DISTRACTION Fig Purpose Positioning Procedure by sanmelody

VIEWS: 17 PAGES: 15

									                                               FIGURE 7-1. Distraction.



DISTRACTION (Fig 7 1)
Purpose
   To examine for tibiofemoral joint impairment
   To increase accessory motion into tibiofemoral joint distraction
   To increase range of motion at the knee joint
   To decrease pain
   To improve periarticular muscle performance
Positioning
1. The patient is sitting with the knee off the edge of the treatment table.
2. The tibiofemoral joint is placed in the resting position if conservative techniques are indicated or approximating
   restricted range of motion if more aggressive techniques are indicated.
3. The clinician is at the patient's foot facing the patient's knee.
4. Both hands grip the distal tibia from the medial and lateral sides.
5. Alternatively, the clinician can use a specialized belt with a strap that wraps around the patient's tibia and a
   stirrup attachment for placement of the clinician's foot to perform this technique.

Procedure
1. Both hands move the tibia distally perpendicular to the tibial joint surface (see Fig. 7-1).
                                               FIGURE 7-2. Posterior glide.



  P OST ERI O R GLIDE (Fig 7 2)
  Purpose
     To examine for tibiofemoral joint impairment
     To increase accessory motion into tibiofemoral joint posterior glide
     To increase range of motion at the tibiofemoral joint
     To decrease pain
     To improve periarticular muscle performance
  Positioning
  1. The patient is supine.
  2. The tibiofemoral joint is placed in the resting position if conservative techniques are indicated or approximating
     restricted range of motion if more aggressive techniques are indicated.
  3. The clinician is at the side of the patient's leg facing the patient's knee.
  4. The stabilizing hand supports the femur from the posterior side.
  5. The mobilizing/manipulating hand grips the proximal tibia from the anterior side.

  Procedure
  1. The clinician applies a grade I traction to the joint.
  2. The stabilizing hand holds the femur in position.
  3. The mobilizing/manipulating hand glides the tibia in a posterior direction (see Fig. 7-2).



Particulars
1. This technique might be especially effective for increasing range of motion into knee joint extension.
                       FIGURE 7-3. Anterior glide of the tibia on the femur: first technique.



ANTERIOR GLIDE OF THE TIBIA ON THE FEMUR: FIRST TECHNIQUE (Fig 7-3)
Purpose
   To examine for tibiofemoral joint impairment
   To increase accessory motion into tibiofemoral joint anterior glide
   To increase range of motion at the tibiofemoral joint
   To decrease pain
   To improve periarticular muscle performance
Positioning
1. The patient is supine.
2. The tibiofemoral joint is placed in the resting position if conservative techniques are indicated or approximating
   restricted range of motion if more aggressive techniques are indicated.
3. The clinician is at the patient's foot facing the patient's knee.
4. Both hands grip the proximal tibia from the posterior side with the fingers while simultaneously positioning the
   thumbs over the anterior surface of the distal femur.

Procedure
1. Both hands glide the tibia in an anterior direction while stabilizing the femur with the thumbs (see Fig. 7-3).

Particulars
1. This technique might be especially effective for increasing range of motion into knee joint extension.
                          FIGURE 7-4. Anterior glide of the tibia on the femur: second technique.




ANTERIOR GLIDE OF THE TIBIA ON THE FEMUR: SECOND TECHNIQUE (Fig 7-4)
Purpose
   To examine for tibiofemoral joint impairment
   To increase accessory motion into tibiofemoral joint anterior glide
   To increase range of motion at the tibiofemoral joint
   To decrease pain
   To improve periarticular muscle performance
Positioning
1. The patient is supine.
2. The tibiofemoral joint is placed in the resting position if conservative techniques are indicated or approximating
   restricted range of motion into extension if more aggressive techniques are indicated.
3. The clinician is at the side of the patient's leg facing the patient's knee.
4. The stabilizing hand grips the proximal tibia posteriorly.
5. The mobilizing/manipulating hand is positioned over the anterior surface of the distal femur.

