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Chapter 3 Notes
Transcript
Therapeutic Kinesiology Instructor Manual: Ch03 p.1
TK INSTRUCTOR MANUAL: CHAPTER 3
Joint Motion
Chapter manuals include:
Objectives
Lecture Notes
Suggested Classroom and Student Development Activities
For other chapter-by-chapter resources, see:
Key Term Quizzes
Muscle Origin and Insertion Worksheets
Muscle OIAs List by Chapter
MyTest Test Bank
For additional resources see “Teaching Tips and Tools”:
7 research-based learning principles for kinesiology courses in massage
5-step self-directed learning cycle for body mechanics courses
Tools that build metacognitive skills: e.g., concept (mind) maps, grading rubrics, and self-assessments inventories
OBJECTIVES
Define a joint and describe its function.
Describe the difference between osteokinematic and arthrokinematic joint motion.
Define and contrast linear, rotary, and curvilinear motion.
Define axial motion and list the axial motions that occur in each plane.
Describe nonaxial motion and list two nonaxial motions and two combined motions.
Define and contrast an open kinetic chain and a closed kinetic chain.
Name and describe three types of movements between the articulating surfaces in a joint.
Explain the convexconcave rule of joint motion.
Explain the difference between a close-packed and loose-packed joint position.
Define range of motion and list four elements that affect it.
Define joint stability and list the passive and active restraints that maintain stability.
Define joint mobility, hypermobility, hypomobility, and instability.
Define active, passive, and resisted joint motion.
Define and contrast sprains and strains.
Name and define three types of normal end-feel to joint motion.
LECTURE NOTES
OSTEOKINEMATICS
Three types of joint movement
Linear (translatory): Motion along straight path
Examples: sliding a box across the floor, effleurage strokes
Rotary (angular): Circular movement around fixed point
Examples: cartwheel, elbow flexion (hand moves in circular path)
Curvilinear: Motion along curved pathway
Examples: belly dancing undulations, petrissage
Axial movements in each plane
Sagittal plane
Flexion
Extension
Hyperextension
Frontal plane
Abduction
Adduction
Lateral flexion
Inversion
Eversion
Horizontal plane
Lateral (external) rotation
Medial (internal) rotation
Right or left rotation of spine
Backward or forward rotation of pelvis
Horizontal flexion and extension (adduction or abduction) of limb
c. Nonaxial movements
Gliding movements in plane joints
Movements of scapula or jaw
Elevation: Lifting scapula up, closing jaw
Depression: Pressing scapula down, opening jaw
Protraction: Moving scapula or jaw forward
Retraction: Pulling scapula or jaw back
Combined and miscellaneous movements
Circumduction:
Inscribes a cone
Combination of flexion, extension, rotation
Supination: Motion that turns palm up
Pronation: Motion that turns palm down
Upward and downward rotation: Motion that turns the scapula
Activities of daily living (ADLs) (e.g., bending and lifting)
Types of kinetic chains
Closed kinetic chain
Terminal end of limb in contact with surface
Example: stance leg
Open kinetic chain
Terminal end of limb freely moving in space
Example: swing leg
Obvious in difference between push and reach
Either compressional or tensional forces involved
ARTHROKINEMATICS
Movement at joint surfaces, three kinds
Roll
Glide
Spin
Concaveconvex rule
When a bone with the convex joint surface moves, the joint surface always moves in the opposite direction as the bone
When a bone with the concave joint surface moves, the joint surface moves in the same direction as the bone
Joint congruency
When shape of articulating surfaces match
Ball-and-socket joints are the most congruent
Joint incongruency
Common because articulating surfaces rarely match
A typical synovial joint is incongruent
Close-packed position
Articulating surfaces reach maximum compression
Supporting ligaments become taut
Joint is maximally stable
Loose-packed position
Articulating surfaces have minimal contact
Supporting ligaments become slack
Joint is least stable
Optimal resting position of joints
RANGE OF MOTION (ROM)
The number of degrees a joint can move
ROM is affected by
Shape of articulating surfaces
Elasticity of joint tissues
Tone, strength, tightness of muscles acting on joint
Injuries, neurological damage, or pain
Stability
