Saturday, September 5, 2009

Grades of accessory movement

Grades of accessory movement

This following article is about introducing the novice manual therapist to grades of applying passive accessory movement.

Variables of Passive accessory movement administration

1. Direction
2. Grade
3. Speed & Rhythm
4. Duration of administration

Aim of grading of passive accessory movements

1. To assess: Different abnormalities of spine & periphery presents with different amount of pain & resistance to passive movements. Our approach to palpation can not be the same to all of them as there may be different grades of tolerance to forces due to either mechanical faults or inflammation.
a) Hence first of all force identified into different grades provides a rational explanation to approach tissue faults.

b) It also helps to find out localized & referred pattern of pain (especially in spinal conditions).

c) It further indicates tissue condition accessible at different depth of penetration (feel of the tissue).

d) It also helps to assess the reaction of pain to that of force. Pain reaction to passive force indicates the receptive capacitance of the tissue.

e) At other end of the finding, we are able to compare the normal to abnormal mobility (hypo-mobile, Hyper- mobile etc).

2. To treat:
a) It is an established fact that graded passive forces of different depth produce different mechanical impacts on the peripheral mechanoreceptors that further affects the pain gait. However, many other hypotheses for explanation are there in vogue.

b) The bottom line is graded forces suitable to the tolerance can be administered to produce reduction of pain or change in local and over all mobility.

c) It is seen that after pain centralization in spine the local tissue can tolerate more mobilizing force (higher grades).

The bottom line of grading passive accessory movements:

There are varying international practices for the description of the grades of technique application. Treatment techniques are usually graded for easier communication between therapists. The grades describe how the technique was applied in terms of amplitude and where in the range it was applied. This allows another therapist to take over a treatment and perform similar techniques on the patient. It also makes recording of treatment easier. One of the more common ways of describing the grades of Passive Accessory Intervertebral Movement application is the 4 grades of classification developed by Maitland 2001.

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