Therapeutic Kinesiology:Musculoskeletal Systems, Palpation, and Body Mechanics

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