스크랩 Joint Mobilization - 관절면 사이의 움직임

[체형연구소장]

Mechanisms of action

The different grades of mobilization are believed to produce selective activation of different mechanoreceptors in the joint:How Manipulation WorksPDF.

• Grade I - Activates Type I mechanoreceptors with a low threshold and which respond to very small increments of tension.

Activates cutaneous mechanoreceptors.

Oscillatory motion will selectively activate the dynamic, rapidly adapting receptors, ie. Meissner's and Pacinian Corpuscles . The former respond to the rate of skin indentation and the latter respond to the acceleration and retraction of that indentation.

• Grade II - Similar effect as Grade I.

By virtue of the large amplitude movement it will affect Type II mechanoreceptors to a greater extent.

• Grade III - Similar to Grade II.

Selectively activates more of the muscle and joint mechanoreceptors as it goes into resistance, and less of the cutaneous ones as the slack of the subcutaneous tissues is taken up.

• Grade IV - Similar to Grade III.

With its more sustained movement at the end of range will activate the static, slow adapting, Type I mechanoreceptors, whose resting discharge rises in proportion to the degree of change in joint capsule tension.

• Grade V - This is the same as joint manipulation. Use of the term 'Grade V' is only valid if the joint is positioned near to its end range of motion during joint manipulation. Evans and Breen^[2] recently contested this assumption, in fact arguing that an individual synovial joint should be positioned near to its resting, neutral position.

관절면 사이에는 3가지의 기본적인 움직임

구름(Roll) - 회전하고 있는 관절면의 여러 점들은 이와 마주보고 있는 다른 관절명의 여러 점들과 만난다.

미끄러짐(Slide) - 한 관절면에 있는 한 점은 이와 마주보고 있는 다른 관절면에 있는 여러 점들과 만난다.

축돌림(Spin) - 한 관절면에 있는 한 점은 이와 마주보고 있는 다른 관절며에 있는 한 점과 만난다.

 

움직임의 관절운동형상학적 원리들

1.오목면에 대한 볼록면의 움직임 동안 볼록면의 구름과 미끄러짐은 서로 반대방향이다.

2.볼록면에 대한 오목면의 움직임 동안 오목면의 구름과 미끄러짐은 서로 같은 방향이다.

Arthrokinematics (contrasted with osteokinematics)

• Osteokinematics
  gross movements of bones at joints
  • flexion / extension
  • abduction / adduction
  • internal rotation / external rotation
• Arthrokinematics
  small amplitude motions of bones at joint surface
  • roll
  • glide (or slide)
  • spin

We use OSTEOKINEMATIC terms, such as abduction or adduction, flexion or extension, to name the movements that occur between bones at synovial joints. These terms describe the movements that occur around a center of rotation, namely the joint axis.

We speak as if this joint axis is a fixed point, as if the center of rotation is stationary like an automobile axle. Joint axes' locations are fairly stable, but only because the joint surfaces move in a very specific way.

ARTHROKINEMATICS is the general term for the specific movements of joint surfaces. Normal joint surface movement is necessary to ensure long-term joint integrity. (Joint surface movements are sometimes called joint play motions or component motions).

Joint surfaces move with respect to one another by simultaneously (1) rolling, (2) gliding, and (3) spinning. This discussion focuses on how joint surfaces roll and glide with respect to one another, and largely ignores the spin component.

The figure, a sagittal plane depiction of the knee (tibio-femoral) joint, illustrates roll, like the rolling of a tire on a surface, and glide, like a tire slipping without rolling.

If the moving joint surface rolls on its partner without simultaneously gliding, the surfaces would separate (gap or subluxate) in some places and impinge in others. Roll and glide must occur simultaneously to preserve joint integrity. We can predict and understand the relationship between bony shapes at a joint surface and the surfaces' movements by applying the rules of concavity and convexity (Kaltenborn 1989, p.27).

NB: Roll and glide do not occur in the direction they do because of the shape of the joint surfaces. Roll and glide, like all motions, are produced by forces.

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Rules of concavity and convexity

Movements at joint surfaces (arthrokinematics) follow the rules of concavity and convexity. Each joint or articulation involves two bony surfaces, one that is convex and one that is concave.

When the concave surface is fixed and the convex surface moves on it, the convex surface rolls and glides in opposite directions.
The figure illustrates how joint subluxation or dislocation would result were a convex surface to roll on a fixed concave surface without gliding at the same time. To preserve joint integrity, roll and glide must occur simultaneously, and must occur in opposite directions. In this example, the convex joint surface must roll posteriorly (curved arrow) and glide anteriorly (straight arrow).

When the convex surface is fixed and the concave surface moves on it, the concave surface rolls and glides in the same direction.
The figure illustrates how joint surfaces would gap in some areas and impinge in others were a concave surface to roll on a fixed convex surface without gliding at the same time. To preserve joint integrity, roll and glide must occur simultaneously, and in the same direction. In this example, the concave joint surface must roll posteriorly (curved arrow) and glide posteriorly (straight arrow).

Source: Kaltenborn, F.M. (1989). Manual Mobilization of the Extremity Joints (4th ed.). Minneapolis: OPTP.

Joint Mobilization 2.ppt

Joint Mobilization.ppt

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