Name:
Johansson: Passive Range of Motion in Diagonals, Including Variations of Distal Joints
Description:
Johansson: Passive Range of Motion in Diagonals, Including Variations of Distal Joints
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Duration:
T00H04M56S
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Upload Date:
2022-02-23T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Often, a therapist chooses to provide range of motion in a diagonal plane, providing motion at more than one joint simultaneously. The clinician positions herself in line with the diagonal motion, or in the groove, for smoother motion, and optimal body mechanics. Within the first two diagonal patterns of the upper and lower extremities, variations of the position of the intervening joint, the elbow and knee respectively, are possible. The first example is D1 flexion of the upper extremity, starting with the patient's shoulder in extension, abduction, and internal rotation, with the elbow, wrist and fingers extended.
Notice the clinician's foot stance in line with the plane of motion. The arm is brought into shoulder flexion, adduction, and external rotation with the elbow, wrist and fingers flexing. The feet of the clinician remain in line with the diagonal plane of motion, pivoting as the patient's arm moves from one end of the diagonal plane to the other. For D1 extension of the upper extremity, move the patient's shoulder from this flexed position into extension, abduction, and internal rotation, with the elbow, wrist and hand extending.
For D2 flexion of the upper extremity, the shoulder begins in extension, internal rotation, and adduction. The arm is moved into shoulder flexion, abduction, and external rotation. The clinician pivots to stay in line with the diagonal. For D2 extension, the arm is brought back into shoulder extension, adduction, and internal rotation, with the extension of the elbow, wrist and hand.
In the D1 pattern for the lower extremity, the clinician is again positioned in the diagonal for smooth movement, and to assist with safe body mechanics when ranging a heavier extremity. For D1 flexion of the lower extremity, the hip begins in extension, abduction, and internal rotation, with the knee extended, and the ankle in plantar flexion. The leg is moved into hip flexion, adduction and external rotation, with knee flexion, and ankle dorsiflexion.
To maintain the diagonal movement, the clinician focuses initially on hip flexion and adduction, allowing the rotation to occur along the way. It may help to imagine that the line of the diagonal is being drawn by the patient's knee. Additional external rotation can be achieved toward the end of the diagonal motion. To avoid stress to the knee joint, the clinician applies the rotary motion primarily at the distal thigh. In this diagonal movement, the clinician stays close to the extremity and shifts his or her weight forward into the motion, as if performing a lunge.
D1 extension moves the hip back into extension, with abduction and internal rotation, along with knee extension, and ankle dorsiflexion. As the leg moves into extension, the clinician shifts her weight to the back foot, to allow full movement and maintain effective body mechanics. For D2 lower extremity flexion, the opposite leg is abducted slightly before range begins, to allow room for the entire movement. The hip begins in extension, adduction, and external rotation, with knee extension, and ankle plantar flexion.
At the beginning of the movement, the clinician stands in the diagonal position facing the patient's foot. As the leg is brought out into hip flexion, abduction, and internal rotation, with knee flexion and ankle dorsiflexion, the clinician steps back while holding the outer foot, to accommodate the full movement of the leg. Again, the clinician must be careful to apply hip internal rotation without excessive force at the knee.
Note the this patient has limited hip internal and external rotation. For D2 lower extremity extension, the leg is moved back into hip extension, adduction, and external rotation, with knee extension and ankle plantar flexion. The clinician steps forward to follow the movement through to the end.