The joint's ability to resist displacement
Joints are stabilized by
Passive restraints: ligaments, joint capsule, fascia
Active restraints: muscles and tendons
Mobility
The joint's ROM without restriction
A measure of flexibility
Active and passive range of motion
Active range of motion (AROM)
Range one can actively move a joint
Defines a joint's physiological movement
Passive range of motion (PROM)
Range a joint can be moved by another person
Somewhat greater than AROM due to muscular relaxation
Joint play
The accessory motion of a joint
Range a joint can be passively, not actively, moved
Example: rotation in fingers and toes
Hypomobility: Restriction to joint mobility
Can be caused by chronic contractions, damage to joint structures, or neurological damage
Hypermobility: Excessive joint motion
Differs from instability
Instability: Inability to control excessive joint play
Usually caused by lax joint structures
Person can still control hyperflexible range
Example: a hypermobile gymnast can control joint motion within a hypermobile range
Joint injuries
Hypermobile joints are susceptible to injuries
Joint injuries can make hypermobile joints unstable
Two types of soft tissue injuries
Sprain: Injuries to noncontractile tissues
Strain: Injuries to muscles or tendons
CLINICAL APPLICATIONS FOR JOINT MOVEMENT
Active movement
Reorganizes firing patterns
Improves overall efficiency and NM coordination
Used in assessments (covered in NM chapter)
Used in muscle energy techniques (covered in NM chapter)
Clinical applications for passive movement
To increase range of motion
To stretch soft tissues around joints
To trigger relaxation response in associated muscles
To alleviate pain by reducing hypersensitivity to stretching
To improve lubrication of joint surfaces
To improve client’s awareness of motion patterns
End-feels: What restricts joint motion at end range
Three types of normal end-feel
Bony (hard)
Occurs when bone meets bone
In only two joint actions: elbow flexion, teeth occlusion
Firm (capsular)
Joint capsule and ligaments reach elastic limits
Most synovial joints have capsular end-feels
Soft
Tissue meeting tissue prevents further motion
In only three joint actions: elbow, hip, or knee flexion
Abnormal end-feels
Boggy
Mushy, spongy quality
Usually from excess joint fluid or swelling
Hard
Has abrupt stop short of normal end range
Caused by abnormal growth or bony restriction
Lax
Lacks an increase in tension
Caused by range of motion beyond normal
Empty or spasm
Muscular guarding prevents motion
Caused by pain during joint movement
Fibrotic end
Rapid buildup of tension
Caused by scarring that restricts range of motion
Resisted range of motion
Technique to elicit contraction of specific muscles
Client moves against practitioner's resistance
Used in
Assessments
Muscle activation (facilitation)
Neuromuscular patterning
Muscle energy techniques
Joint mobilization
Technique to increase ROM in restricted joint
Used for
Restoring normal ROM
Relieving pain from restriction
Loosening and stretching stiff joint structures
Recovery from injury
Joint articulation
Technique to improve quality of joint motion
Involves slow, specific motion
Can be active or passive
SUGGESTED CLASSROOM AND STUDENT DEVELOPMENT ACTIVITIES
PROVIDE AN OVERVIEW OF CLASS.
Before class, write a short, schematic overview of the class on the board, then go over it at the beginning of class. For example:
Today's class covers:
Joint motion
Movement at joint surfaces
Range of motion
Clinical applications
Activities: Review, lecture and learning activities, recap, and homework
REVIEWING GUIDELINES EXERCISES
Naming joint actions (p. 55)
Steps in passive range of motion stretching (p. 65)
Contraindications to practicing passive joint motion with clients (p. 65)
EXPLORING TECHNIQUE EXERCISES
Exploring roll, glide, and spin in joint motion (p. 58)
Placing your client’s joints in a loose, resting position (p. 60)
JOINT MOVEMENT AND BODY AWARENESS EXERCISES
Have students break into three groups. Assign one plane to each group, then have the groups come up with a routine moving every major joint in that plane (hips, knees, ankles, shoulders, elbows, wrists, and spine). The movements can be rhythmic, for example, marching in the sagittal plane. Students need to show the movement cycle of each joint from neutral through outer range, midrange, inner range several times.
