관절가동의 원리(joint mobilization)

관절가동법을 잘 알면 관절강직이 일어난 관절 통증감소, rom증진에 효과적이다. deep mechanoreceptor 4가지의 관점에서 관절가동의 시간, 강도, 횟수를 정하면 짱 <a href='javascript:fileFilterViewer("http://cfile251.uf.daum.net/attach/1271884B4EC5FAFF325EC0", "/cfile251/12/71884B4EC5FAFF325EC0", "principle of Joint mobilization.pdf", "grpid%3Dz4ZG%26fldid%3DOU8N%26dataid%3D77%26fileid%3D3%26regdt%3D20111118154531&url=http%3A%2F%2Fcfile251.uf.daum.net%2Fattach%2F1271884B4EC5FAFF325EC0")'><img src="https://t1.daumcdn.net/daumtop_deco/icon/icon.hanmail.net/editor/p_pdf_s.gif" border="0" alt="첨부파일" class="vam"/> principle of Joint mobilization.pdf</a> <a href='javascript:fileFilterViewer("http://cfile287.uf.daum.net/attach/1713D24B4EC5FB080395D8", "/cfile287/17/13D24B4EC5FB080395D8", "Joint Mobilization.ppt", "grpid%3Dz4ZG%26fldid%3DOU8N%26dataid%3D77%26fileid%3D4%26regdt%3D20111118154531&url=http%3A%2F%2Fcfile287.uf.daum.net%2Fattach%2F1713D24B4EC5FB080395D8")'><img src="https://t1.daumcdn.net/daumtop_deco/icon/icon.hanmail.net/editor/p_ppt_s.gif" border="0" alt="첨부파일" class="vam"/> Joint Mobilization.ppt</a> 1. MOBILIZATION 관절 가동법 - Definition: 관절가동의 정의- passive by the therapist 치료사에 의해 수동적인 관절 움직임. - slow - patient can stop the movement 천천히 관절 움직임을 지속- oscillatory or sustained 진동을 주는 방법과 지속적으로 관절가동을 하는 방법- aimed at decreasing pain and/or increasing mobility 관절가동의 목적은 통증을 줄이고 관절가동성을 증진하는 것 2. MANIPULATION- Definition:- high velocity, low amplitude thrust (non-oscillatory) performed by the therapist - 빠른 속도, 작은 진폭의 쓰러스트 3. ACCESSORY AND PHYSIOLOGICAL MOVEMENTS- Physiologic movements - can be done actively by patient or passively by therapist.- 생리적 움직임 - 환자 스스로 능동적으로 움직이는 것 또는 치료사에의해 수동적으로 움직이는 것 <img src="https://t1.daumcdn.net/cfile/cafe/1415784D4EC5FBAE49" class="txc-image" actualwidth="891" hspace="1" vspace="1" border="0" width="891" style="clear:none;float:none;" id="A_1415784D4EC5FBAE4914FD"/> PRINCIPLE OF JOINT MOBILIZATIONS (Tomberlin & Saunders, 1995; Hertling & Kessler, 1996) 1. Place joint in resting position 1) Closed pack position 관절이 닫힌 상태   - maximal congruency & compression of the articular surfaces 관절면의 최대 닫힘과 압박상태   - the ligaments and capsule are taut - 인대와 관절낭이 팽팽함.   2) <a href="http://cafe.daum.net/panicbird/QzIa/59" target="_blank" class="tx-link">Loose pack position 열린 관절상태</a>   - Any position that is not close packed. 2. Determine treatment plane: Draw a line over the articular surface of the concave joint partner. When the concave surface is moving the treatment plane moves but when the convex surface is moving the treatment plane remains the same.- Gliding - Move the joint surface parallel to the treatment plane.- Traction and compression - Move the joint surface perpendicular to the treatment plane. - 치료관절면의 결정 : 오목관절의 상대관절면의 선을 그음. 오목면이 치료면을 움직일때.. 하지만 볼록면이 움직일때... - 활주 - 관절면이 치료면에 따라서 움직임- 견인과 압박 - 관절면이 치료면과 수직으로 움직임... 3. Determine direction of mobilization using concave/convex rule.- 볼록/오목 규칙을 이용하여 관절가동의 방향을 결정 4. Patient and body part well supported- 환자와 인체부분이 잘 지지되어야 5. Patient and therapist relaxed- 환자와 치료사는 모두 이완되어야 6. Mobilizing force should be close to therapist’s center of gravity- 가동힘은 반드시 치료사의 중력중심에 가까워야 함... 7. Compare involved extremity to uninvolved. 8. Check one joint at a time, one movement at a time- 움직임 시간을 결정 9. Stabilize one bone and mobilize the other.   - Usually stabilize proximal bone. Contact should not bepainful. 10. Therapist’s hands should be as close to joint surfaces as possible. 11. When possible work with force of gravity rather than against it. 12. Stop the mobilization test or treatment if too painful. 13. Initial mobs are in the loose pack position. 14. Treat deficiencies in joint play before attempting to treat component motions. 15. Assess before and after treatment. INDICATIONS FOR JOINT MOBILIZATIONS1. Pain2. Subluxation or Dislocation3. Joint Hypomobility - majority of the time treating a capsular pattern <img src="https://t1.daumcdn.net/cfile/cafe/1510193C4EC5FEBC13" class="txc-image" actualwidth="859" hspace="1" vspace="1" border="0" width="859" style="clear:none;float:none;" id="A_1510193C4EC5FEBC13F156"/> PROPOSED EFFECTS OF JOINT MOBILIZATIONS • Pain relief - Stimulation of mechanoreceptors causing increased proprioceptive input to the spinal cord, therebyinhibiting transmission of pain impulses to the anterior horn cells and higher centers.• Increase extensibility of joint capsule. 􀂾 Breaking adhesions 􀂾 Stretching the capsule 􀂾 Disrupt abnormal cross-linking 􀂾 Elastic vs. Plastic deformation• Can morphological changes occur in the short time that joint mobilizations are applied?