Procedure
1. The clinician applies a grade I traction to the joint.
2. The stabilizing hand holds the tibia in position.
3. The mobilizing/manipulating hand glides the femur in a posterior direction, imparting an anterior force to the tibia
   on the femur (see Fig. 7-4).



Particulars
 1. This technique might be especially effective for increasing range of motion into knee joint extension.
                         FIGURE 7-5. Anterior glide of the tibia on the femur: third technique.




ANTERIOR GLIDE OF THE TIBIA ON THE FEMUR: THIRD TECHNIQUE (Fig 7-5)
Purpose
   To examine for tibiofemoral joint impairment
   To increase accessory motion into tibiofemoral joint anterior glide
   To increase range of motion at the tibiofemoral joint
   To decrease pain
   To improve periarticular muscle performance
Positioning
1. The patient is prone with a small pillow positioned under the distal femur to protect the patellofemoral joint.
2. The tibiofemoral joint is placed in the resting position if conservative techniques are indicated or approximating
   restricted range of motion into extension if more aggressive techniques are indicated.
3. The clinician is at the side of the patient's leg facing the patient's knee.
4. The stabilizing hand grips the distal femur from the anterior side.
5. The mobilizing/manipulating hand is positioned over the posterior surface of the proximal tibia.

Procedure
1. The clinician applies a grade I traction to the joint.
2. The stabilizing hand holds the femur in position.
3. The mobilizing/manipulating hand glides the tibia in an anterior direction (see Fig. 7-5).




Particulars
1. This technique might be especially effective for increasing range of motion into knee joint extension.
MEDIAL GLIDE (Fig. 7 -6)
Purpose
   To examine for tibiofemoral joint impairment
   To increase accessory motion into tibiofemoral joint medial glide
   To increase range of motion at the tibiofemoral joint
   To decrease pain
   To improve periarticular muscle performance
Positioning
1. The patient is supine.
2. The tibiofemoral joint is placed in the resting position if conservative techniques are indicated or approximating
   restricted range of motion if more aggressive techniques are indicated.
3. The clinician is between the patient's knees with the patient's lower leg between the clinician's arm and trunk.
4. The stabilizing hand grips the distal femur from the medial side.
5. The mobilizing/manipulating hand grips the proximal tibia and fibula from the lateral side and supports the
   lateral lower leg with the forearm.

Procedure
1. The clinician applies a grade I traction to the joint.
2. The stabilizing hand holds the femur in position.
3. The mobilizing/manipulating hand glides the proximal tibia in a medial direction indirectly through the fibula,
   while the trunk guides the motion (see Fig. 7-6).
                                               FIGURE 7-7. Lateral glide.




LATERAL GLIDE (Fig. 7-7)
Purpose
   To examine for tibiofemoral joint impairment
   To increase accessory motion into tibiofemoral joint lateral glide
   To increase range of motion at the tibiofemoral joint
   To decrease pain
   To improve periarticular muscle performance
Positioning
1. The patient is supine.
2. The tibiofemoral joint is placed in the resting position if conservative techniques are indicated or approximating
   restricted range of motion if more aggressive techniques are indicated.
3. The clinician is at the side of the treatment table facing the patient's knee with the patient's lower leg between the
   clinician's arm and trunk.
4. The stabilizing hand grips the distal femur from the lateral side.
5. The mobilizing/manipulating hand grips the proximal tibia from the medial side and supports the medial lower leg
   with the forearm.