If the students are having difficulty, provide them with examples of natural movements in each plane with words prompts such as:
Sagittal: Wheel rolling, crouch and pounce
Horizontal: Lasso, stirring, turning on a merry-go-round
Frontal: Bending sideways, facing, cartwheels
After students spend 510 minutes working in small groups, have each group pick a representative to present the movements in their plane. Use their presentation as a class review of the movement in each plane.
SYNOVIAL JOINT NAMES AND TYPES
Name of joint Type of joint
Acromioclavicular (AC) Gliding
Atlantoaxial (AA) Gliding
Atlanto-occipital (AO) Ellipsoid
Carpometacarpal (CMC) Gliding
Coxofemoral Ball-and-socket
First metacarpal carpal Saddle
Glenohumeral (GH) Ball-and-socket
Humeroradial Gliding
Humeroulnar (elbow) Hinge
Intercarpal (IC) Gliding
Interphalangeal (IP) Hinge
Intertarsal (IT) Gliding
Metacarpophalangeal (MCP) Ellipsoid
Metatarsophalangeal (MTP) Ellipsoid
Radiocarpal Ellipsoid
Radioulnar (distal) Gliding
Radioulnar (proximal) Pivot
Scapulothoracic False joint
Sternoclavicular (SC) Gliding/ball-and-socket
Subtalar Ellipsoid
Talocrural (true ankle) Hinge
Temporomandibular (TMJ) Gliding/ball-and-socket
TK JOINT RANGE OF MOTION CHARTS
Table not in book: Range of Motion in the Toes
Range of motion Degrees of motion End-feel
MTPs flexion 35 degrees Firm
MTPs hyperextension 45 degrees Firm
IPs flexion Dips: 60 degrees, PIPs: 35 degrees Firm
Table 11.2 Range of Motion in the Ankle
Range of motion Degrees of motion End-feel
Dorsiflexion 20 degrees Firm
Plantarflexion 45 degrees Firm
Inversion 45 degrees Firm
Eversion 20 degrees Firm
Table 12.1 Range of Motion in the Knee
Knee motion Range of motion End-feel
Flexion 140 degrees with hip flexion
120 degrees with hip extension
160 degrees with passive flexion Soft
Extension 5 degrees Firm
Lateral rotation 40 degrees only with knee flexion Firm
Medial rotation 30 degrees only with knee flexion Firm
Table 13.1 Range of Motion in the Hip
Hip motion Range of motion End-feel
Flexion 125 degrees with knee extension
140 degrees with knee flexion Soft
Hyperextension 1015 degrees Firm
Abduction 45 degrees Firm
Adduction 10 degrees Firm
Lateral rotation 45 degrees Firm
Medial rotation 45 degrees Firm
Table 14.1 Range of Motion in the Spine
Spinal motion Cervical Spine Thoracic Spine Lumbar spine Total range
Flexion 4060 degrees 3040 degrees 50 degrees 120150 degrees
Hyperextension 4075 degrees 2025 degrees 15 degrees 75115 degrees
Lateral flexion 45 degrees 30 degrees 20 degrees 95 degrees
Rotation 5080 degrees 30 degrees 5 degrees 85115 degrees
Table 15.1 Range of Motion in the Cervical Spine
Cervical motion Range of motion End-feel
Flexion 4060 degrees Firm
Hyperextension 4075 degrees Firm
Lateral flexion 45 degrees to each side Firm
Rotation 5080 degrees to each side Firm
Table 16.1 Range of Motion in the Shoulder
Shoulder motion Range of motion End-feel
Flexion 180 degrees Firm
Hyperextension 45 degrees Firm
Abduction 180 degrees Firm
Adduction 10 degrees Firm
Lateral rotation 45 degrees Firm
Medial rotation 45 degrees Firm
Table 17.1 Range of Motion in the Wrist
Wrist motion Range of motion End-feel
Flexion 80 degrees Firm
Hyperextension 70 degrees Firm
Ulnar deviation (abduction) 45 degrees Firm
Radial deviation (adduction) 20 degrees Firm
© 2013 by Education, Inc. Foster, Instructor Resources for Therapeutic Kinesiology
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