Articular Kinematics: Osteokinematics & Arthrokinematics

Articular Kinematics: Arthrokinematics & Osteokinematics

• The course is MPTY03, Articular Kinematics: arthrokinematics & osteokinematics, taught by Michael PHILIPPE, MSc, PT, OMT.
• The context of the lecture revisits previously acquired knowledge and deepens the concept, bridging it with applied manual therapy.
• Before leaving the topic, students will interpret joint movements, symptoms, apply manual therapy techniques, and administer therapeutic exercise.
• The lecture outline includes definitions, osteokinematics and arthrokinematics, capsular patterns, and implications/practical examples.

Joint Kinematics

• Biomechanics is divided into kinematics and Kinetics is the branch of biomechanics that focuses on the forces that cause motion and changes in the state of an object's movement. In contrast to kinematics, which solely examines the paths of moving objects without considering the forces involved, kinetics looks at the interactions between forces, such as gravity, friction, and applied loads, and how they influence motion. Understanding kinetics is essential in fields like physical therapy, sports science, and rehabilitation, as it helps professionals analyze movement patterns, determine the underlying causes of pain or dysfunction, and develop effective treatment and training strategies. Kinetics also encompasses the study of both internal forces, such as muscle contractions, and external forces, such as environmental impacts. By analyzing these forces, one can gain insight into how to improve performance, prevent injuries, and create a better understanding of human movement dynamics.. Kinematics deals with the geometry of motion (displacement, velocity, acceleration) without considering the forces.
• Movements are generally categorized into rotation (circular movement around a pivot) and translation (straight or curved linear motion).

Osteokinematics

• Osteokinematics describes the angular motions of bone segments in three spatial planes.
• A practical example is the glenohumeral joint, which has three axes of rotation perpendicular to each plane, passing through the humeral head.
• The movements include flexion/extension, abduction/adduction, and rotation.
• Movement planes are sagittal, frontal, and transverse (horizontal).
• Movement axes are transverse, frontal, and sagittal.

Degrees of Freedom

• Degrees of freedom refer to the number of directions of angular motion allowed in a joint.
• The glenohumeral joint has three degrees of freedom, while the wrist has two and the elbow one.

Degrees of Freedom (Biomechanics)

• Engineering-wise, degrees of freedom apply to translational movement and are typically restricted by the joint capsule, ligaments, and surrounding structures.
• These factors include antero-posterior, medial-lateral, and superior-inferior movements.
• The importance relates to joint stability, shock absorption, and injury assessment (e.g., ligament tears).
• The knee joint, for instance, has rotational degrees of freedom (flexion/extension, internal/external rotation) and translational degrees of freedom (anterior-posterior, medial-lateral, superior-inferior).

Arthrokinematics

• Arthrokinematics describes the accessory movements occurring between joint surfaces during body movement.
• The main movements are roll, slide, and spin.
• The concave-convex relationship describes the geometry of joint surfaces (from flat to curved, concave to convex).

Arthrokinematics (Slide / Glide)

• Glide or sliding refers to the translational motion between joint surfaces..
• Slide occurs when a single point on a bone surface touches multiple areas on the adjacent surface.

Arthrokinematics (Roll / Swing)

• Roll occurs when multiple points on the joint end make contact with multiple points of the opposite end.
• Swing describes angular motion in the same direction as the segment's movement.

Arthrokinematics (Spin)

• Spin occurs when one point on the joint end touches only one point on the opposite end.
• Rotary motion occurs when the segment rotates around its own axis.

Arthrokinematics (Combined Movement)

• Combined movements involve both roll and slide or swing and glide, depending on the respective concave/convex relationships in the joint.

Considerations (Geometry of Extremities & Joint Profiles)

• Geometry of extremities and joint profile determine the location and orientation of the center of rotation during movement.
• The location and orientation of rotation centers affect the kinetic chain.
• A concave/convex/flat classification describes joint geometry.

Arthrokinematics (Concave-Convex Rules)

• The concave-convex rule guides clinicians in manual therapy.
• Researchers have questioned its universal applicability, highlighting the importance of considering joint position, surrounding tissues, and other anatomical factors.
• Neumann's answer provides a corrective perspective in the shoulder.

Manual Therapy (Looking Beyond The Joint)

• Manual therapy extends beyond the joint, encompassing joint position and capsular patterns.
• Joint congruence describes the imperfect contact between joints in different ranges.
• Closed-packed position maximizes joint stability with high tension in ligaments and capsule, while the open packed position minimizes joint stability for maximum flexibility.

Capsular Pattern

• Capsular pattern describes a specific and predictable order of movement restrictions influenced by joint capsule stiffness.
• This stiffness affects movements in the opposite direction.
• Causes of capsular patterns include arthritis, inflammation, and post-immobilization stiffness.
• Recognizing a capsular pattern aids in identifying joint pathologies.

End-Feel

• End-feel refers to the sensation at the endpoint of passive joint movement, providing info on tissue limitations.
• Normal end-feels include soft, firm, and hard.
• Abnormal end-feels are inconsistent with expected motion/occur prematurely.

Manual Therapy: Treatment Rationale

• Pain and reduced mobility lead to disability, which emphasizes the importance of ROM in musculoskeletal rehabilitation.
• Understanding of musculoskeletal disorder, joint biomechanics, joint/muscle anatomy/physiology, and arthrokinematics is crucial to effective treatment.
• Total knee arthroplasty, tibia fracture, and other treatment rationales are considered.

Manual Therapy: Applications

• The applications include Graded Mobilizations (Maitland), Strain-Counterstrain (Positional Release Therapy).
• These methods involve specific techniques to target soft tissue tension reduction, and joint mobilization for range of motion recovery.

Conclusion

• Osteokinematics and arthrokinematics interplay in joint behavior visualization and in joint treatment approaches.
• The concave-convex pattern is key in decision-making, and it's integrated with new pain-related neuroscience findings.

Bibliography

• Numerous references are cited. This section provides the sources of the information presented in the notes.