Osseous Mobes & Manip Simulated Exam
Mobilization – passive movement of a skeletal joint. It is usually aimed at a ‘target’ synovial joint with the aim of achieving a therapeutic effect. When applied to the spine, it is known as spinal mobilization.
Manipulation (adjustment)– a therapeutic procedure utilizing controlled force, leverage, direction, amplitude (depth) and velocity; most commonly applied as a high velocity low amplitude (HVLA) thrust to the spine utilizing parts of the vertebra and contiguous structures as levers to correct articular malposition (subluxations), restrictions of movement or other dysfunctions of the body. It may be accompanied by a ‘popping’ sound or cavitation as nitrogen gas is released from synovial fluid within the joint cavity (grade 5 mobilization)
Subluxation – a partial dislocation or slight misalignment of tissue – defined by the World Health Organization (WHO) as – “A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity”
Grades of Mobilization & Example
Grade |
Definition |
1 |
Slow, small amplitude, rhythmic oscillations at the beginning of available joint play range (between initiation of movement and tissue resistance)
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2 |
Slow, large amplitude, rhythmic oscillations within the midrange of available joint play range (between initiation of movement and tissue resistance)
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3 |
Slow, large amplitude, rhythmic oscillations from the middle to the end of available joint play range (within tissue resistance, and backing out again – below elastic limit)
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4 |
Slow, small amplitude, rhythmic oscillations end of available joint play range (within tissue resistance, but below elastic limit)
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5 |
High velocity, low amplitude (HVLA) thrust at the elastic limit (end of PROM)
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Contraindications
Misc. |
Arthro |
Osteo |
Neuro |
Vascular |
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Relative |
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Absolute |
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5 Ds And 3Ns Contraindications for Cervical manipulation or mobilization |
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Dizziness (vertigo, giddiness) Drop attacks (loss of consciousness) Diplopia (or other visual disturbances) |
Dysarthria Dysphagia Ataxia |
Nausea & vomiting Numbness (unilateral) Nystagmus |
Reference: Vizniak, NA. Physical Medicine. Professional Health Systems Inc. 2014