THERAPEUTIC INTERVENTIONS Exam 3
Questions and Answers Latest Versions 2025 A+
stress
term to denote the external force applied to tissue
strain
term to denote tissue transition
elastic
1st phase of the stress-strain curve where there is an immediate
return to resting state when load is removed
plastic
2nd phase of the stress-strain curve where the tissue remains
elongated when force is removed
necking point (yellow)
occurs during the 2nd/plastic phase of the stress-strain curve
where decreased force application continues to produce
elongation that indicates the tissue is about to fail
0
grade of a joint excursion assessment where there is no motion
and the joint is ankylosed, so no mobilization is indicated
1
grade of a joint excursion assessment where there is
considerable limitation, but mobilization is indicated
2
grade of a joint excursion assessment where there is slight
limitation, but mobilization is indicated
3
grade of a joint excursion assessment that is normal
4
grade of a joint excursion assessment where there is a slight
increase in mobility that indicates the need for stabilization,
posture/positioning, and possible taping/bracing
5
,grade of a joint excursion assessment where there is a
considerable increase in mobility that indicates the need for
stabilization, posture/positioning, and taping/bracing
6
grade of a joint excursion assessment where the joint is deemed
unstable and requires stabilization through taping or bracing
spasm, springy, leathery
what are characteristics of an abnormal firm end feel?
osteophyte, malunion of fracture, myositis ossificans, loose
body
what are characteristics of an abnormal hard (bony) end feel that
occurs before expected end of motion?
effusion/edema associated with inflammation
what are characteristics of a soft (boggy0 end feel?
capsule
fibrous connective tissue that acts to maintain integrity of synovial
joints
capsular pattern
injuries to a joint capsule that follows a distinct pattern in loss of
passive range of motion
positional faults
alignment of a joint with respect to other surrounding joints that is
assessed through palpation of bony landmarks in relation to each
other and indicates positional faults vs inherent developmental
anomaly
contraindication/precaution
any condition that has not been fully evaluated or a lack of patient
consent
mechanical and neurophysiological
what are the 2 main effects of joint mobilization?
mechanical
effect of joint mobilization that is related to restoring normal joint
mobility or range of motion and correct positional faults
neurophysiological
,effect of joint mobilization that affects the interaction between
inflammatory mediators and peripheral nociceptors in an attempt
to "reset" nervous activity
placebo, nocebo, patient expectations, therapeutic alliance
what are the physiological effects of joint mobilization?
regional interdependence
unrelated impairments in a remote anatomic region may
contribute to or be associated with a client's primary complaint
due to both mechanical and neurophysiological effects
Kaitenborn, Maitland, and Mulligan
what are 3 common intervention strategies?
Kaitenborn
intervention strategy that identifies joint hypomobility using
accessory motion testing by moving the joint in the same direction
as hypomobility
Maitland
intervention strategy that identifies the painful accessory motion
and treats with techniques that move the joint in the same
direction as the painful accessory motion, but not into pain
Mulligan (treatment based classifications/pattern
recognition)
intervention strategy that recognizes patterns of signs and
symptoms and treats based on the presence of those signs and
symptoms
subjective exam, objective exam, obtain consent, exam joint
in resting/loose packed position, evaluate accessory motion
what are the basic principles of examination/evaluation?
selection of technique, treat restriction with respect to pain,
open communication, use proper body mechanics
what are the primary principles of intervention?
grade 1
grade of mobilization characterized as a slow, small-amplitude
movement that does not take the joint capsule to the limit of
available joint motion
grade 2
, grade of mobilization characterized as a slow, large-amplitude
movement that does not take the joint capsule to the limit of
available joint motion
grade 3
grade of mobilization characterized as a slow, large-amplitude
movement that takes the joint up to and slightly through the limit
of available joint motion and into tissue resistance
grade 4
grade of mobilization characterized as a slow, small-amplitude
movement that is performed through the limit of available joint
motion and into tissue resistance
grade 5
grade of mobilization characterized as a high-velocity, small
amplitude, non-oscillatory movement that begins at the limit of
available joint motion and takes the joint into tissue resistance
R1
the first perceptible tissue resistance
R2
the end of the joint motion/limit of resistance
grade 1 and 2
what grades of joint mobilizations are used for the treatment of
high severity and high irritability pain-treat joints with empty end
feel?
grade 3 and 4
what grades of joint mobilizations are used as treatment to
improve ROM/stiffness that is very often associated with the pain?