Procedure
1. The clinician applies a grade I traction to the joint.
2. The stabilizing hand holds the femur in position.
3. The mobilizing/manipulating hand glides the proximal tibia in a lateral direction while the trunk guides the
   motion (see Fig. 7-7).
MEDI AL GAP ( Fig 7 8 )
Purpose
   To examine for tibiofemoral joint impairment
   To increase accessory motion into tibiofemoral joint medial gap
   To increase range of motion at the tibiofemoral joint
   To decrease pain
   To improve periarticular muscle performance
Positioning
1. The patient is supine.
2. The tibiofemoral joint is placed in the resting position if conservative techniques are indicated or approximating
   restricted range of motion if more aggressive techniques are indicated.
3. The clinician is at the side of the treatment table facing the patient's knee with the patient's lower leg between the
   clinician's arm and trunk.
4. The stabilizing hand supports the distal lower leg from the medial side and holds the lower leg against the
   clinician's trunk.
5. The mobilizing/manipulating hand grips the lateral side of the knee at the joint line.

Procedure
1. The stabilizing hand holds the lower leg in position.
2. The mobilizing/manipulating hand moves the knee at the lateral joint line in a medial direction, creating a
   gapping at the joint line medially (see Fig. 7-8).
                                               FIGURE 7-9. Lateral gap.




LATERAL GAP (Fig. 7 -9)
Purpose
   To examine for tibiofemoral joint impairment
   To increase accessory motion into tibiofemoral joint lateral gap
   To increase range of motion at the tibiofemoral joint
   To decrease pain
   To improve periarticular muscle performance

Positioning
1. The patient is supine.
2. The tibiofemoral joint is placed in the resting position if conservative techniques are indicated or approximating
   restricted range of motion if more aggressive techniques are indicated.
3. The clinician is between the patient's knees with the patient's lower leg between the clinician's arm and trunk.
4. The stabilizing hand supports the distal lower leg from the lateral side and holds the lower leg against the
   clinician's trunk.
5. The mobilizing/manipulating hand grips the medial side of the knee at the joint line.

Procedure
1. The stabilizing hand holds the lower leg in position.
2. The mobilizing/manipulating hand moves the knee at the medial joint line in a lateral direction, creating a
   gapping at the joint line laterally (see Fig. 7-9).
S U P E R I O R GLIDE (Fig 7-10)
Purpose
' To examine for patellofemoral joint impairment
    To increase accessory motion into patellofemoral joint superior glide
    To increase range of motion at the patellofemoral joint
    To decrease pain
    To improve periarticular muscle performance

Positioning
1. The patient is supine.
2. The knee is placed in slight flexion by placing a rolled towel underneath the knee.
3. The clinician is at the patient's lower leg facing the patellofemoral joint.
4. The mobilizing/manipulating hand is positioned with either the web space or the heel of the hand on the inferior
   surface of the patella.
5. The guiding hand is positioned over the mobilizing/manipulating hand.

Procedure
1. The mobilizing/manipulating hand glides the patella in a superior direction, taking care to avoid compressing the
   patella into the femur.
2. The guiding hand controls the position of the mobilizing/manipulating hand (see Fig. 7-10).
I N F E R I O R GLIDE (Fig 7- 11)
Purpose
    To examine for patellofemoral joint impairment
    To increase accessory motion into patellofemoral joint inferior glide
    To increase range of motion at the patellofemoral joint
    To decrease pain
    To improve periarticular muscle performance
Positioning
1. The patient is supine.
2. The knee is placed in slight flexion by placing a rolled towel underneath the knee.
3. The clinician is at the patient's hip facing the patellofemoral joint.
4. The mobilizing/manipulating hand is positioned with either the web space or the heel of the hand on the
   superior surface of the patella.
5. The guiding hand is positioned over the mobilizing/manipulating hand.

Procedure
1. The mobilizing/manipulating hand glides the patella in an inferior direction, taking care to avoid compressing the
   patella into the femur as much as possible by attempting to position the web space or the heel of the hand under
   the patella before initiating the technique.
2. The guiding hand controls the position of the mobilizing/manipulating hand (see Fig. 7-1 1).

