Lecture No

02
 Classification of the joints
Three-dimensional joint positioning
◦ Open pack …………………………. Close Pack
 Bone and joint Movements
 Treatment plan

 Concave Convex Rule

STRUCTURAL CLASSIFICATION OF JOINTS
1. Fibrous joints
◦ Generally immovable
2. Cartilaginous joints
◦ Immovable or slightly moveable
3. Synovial joints
◦ Freely moveable
FIBROUS JOINTS (SYNARTHROSIS)
 Collagen fibers span the space
between bones
1. SUTURES,
2. GOMPHOSES
3. SYNDESMOSE
S
CARTILAGENOUS JOINTS
(AMPHIARTHROSIS)
 Articulating bones united

by cartilage, Lack a joint

cavity, Not highly movable
 Two types

1. SYNCHONDROSES
2. SYMPHESES
SYNOVIAL JOINT (DIARTHROSIS)
 Joint in which two bones are separated by a

space called a joint cavity

 Most are freely movable
Figure 5.28
 Plane
 Hinge
 Pivot
 Condyloid
 Saddle
 Ball-and-socket
MacConaill describes four structural
classifications of synovial joints which are
correlated with the types of bone movements
and the degrees of freedom allowed at each
articular pair:
1. OVOID
2.

SELLA
R
 In ovoid joints one surface is convex, the
other is concave.
1. Unmodified ovoid: (art. spheroidea), ball and
socket, triaxial, e.g., hip and shoulder joints

1. Modified ovoid: (art. ellipsoidea), ellipsoid,

biaxial, e.g., metacarpophalangeal (MCP)
joints
 In sellar joints, one surface is concave in one
direction and convex in the other, with the
opposing surface convex and concave,
respectively; similar to a horseback rider
being in complementary opposition to the
shape of a saddle
1. Unmodified sellar: (art. sellaris), saddle,
biaxial, e.g., first carpometacarpal
joint
2. Modified sellar: (art. ginglymus), hinge,
uniaxial, e.g., interphalangeal joints
 ANATOMICAL PLANES OF REFERENCE

1. The median plane divides the body

symmetrically into right and left halves and all
planes parallel to this are called sagittal planes.
2. The frontal plane divides the body into anterior
(ventral) and posterior (dorsal) halves.
3. The transverse plane or horizontal plane
divides the body into cranial and caudal
halves and the extremities into distal and
proximal halves.
ANATOMICAL PLANES OF REFERENCE
ANATOMICAL PLANES OF REFERENCE
 The anatomical axes lie at the intersection of
two anatomical planes.
Anatomical bone movements take place
around these axes.
 The frontal axis lies at the intersection of the
frontal and transverse planes and runs from
right to left.
 The sagittal axis lies at the intersection of the
sagittal and transverse planes and runs in a
dorsal-ventral direction.
 The Iongitudinal
(vertical) axis lies at the
intersection of the
sagittal and frontal
planes and runs in a
cranial-caudal
direction. In the
extremities, this axis
passes through a part
of a bone such as the
neck of the femur or
the entire length of a
bone
 Shoulder joint has 3 degrees of freedom
= multiaxial joint
 Other joints – monoaxial or biaxial 9-
26
 For practical purposes, we classify joint
positions into five categories:
1. Zero position

2. Resting position (Loose-packed

position)
3. Actual resting position

4. Non-resting positions

5. Close-packed position
 Also known as position of reference

 Joints ROM measurements are taken from the

zero starting position

 ROM is measured with a goniometer on both

sides of zero
Zero Position
 First described by McConnell
It is a position in which
◦ Joint capsule and ligaments are most relaxed
◦ Little joint contact
◦ Maximum joint play
 Alsocalled Loose/open-packed position
 How we measure the Open packed position
RESTING
POSITION
 Sometimes we are unable to test
our patients joint in the resting
position due to pain or
significantly limited motion.
 This is often the position where
treatment is initiated.
 As your skills improve and your patients
impairments decrease you will find that you
need to perform joint play testing out of
the resting position.
 In order to judge the degree of capsular
looseness or tightness in these positions it is
important to have a thorough sense of how
these tissues feel normally in the resting
position.
 Joint surfaces are in maximal contact to each
other

 Most ligaments & capsules surrounding the

joint are taut
 Osteokinematics
◦ gross movements of bones at joints
 flexion / extension
 abduction / adduction
 internal rotation / external rotation
Arthrokinematics
◦ small amplitude motions of bones at
joint surface
 roll
 glide (or slide)
 spin
  Two types of bone movements are important
in OMT system:
1. Rotations: curved (angular) movement
around an axis
2. Translations: linear (straight-lined)
movement parallel to an axis in one plane
 BONE AND JOINT MOVEMENT
Bone
Movements