3-4; 30-60
___-___ sets of ___-___ seconds for grade 1-4 per treatment
based on patient response
3
grade 5 should be a grade ____ assessment followed by a pre-
manipulative hold of at least 10 seconds then a single high
velocity thrust
active exercises
Questions and Answers Latest Versions 2025 A+
stress
term to denote the external force applied to tissue
strain
term to denote tissue transition
elastic
1st phase of the stress-strain curve where there is an immediate
return to resting state when load is removed
plastic
2nd phase of the stress-strain curve where the tissue remains
elongated when force is removed
necking point (yellow)
occurs during the 2nd/plastic phase of the stress-strain curve
where decreased force application continues to produce
elongation that indicates the tissue is about to fail
0
grade of a joint excursion assessment where there is no motion
and the joint is ankylosed, so no mobilization is indicated
1
grade of a joint excursion assessment where there is
considerable limitation, but mobilization is indicated
2
grade of a joint excursion assessment where there is slight
limitation, but mobilization is indicated
3
grade of a joint excursion assessment that is normal
4
grade of a joint excursion assessment where there is a slight
increase in mobility that indicates the need for stabilization,
posture/positioning, and possible taping/bracing
5
,grade of a joint excursion assessment where there is a
considerable increase in mobility that indicates the need for
stabilization, posture/positioning, and taping/bracing
6
grade of a joint excursion assessment where the joint is deemed
unstable and requires stabilization through taping or bracing
spasm, springy, leathery
what are characteristics of an abnormal firm end feel?
osteophyte, malunion of fracture, myositis ossificans, loose
body
what are characteristics of an abnormal hard (bony) end feel that
occurs before expected end of motion?
effusion/edema associated with inflammation
what are characteristics of a soft (boggy0 end feel?
capsule
fibrous connective tissue that acts to maintain integrity of synovial
joints
capsular pattern
injuries to a joint capsule that follows a distinct pattern in loss of
passive range of motion
positional faults
alignment of a joint with respect to other surrounding joints that is
assessed through palpation of bony landmarks in relation to each
other and indicates positional faults vs inherent developmental
anomaly
contraindication/precaution
any condition that has not been fully evaluated or a lack of patient
consent
mechanical and neurophysiological
what are the 2 main effects of joint mobilization?
mechanical
effect of joint mobilization that is related to restoring normal joint
mobility or range of motion and correct positional faults
neurophysiological
,effect of joint mobilization that affects the interaction between
inflammatory mediators and peripheral nociceptors in an attempt
to "reset" nervous activity
placebo, nocebo, patient expectations, therapeutic alliance
what are the physiological effects of joint mobilization?
regional interdependence
unrelated impairments in a remote anatomic region may
contribute to or be associated with a client's primary complaint
due to both mechanical and neurophysiological effects
Kaitenborn, Maitland, and Mulligan
what are 3 common intervention strategies?
Kaitenborn
intervention strategy that identifies joint hypomobility using
accessory motion testing by moving the joint in the same direction
as hypomobility
Maitland
intervention strategy that identifies the painful accessory motion
and treats with techniques that move the joint in the same
direction as the painful accessory motion, but not into pain
Mulligan (treatment based classifications/pattern
recognition)
intervention strategy that recognizes patterns of signs and
symptoms and treats based on the presence of those signs and
symptoms
subjective exam, objective exam, obtain consent, exam joint
in resting/loose packed position, evaluate accessory motion
what are the basic principles of examination/evaluation?
selection of technique, treat restriction with respect to pain,
open communication, use proper body mechanics
what are the primary principles of intervention?
grade 1
grade of mobilization characterized as a slow, small-amplitude
movement that does not take the joint capsule to the limit of
available joint motion
grade 2
, grade of mobilization characterized as a slow, large-amplitude
movement that does not take the joint capsule to the limit of
available joint motion
grade 3
grade of mobilization characterized as a slow, large-amplitude
movement that takes the joint up to and slightly through the limit
of available joint motion and into tissue resistance
grade 4
grade of mobilization characterized as a slow, small-amplitude
movement that is performed through the limit of available joint
motion and into tissue resistance
grade 5
grade of mobilization characterized as a high-velocity, small
amplitude, non-oscillatory movement that begins at the limit of
available joint motion and takes the joint into tissue resistance
R1
the first perceptible tissue resistance
R2
the end of the joint motion/limit of resistance
grade 1 and 2
what grades of joint mobilizations are used for the treatment of
high severity and high irritability pain-treat joints with empty end
feel?
grade 3 and 4
what grades of joint mobilizations are used as treatment to
improve ROM/stiffness that is very often associated with the pain?
3-4; 30-60
___-___ sets of ___-___ seconds for grade 1-4 per treatment
based on patient response
3
grade 5 should be a grade ____ assessment followed by a pre-
manipulative hold of at least 10 seconds then a single high
velocity thrust
active exercises
