Contractile and non contractile dysfunction, Manual Grading

Contractile and Non Contractile dysfunction:

Cyriax provides one model for distinguishing contractile (muscle) lesions from non-contractile (example. joint) lesions by comparing responses to various tests of active and passive movements. Cyriax divide musculoskeletal structures into contractile and non-contractile elements for diagnosis purposes. Contractile elements consist of muscle with its tendons and its attachments. Non-contractile elements include all other structures such as bones, joint capsules, ligaments, bursae, fascia, dura-mater and nerve roots. Contractile and non contractile dysfunction differs in that, in contractile dysfunction Pain is caused by mechanical deformation of structurally impaired soft tissues which is felt when this abnormal tissue is loaded. In non contractile dysfunction Active and passive movements produce or increase symptoms and are restricted in the same direction and at the same point in the range.

Contractile & Non Contractile Dysfunction
Contractile and Non contractile dysfunction

Contractile Dysfunction:

Definition:

Pain that is caused by mechanical deformation of structurally impaired soft tissues which is felt when this abnormal tissue is loaded.

Principle:

  • Passive joint play movements are normal and symptoms free.
  • Restricted movements produce or increase symptoms
  • Active and passive movements produce or increase symptoms and are restricted in opposite direction. 

Example:

  1. Active external rotation of the shoulder is painful and restricted as the affected muscle contracts.
  2. Passive external rotation is pain free and shows a greater range of movement, Passive internal rotation is painful as the affected muscle is stretched.

Non-Contractile Dysfunction:

Definition: Active and passive movements produce or increase symptoms and are restricted in the same direction and at the same point in the range.

Principles:

  • Passive joint play movement produce or increase symptoms and are restricted.
  • Restricted movements are symptom free.

Example:

  1. Active and Passive external rotation of the shoulder is painful and is restricted at the same degree.

Translatoric Joint Play: 

Movements, Compression, Gliding, Traction:

In every joint there are positions in which looseness or or slack in a capsule & ligament and allow small, precise movements of joint play to occur as a consequence of internal & external movement forces on a body.

Purpose of Mobilization:

The purpose of joint mobilization is to restore normal, painless joint function.

Traction:

Traction (separation) is a linear translatoric joint play movement at a right angle and away from treatment plane. It is often done using ropes, pulleys and weight. These tools help apply force to tissues surrounding the damaged area.

Uses of Traction:

  • Stabilize and realign bone fractures.
  • Help reduce pain of fracture.
  • Treat bone deformities i.e caused by scoliosis.
  • Correct stiff and constricted muscles, joints, tendons or skin.

Types of Traction:

  1. Skeleton traction
  2. Skin traction
  3. Cervical traction

1.Skeletal Traction: Involves placing a pin, wire or screw in a facilitated bone. The force is directly applied to bone which means has less risk of damaging.
2.Skin Traction: Skin traction is for less invasive than skeleton traction.
3.Cervical Traction: During cervical traction a metal brace is applied around your neck the brace is then attached to body harness or weights which are used to help correct the affected area.

Risk of traction:

An adverse reaction to anesthesia , Excessive bleeding

Infection of pin size damage to surrounding tissue.

Compression:

It is a linear translatoric movement at right angle to and toward the treatment plane. Compression presses the joint surfaces together. Joint compression can be useful as an evaluation technique to differentiate between articular and extra-articular lesions.

Gliding:

Translatoric gliding is a joint play movement parallel to treatment plane.

Grade 3 Stretch Mobilization, General Mobilization Contraindications:

Grade 3 Mobilization:

Moderate movements of large amplitude done through available range of motion and into the resistance, primarily used to increase motion.

Contra-indications:

Contraindications to joint mobilization are relative and depend upon many factors including:


Manual Grading, Grade 3 Stretch Mobilization

Relationships between musculoskeletal joint play and Range of movement Joint play end feel Patients symptoms. Grade 1 and 2 within the slack mobilizations are seldom contraindicated but many contraindications exists for grade 3 stretch mobilizations. There are many additional specific contraindications for grade 3 manipulative (high velocity thrust) techniques which are performed so quickly that patient is unable to abort procedure.

General Contra-Indications to grade 3 Stretch Mobilization:

Relate primarily to health problems that reduce body’s tolerance to mechanical forces and therefore increase risk of injury. Pathological changes due to infections, inflammation, neoplasm. Active collagen vascular disorders. Massive degeneration changes. Certain congenital anomalies i.e. dysplasia, aplasia, hyperplasia. Anomalies or pathological changes in vessels. Coagulation problems eg. hemophilia. Dermatological problems aggravates by skin contact & open lesions. Mobilization may contraindicated in autonomic nervous system disorders. Mobilization can affect autonomic nervous responses.

Specific Contra-indications to Grade 3 Stretch Mobilization:

Decreased joint play with a hard, non-elastic end-feel in a hypomobile movement direction. Increased joint play with soft elastic end feel in a hypomobile movement direction. Pain & Protective muscle spasm during mobilization. Positive screening tests. Screening tests identify conditions that contra-indicated specific mobilization techniques and should be completed prior to treatment.

Manual Grading, Assessing Quantity of movements in Physiotherapy:

Assessing Quantity of movements: 

With smaller passive movements in joint with little range of motion as the spinal segments, test range of movement first with more rapid oscillatory movement that do not require stabilization neighboring joints. If these oscillatory tests reveal restrictions or sympathetic areas, follow up and stabilization of adjacent joints.

Measuring With a Device:

The amount of active or passive range of movement can be measured with an instrument such as goniometer, ruler or other device for example distance of the finger tips and floor as a measurement of standard rotatory spin and hip movement. Hyper mobility and hypo mobility are only pathological findings if they are associated with symptoms.

Example:

Positive symptom provocation or alleviation tests if associated end feel is pathological.Normal end feel is usually due to some congenital structural anomaly.

Manual Grading 0 to 6 scale:

In joints with little range of motion such as carpal joints of single spinal segments it may be impossible or impractical to measure range of motion with goniometer.

Hypomobility:
0=No movement (ankylosis)
1=Considerable decreased movement
2=Slight decreased movement

Normal:
3=Normal

Hypermobility:
4=Slight increased movement
5=Considerable increased movement
6=Complete instability


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