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.
A joint is a junction between two bones and in the body our joints have different functions such as force transmission, weight bearing and movement. The symphysis pubis and acromioclavicular joints are examples of force transmission joints, the back is mostly a weight bearing series of joints and the shoulders and knees have to do with movement. The joints we are most familiar with are the synovial joints, the most common type and these have a cartilage lining over the bone ends, synovial fluid secreted by the joint lining and have ligamentous structures surrounding the joint to support its function.
The physiotherapist will initially observe the patient as they make their way into the exam room and sit down. They might limp, splint the joint in some way, have very guarded movement to reduce joint stresses or hold the joint in a protective position to minimise further injury. A history will be taken by the physio initially then they will move on to examine the joint visually, looking for normal alignment, any warmth, effusion or tissue swelling. There may be a fault in a cool joint with no swelling but the physio will have to test it more thoroughly to discover the fault. If the joint is inflamed, hot and swollen then acute treatment should be instituted.
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.
The physiotherapist will assess the active range of the joint movement which is what the patient can manage independently, noting the ranges as a proportion of normal and why the joint could not achieve full range, e.g. pain or muscle weakness. The physio will then move the patients joint passively without the patients effort to see if the joint ranges are different. If the physio can move the joint through its full normal range but the patient cannot do this, then either pain or muscle weakness is the likely cause. If neither the physio nor the patient can get the joint to full range, pain or joint stiffness may be the problem.
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. - 14130
A joint is a junction between two bones and in the body our joints have different functions such as force transmission, weight bearing and movement. The symphysis pubis and acromioclavicular joints are examples of force transmission joints, the back is mostly a weight bearing series of joints and the shoulders and knees have to do with movement. The joints we are most familiar with are the synovial joints, the most common type and these have a cartilage lining over the bone ends, synovial fluid secreted by the joint lining and have ligamentous structures surrounding the joint to support its function.
The physiotherapist will initially observe the patient as they make their way into the exam room and sit down. They might limp, splint the joint in some way, have very guarded movement to reduce joint stresses or hold the joint in a protective position to minimise further injury. A history will be taken by the physio initially then they will move on to examine the joint visually, looking for normal alignment, any warmth, effusion or tissue swelling. There may be a fault in a cool joint with no swelling but the physio will have to test it more thoroughly to discover the fault. If the joint is inflamed, hot and swollen then acute treatment should be instituted.
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.
The physiotherapist will assess the active range of the joint movement which is what the patient can manage independently, noting the ranges as a proportion of normal and why the joint could not achieve full range, e.g. pain or muscle weakness. The physio will then move the patients joint passively without the patients effort to see if the joint ranges are different. If the physio can move the joint through its full normal range but the patient cannot do this, then either pain or muscle weakness is the likely cause. If neither the physio nor the patient can get the joint to full range, pain or joint stiffness may be the problem.
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. - 14130
About the Author:
Jonathan Blood Smyth is a Superintendent Physiotherapist 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 Physiotherapists in Coventry.
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