MOBILITY

OBJECTIVES
What is Mobility? What are various methods to assess mobility? What are the causes of limitation of mobility? How to manage the patients with mobility limitation?

What is mobility?
The ability of structures or segments of the body to move or to be moved in order to allow the occurrence of range of motion for functional activities.

Hypermobility
- It refers to increase in mobility or excessive joint motion.

Hypomobility
- It refers to decreased mobility or restricted joint motion.

VARIOUS METHODS TO ASSESS MOBILITY

Subjective - By knowing which Passive which functional activities patient is able to perform. Objective - Active &

ROM. - Joint play.

large joints mm.

In small joints - 2 to 4 mm.

In - 4 to 6

CAUSES FOR LIMITATION OF MOBILTY

IMMOBILIZATION
The procedure of making a normal movable part of the body, such as joint immovable. Muscle immobilization may in shortened or lengthened positions. example-immobilization of elbow in flexion may cause shortening of biceps brachii and lengthening of triceps brachii.

Immobilization in shortened position

May occur after fractures, surgical repair, muscle tear, tendon rupture. Decreasing the no. of sarcomeres in series leads to reduction in length of muscle fiber. Muscle atrophies and weakness at faster rate and than if held in lengthened position. Shift to length tension curve of a shortened position,which does muscle capacity to produce maximum tension.

CAUSES OF IMMOBILISATION
1) Pain - Pain is an unpleasant sensory and emotional experience associated with active potential tissue damage or described in terms of such damage. * EFFECTS OF PAIN: -pain is protective mechanism of the body. -pain leads to muscle spasm, muscle guarding which affects mobility. -damage to the tissue protects the area from -excessive movement for promoting healing and preventing further damage.

MANAGEMENT

SKIN
Tightness of skin- due to incision, healed traumatic/incisional scar. If scar crossing joint than mobility is decreased. INCISION-mobility restricted due to pain or surrounding inflammation. INTERVENTION high tens decrease pain by blocking pain gate mechanism.

MASSAGE- friction & kneading mainly by increasing blood supply & increasing extensibility of collagen tissue. BURNS- it is very painful condition so pt keep in guarded posture to prevent stretching pain. INTERVENTION- full passive motion with end stretch. ANTI DEFORMITY POSITIONmaintains length of muscle & prevent contracture.

IR- Increase blood circulation, mild sedative effect decreases mobility. RELAX POSITION- prevent undue tension on incisional site HEALED TRAUMATIC/INCISIONAL OLD SCAR- it is adherent and restricts mobility US-shown to increase tensile strength ,affecting direction of fibers and make it more pliable for effecting stretching.

2). Muscular causes:EFFECT OF IMMOBILISATION ON MUSCLES: -Decay of contractile protein -decrease in no of muscle fibers -decrease in no of myofibrils -decrease in intramuscular capillary density All this leads to muscle atrophy and weakness.

* Immobilization in the muscles may cause - muscle weakness -muscle tightness and contractures -muscle spasm -inhibition of muscles

* MUSCLE WEAKNESS * INTERVANTION 1)Relaxed passive movement -relaxed passive movements maintain mobility but it not improves mobility - it used when active ROM in same cause is contraindicated.

2)ACTIVE EXERCISE A. Assisted exercises rhythmical movement in which muscle contraction and assistance combine at the limit of free range against resistance of limiting structures is useful in increase in ROM. B. Free exercises pendular movement with an attempt to increase amplitude/series of contraction/pressing movements at the limit of range.

C. Resisted exercises an external force may be applied to the body levers to appose the muscle contraction. increase tension within muscle by resistance and muscle responds by increase in power and hypertrophy causing muscle development. this also includes PRE PNF: hold relax, contract relax and rhythmic stabilization

*TIGHTNESS & CONTRACTURE gentle passive stretching

* Muscle spasm -spasm is a protective mechanism of the muscles under injury -spasm of the muscles decrease mobility + Intervention -Heating modalities: IR,MH,cryo,MWD -local relaxation :Hold & contract relax methods Rhythmic passive movt. Induces muscle relaxation.

MUSCLE INHIBITION -Cryo therapy : It is suggested that it increases excitatory bias around anterior horn cell and thereby excitatory stimulus applied by ice.