Particulars
1. This technique might be especially effective for increasing range of motion into knee joint flexion.
MEDIAL GLIDE (Fig. 7-12)
Purpose
    To examine for patellofemoral joint impairment
    To increase accessory motion into patellofemoral joint medial glide
    To increase range of motion at the patellofemoral joint
    To decrease pain
    To improve periarticular muscle performance

Positioning
1.   The patient is supine.
2.   The knee is placed in slight flexion by placing a rolled towel underneath the knee.
3.   The clinician is at the side of the patient's leg facing the patellofemoral joint.
4.   The stabilizing hand is positioned with the fingers on the medial surface of the distal femur.
5.   The mobilizing hand or hands are positioned with both thumbs or the heel of one hand on the lateral surface of the
     patella.

Procedure
1. The stabilizing hand holds the femur in position.
2. The mobilizing/manipulating hand or hands glide the patella in a medial direction, taking care to avoid
   compressing the patella into the femur (see Fig. 7-12).
                                               FIGURE 7-13. Lateral glide.




LAT ERAL GLIDE (Fig. 7- 13)

Purpose
    To examine for patellofemoral joint impairment
    To increase accessory motion into patellofemoral joint lateral glide
    To increase range of motion at the patellofemoral joint
    To decrease pain
    To improve periarticular muscle performance
Positioning
1.   The patient is supine.
2.   The knee is placed in slight flexion by placing a rolled towel underneath the knee.
3.   The clinician is at the side of the patient's unaffected leg facing the patellofemoral joint.
4.   The stabilizing hand is positioned with the fingers on the lateral surface of the distal femur.
5.   The mobilizing/manipulating hand or hands are positioned with both thumbs or the heel of one hand on the
     medial surface of the patella.

Procedure
1. The stabilizing hand holds the femur in position.
2. The mobilizing/manipulating hand or hands glide the patella in a lateral direction, taking care to avoid
   compressing the patella into the femur (see Fig. 7-13).

Particulars
1. The clinician should use caution in performing this technique because this motion might be hypermobile. If it is,
   performing a lateral glide mobilization/manipulation technique might cause the patella to dislocate.
                                                FIGURE 7-14. Medial tilt.




MEDIAL TILT (Fig 7 14)
Purpose
' To examine for patellofemoral joint impairment
    To increase accessory motion into patellofemoral joint medial tilt
    To increase range of motion at the patellofemoral joint
    To decrease pain
    To improve periarticular muscle performance

Positioning
1.   The patient is supine.
2.   The knee is placed in slight flexion by placing a rolled towel underneath the knee.
3.   The clinician is at the side of the patient's leg facing the patellofemoral joint.
4.   The stabilizing hand is positioned with the fingers on the distal femur.
5.   The mobilizing/manipulating hand or hands are positioned with both thumbs or the heel of one hand on the
     medial surface of the patella.

Procedure
1. The stabilizing hand holds the femur in position.
2. The mobilizing/manipulating hand or hands glide the medial surface of the patella in a posterior direction, tilting the
   anterior surface of the patella toward the midline of the body (see Fig. 7-14).
3.




            FIGURE 7-15. Lateral tilt.




LATERAL TILT (Fig 7 15)

Purpose
•        To examine for patellofemoral joint impairment
•        To increase accessory motion into patellofemoral joint lateral tilt
•        To increase range of motion at the patellofemoral joint
•        To decrease pain
•        To improve periarticular muscle performance
Positioning
1. The patient is supine.
2. The knee is placed in slight flexion by placing a rolled towel underneath the knee.
3. The clinician is at the side of the patient's leg facing the patellofemoral joint.
4. The stabilizing hand is positioned with the fingers on the distal femur.
5. The mobilizing/manipulating hand or hands are positioned with both thumbs or the heel of one hand on the
   lateral surface of the patella.
Procedure
1. The stabilizing hand holds the femur in position.
2. The mobilizing/manipulating hand or hands glide the lateral surface of the patella in a posterior direction, tilting the
   anterior surface of the patella away from the midline of the body (see Fig. 7-15).

								
To top