Rotations Translations

Combined
Standard bone
bone Traction Compression Gliding
movement
movement

Coupled Non coupled

movements movements
 Curved (angular) movements around an
axis
Produce roll-gliding
 Two types
A. Standard bone movement
B. Combined bone movement
A. Standard bone movement
◦ Anatomical movements
◦ Uniaxial
◦ e.g. flexion, extension etc
B. Combined bone movement
◦ Functional movements
◦ Multiaxial
◦ e.g. Flex. + Lat. Flex. + Rot.
◦ Two types
i. Coupled movements
ii. Non coupled movements
 Movement combinations that result in the
most ease of movement
These movements have
◦ greatest range
◦ least resistance to movement
◦ softest end-feel
 e.g. lumbar side bending and rotation to
opposite side are coupled when erect (or in
extension)
 Movement combinations that result in less
ease of movement
These movements have
◦ less range
◦ more resistance to movement
◦ harder end-feel
 e.g. lumbar side bending and rotation to the
same side (in ext)
 Standard, uniaxial
◦ MacConaill 's "pure, cardinal swing"
 Combined, multiaxial
◦ MacConaill 's "impure arcuate swing"
  Two types of bone movements are important
in OMT system:
1. Rotations: curved (angular) movement
around an axis
2. Translations: linear (straight-lined)
movement parallel to an axis in one plane
 Bone
Movements

Rotations Translations

Combined
Standard bone
bone Traction Compression Gliding
movement
movement

Coupled Non coupled

movements movements
 During translation of a bone all parts of the
bone move in a straight line, at equal
distance, in the same direction, and at the
same speed
 Produces joint play movements of traction,
compression, and gliding
 Before a / m movement, first we know
about the treatment plan.
 Treatment plane lies
on the concave
articulating surface,
perpendicular to a
line from the center
of the convex
articulating surface
 It moves when the
concave surface
moves
 It remains essentially
still when the convex
surface moves
TREATMENT PLANE
 Longitudinal
bone
separation
away from the
treatment plane
 Traction and distraction are not synonymous.
 Traction is a longitudinal pull.
 Distraction is a separation, or pulling apart.
 Decrease in space
between two
joint surfaces
 Longitudinal bone
approximation
towards the
treatment plane
 Translatory
movement
where the joint
surfaces are
passively
displaced
parallel to the
treatment plane
 In a healthy joint, functional
movement (bone rotation)
produces joint roll-gliding.
 Roll-gliding is a combination of
rolling and gliding movement
which takes place between two
joint surfaces
 New points on one surface meet new
points on the opposing surface
 Specific point on one surface comes
into contact with a series of points on
another surface

 Surfaces must be congruent either flat

or curved
 Follow Concave-Convex Rule
JOINT ROLL-GLIDING
JOINT ROLL-GLIDING
 Since there is never pure congruency
between joint surfaces; all motions
require rolling and gliding to occur
simultaneously
 This combination of roll and glide is
simultaneous but not necessarily in
proportion to one another
 Combined rolling-gliding in
a joint

◦ The more congruent (flat or curved)

the surfaces are, the more gliding
there is
◦ The more incongruent the joint
surfaces are, the more rolling there
is
 Usually the restricted movement is
associated with an impaired gliding
component which may allow joint
rolling to occur without its associated
gliding.
 Joint rolling movements in the
absence of gliding can produce a
damaging concentration of forces in
a joint.
 A common goal in our approach to OMT is to
restore the gliding component of roll-
gliding to normalize movement mechanics.
Abnormal roll-gliding
 The direction of limitation for joint gliding
may be determined either directly (using glide
testing) or indirectly using Kaltenborn
Concave-convex rule.
 The therapist applies passive translatoric
gliding movements in all possible directions
and determines in which directions joint
gliding is restricted.
This is the preferred method as it gives the
most information about the degree and
nature of gliding restrictions !
 The therapist determines which bone
rotations are decreased and also notes
whether the moving joint partner is convex
or concave
 Indirect method is used when
◦ Patient has severe pain
◦ Joint is extremely hypomobile
◦ Therapist is inexperienced with
direct assessment
 The shape of the joint surface influences
the direction of the accessory movement
 One joint surface is MOBILE & one is STABLE
 Concave-convex rule:
concave joint
surfaces slide in the
SAME direction as the
bone movement
(convex is STABLE)
◦ If concave surface is
moving on stationary
convex surface – glide
occurs in same
direction as roll
 Convex-concave rule:
convex joint surfaces
slide in the OPPOSITE
direction of the bone
movement (concave
is STABLE)
◦ If convex surface is
moving on stationary
concave surface – gliding
occurs in opposite
direction to roll
Concave-Convex & Convex-
Concave Rule
Concave-Convex & Convex-
Concave Rule
ABDUL GHAFOOR SAJJAD 77