)
- passive movement at the end of amplitude (prolonged elongation with purpose of higher range of motion in chronic phases)
- passive movement at the end of amplitude with extra pressure of minimal amplitude (with purpose to break a small adhesions)