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Title:

Mobility Exercise

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Joint capsule collagen shortness. Menisci tears and loose bodies. Intracapsular adhesions ... Between collagenous tissues - Fascia ... – PowerPoint PPT presentation

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Title: Mobility Exercise


1
Mobility Exercise
  • David D. Wise, PT, Ph.D.

2
Mobility Continuum
  • Hypomobile
  • Contracture
  • Tightness
  • Normal
  • Relatively hypomobile
  • Normal
  • Relatively hypermobile
  • Hypermobile
  • With muscular control assymptomatic
  • Instability

3
Pathological Focus
  • Joint hypomobility
  • Joint capsule collagen shortness
  • Menisci tears and loose bodies
  • Intracapsular adhesions
  • Apparent (not actual) joint shortness
  • Intracapsular swelling
  • Muscle guarding

4
Pathological Focus
  • Muscle hypomobility
  • Tenin
  • Loss of sarcomeres in a series
  • Collagen shortness in passive elastic component
    (PEC) or series elastic component (SEC)
  • Terms referring to muscle shortness
  • Common muscle tightness
  • Myostatic contracture mod collagen shortness
  • Irreversible contracture e.g., Volkmanns
    contracture
  • Pseudomyotactic contracture - neurological

5
Pathological Focus
  • Abnormal relative flexibility
  • Joint or muscle shortness often affects the
    entire kinematic chain in which the hypomobile
    joint resides.
  • The hypomobile joint will often cause excessive
    movement in the more freely moveable joints in
    the chain.

6
Pathological Focus
  • Collagenous Tissue Remodeling (effect of
    immobilization or movement restriction
    deprivation of normal elongation)
  • Loss of GAGs separation of collagen fibers
  • Serial Length remodeling registers taken off
    the ends. This is done because the fibrocytes
    are signalled that the current length is not
    necessary.

7
Pathological Focus
  • Secondary problems to Collagenous Tissue
    Remodeling
  • Abnormal joint mechanics
  • Excessive and poorly distributed compression
  • Cross binding at pleats in the joint capsule
    leading to severe restriction.
  • Stiff tendon or ligament pulls more sharply at
    periosteal attachment
  • Stiff tendon or ligament rubs on periosteum

8
Pathological Focus The use of mobility
exercises during inflammation and repair
Breaking Point
9
Pathological Focus The use of mobility
exercises during inflammation and repair Acute
Inflammation
Breaking point
10
Pathological Focus The use of mobility
exercises during inflammation and repair
Proliferative phase
Breaking point
11
Pathological Focus The use of mobility
exercises during inflammation and repair Early
Remodeling
Breaking point
12
Pathological Focus The use of mobility
exercises during inflammation and repair Late
Remodeling
Breaking point
13
Pathological Focus
  • Other collagenous tissue problems
  • Normal (Collagen and GAG ratio normal)
    remodeled short e.g., frozen shoulder
  • Scars
  • From burns and wounds
  • An entire branch of PT
  • Adhesions
  • Between collagenous tissues - Fascia
  • Between collagenous tissues and other types of
    tissue, e.g., nerve

14
Impairment or Clinical Focus
  • Units of measure
  • Joint ROM
  • ROM c muscles slack
  • Levels tightness contracture
  • Muscle ROM
  • ROM of one or several joints in the direction
    opposite all the action of the muscle.
  • Levels Tightness Contracture
  • SLR, 90o-90o test, Thomas test,

15
Impairment or Clinical Focus
  • Nerve excursion or extensibility
  • SLR ULTTs
  • Tendon gliding or excursion
  • Bunnells test

16
Functional Focus
  • BADLs
  • ROM sufficient to do BADL movement S lt -- gtS
    gait, transfers,
  • ROM sufficient to do functional postures lying,
    sitting, standing.
  • IADLs
  • Work
  • Sports
  • Tightness pt can often accommodate but may
    cause secondary problems or problems over time.
  • Contracture pt cant compensate severe
    deficits

17
Intensity
SI
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