Our joints are extremely important for our functional activities, from the temporomandibular joint for eating and talking to the major weight bearing joints such as the hips and knees. Our joints are designed to allow us to move about, to accomplish tasks and to bear weight, a job they do superbly well. However, with injury, illness or disease our joints can be affected in various ways, limiting our abilities and causing stiffness and pain. Physiotherapists are trained to examine joints logically, determine the limiting factors and construct a treatment plan accordingly, with many techniques at their disposal.
In the human body the junction between two bones is called a joint and they can function as movement, weight bearing or force transmission joints according to their structure. The shoulder is a movement joint, the symphysis pubis a force transmission joint and the hip a weight bearing and movement joint. Synovial joints are the most common type, making up all of our major obviously useful joints. Articular cartilage lines the bone ends to reduce friction and allow effortless movement, the synovial membrane lining the joint secretes synovial fluid and the joint capsule, a ligamentous bag, supports the joint against stresses.
Moving on from the relatively quick visual joint assessment the physiotherapist will start to palpate round the joint structures. This systematic manual examination allows the physiotherapist to clarify which parts of the anatomy are involved in the problem. The typical areas tested will be the ligaments, the areas where the tendons and ligaments insert to the bone, the joint line itself and around the margins of the joint. Any fluid in the knee, called an effusion, can be identified as it moves about if it is thin, it is very firm if the swelling is tight and it is thick and deformable if the swelling is older and stickier.
Assessment of the active joint ranges of motion is routinely recorded by the physiotherapist, who also records why the joint range is not full and states the results in degrees or as a proportion of normal. The physio then tests the passive joint ranges, with the patient relaxing the joint, to see if there are restrictions or pain with this technique. If the patient cant move their joint through its full range but the physiotherapist can then muscular weakness or pain is the likely limiting reason. If the patients own movement is limited and the physio can get no more on testing, then stiffness of the joint and/or pain may be involved.
Normal joint function is dependent on normal ligaments and physiotherapy testing of them is routine by manual stressing. Major joint ligaments have great strength and normally should show no reaction to being stressed, however testing can reveal a stretched, painful or ruptured ligament. Muscle strength is charted on the Oxford scale of 0 to 5, although patients may not exert their strength if they are in pain or very anxious. Sensibility of the joint and joint position testing tells the physio that normal joint feedback is occurring which is vital for planning of normal movement.
Functional testing of the joint in normal activities and typical postures may be used by the physiotherapist particularly if the joint examination has not indicated clear problems. This way any deficiencies that may not have been obvious on less stressful testing can become evident. - 16004
In the human body the junction between two bones is called a joint and they can function as movement, weight bearing or force transmission joints according to their structure. The shoulder is a movement joint, the symphysis pubis a force transmission joint and the hip a weight bearing and movement joint. Synovial joints are the most common type, making up all of our major obviously useful joints. Articular cartilage lines the bone ends to reduce friction and allow effortless movement, the synovial membrane lining the joint secretes synovial fluid and the joint capsule, a ligamentous bag, supports the joint against stresses.
Moving on from the relatively quick visual joint assessment the physiotherapist will start to palpate round the joint structures. This systematic manual examination allows the physiotherapist to clarify which parts of the anatomy are involved in the problem. The typical areas tested will be the ligaments, the areas where the tendons and ligaments insert to the bone, the joint line itself and around the margins of the joint. Any fluid in the knee, called an effusion, can be identified as it moves about if it is thin, it is very firm if the swelling is tight and it is thick and deformable if the swelling is older and stickier.
Assessment of the active joint ranges of motion is routinely recorded by the physiotherapist, who also records why the joint range is not full and states the results in degrees or as a proportion of normal. The physio then tests the passive joint ranges, with the patient relaxing the joint, to see if there are restrictions or pain with this technique. If the patient cant move their joint through its full range but the physiotherapist can then muscular weakness or pain is the likely limiting reason. If the patients own movement is limited and the physio can get no more on testing, then stiffness of the joint and/or pain may be involved.
Normal joint function is dependent on normal ligaments and physiotherapy testing of them is routine by manual stressing. Major joint ligaments have great strength and normally should show no reaction to being stressed, however testing can reveal a stretched, painful or ruptured ligament. Muscle strength is charted on the Oxford scale of 0 to 5, although patients may not exert their strength if they are in pain or very anxious. Sensibility of the joint and joint position testing tells the physio that normal joint feedback is occurring which is vital for planning of normal movement.
Functional testing of the joint in normal activities and typical postures may be used by the physiotherapist particularly if the joint examination has not indicated clear problems. This way any deficiencies that may not have been obvious on less stressful testing can become evident. - 16004
About the Author:
Jonathan Blood Smyth is a Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiothrapists in Southampton.