LIGAMENTS
Effect of immobilizationDecrease in collagen content & cross linking. Tissue weakness Decrease tensile strength. GRADE 1-minimal damage with pain tenderness & slight swelling

INTERVENTION- ICE,REST-24HRS, CREP BANDAGE. Followed by static muscle contraction- blood flow increases & decrease swelling, strong muscle ,strong ligament. GRADE 2- partially detach from attachement.pain tenderness, swelling. INTERVENTION-Ice, compression & elevation.

GRADE 3 complete loss of function INTERVENTION-after 1wk of operation isometric exs. M/A- ICE-The initial vasoconstriction help to limit extravasation of blood into tissues there by preventing swelling. Crep bandage-there is no movt allowed at joint so no further damage.

CAPSULE
If there is tightness of capsule than there is decrease in motion in capsular pattern. E,g. in frozen shoulder ext.rot ,abd, int rot. Rom restricted INTERVENTION- MOBILISATION Graded oscillation technique-Grade 3&4

SUSTAINED TRANSATLORY JT.PLAY TECHNIQUE- Grade 3 M/A- stimulate biological activity by moving synovial fluid which bring nutrients.Elongate hypomobile capsule. CAPSULAR STRETCH-

FRACTURE (#)
A break in continuity of bone fracture. INTERVENTION (A)SIMPLE FRACTURE :(1)Undisplaced fracture :- Plaster, slab :- isometric exs for that joint. active movement of distal joint.

(2) Displaced fracture :- Traction is given in displaced fracture for proper alignment.

During period of immobilisation :- Keep limb in elevation to reduce swelling. - For unaffected limb active exs and strengthening. - Affected joint isometric exs. to prevent atropy of muscles.

(B) Open / complex fracture :-

POSTURAL IMBALANCE
INTERVENTION :Biofeedback. Advice to the pt. regarding postural correction.

NEUROLOGICAL CAUSES
SPASTICITY.
RIGIDITY. FLACCIDITY.

PSYCHIATRIC CAUSES
ANXIETY. DEPRESSION.

INTERVENTION
- Relaxation.
- Counselling of the patient.

References
Cashs textbook of orthopaedics & rheumatology for physiotherapists. Joint structure & function cynthia norkins Therapeutic exercise- kishner & colby Principles of exercise therapy- dina gardiner Physical rehabilitation of injured athlete- andrews

ADHESIONS
There is serofibrinous exudate into region of joint,structures become soaked in exudate & if not speedily removed the fibrinous constituents of exudate glue the collagenous fibres of ligaments & tendons together.

INTERVENTION1. Elevation of part , elastic bandage & rhythmical active exercises of muscles in vicinity assist venous return & ensure free movement of tendons passing over affected joint and thereby loosen adhesion & increase mobility. 2. Moist heat,contrast bath are given prior to mobilisation to increase blood circulation.

3. MOBILIZATION TECHNIQUE M/A- extensibility & tensile strength of articular & periarticular tissues is maintained by joint motion which can be achieved with various mobilization technique like:(1) Graded oscillation technique Grade 2,3,4 Dosage-:2-3 per second for 1-2mins.

(2)Sustained Translatory joint play technique Grade 3 Dosage for painful joint apply intermittent distraction for 7-10 seconds with few seconds rest in between for several cycles.

THANK YOU
Pooja vora (16) Pooja desai (17) Ronak thakur(18) Sharvaree kharsikar (19) Shraddha panchal(20)

JOINT INFLAMMATION & EFFUSION

Whenever there is inflammation around joint & increase in synovial fluid(effusion) mobility is restricted d/t pain & swelling. E.g.- rheumatoid arthritis INTERVENTIONFor decreasing pain-massage,cryo relaxation techniques.

Gentle grade 1 & 2 distraction & oscillation technique to inhibit pain & minimize fluid stasis. M/A- help nutrient exchange & increases synovial fluid movement .

VASCULAR DISORDERS
These disorders cause insufficient circulation and thereby decrease mobility. E.g.- peripheral lymphedema INTERVENTIONElevation & compression bandage increase venous return. Active rom exs(pumping exs)

TENDONITIS & FASCITIS

Inflammation of tendons & fascia would reduce mobility. INTERVENTION- Ice & ultrasound M/A- Accelerated protein synthesis stimulates rate of repair of damaged tissues.

BONY BLOCK
E.g- myositis ossificans INTERVENTIO Rest,Immobilization, pulsed Ultra sound & phonophoresis Maintain available range of motion but avoid stretching and massage, until maturation.

So our role is to identify cause of problem & to select appropriate procedure to alleviate or eliminate the cause of loss of mobility is important as rightly said :RIGHT TOOL FOR RIGHT JOB