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FUNCTIONAL

ASSESSMENT
PROTOCOL

• Marty Hall, D.C., DACNB


F.A.P.
• In order to understand joint instability you must
understand joint stability.
• Where does joint stability primarily come from?
• What are its components?
• When damaged which structures must take over the role?
• What is the difference between instability and laxity?
F.A.P.
Midline neutral (neutral axis) – A
longitudinal line in a long structure
where normal axial stresses are zero
when the structure is subjected to
bending. That is to say there are no
“stresses” imposed upon the soft
tissue components about the joint.
F.A.P.
• Zone’s
• Neutral Zone (apart of the physiologic zone)
• Elastic Zone (apart of the physiologic zone)
• Plastic Zone (apart of the pathologic zone)
• Destructive Zone (apart of the pathologic zone)
F.A.P.
• Neutral zone – The initial phase of ROM is called the neutral zone
(NZ) and is usually quite small.
• An exception to the rule is the atlanto-axial joint (C1-2) where the
NZ makes up 75% (30 degrees) of the total ROM for Y axis motion
(40-45). Therefore the NZ can be thought as the free-play or “slop” of
the motion segment or joint laxity around the neutral position.
F.A.P.
• NZ continued – Also described as the displacement between the
neutral position and the initiation point (beginning) of spinal
resistance to physiological motion. Translatory and rotatory
neutral zones are expressed in meters and degrees, respectively.
The neutral zone can be expressed for each of the six degrees of
freedom. (X-Y-Z, + & -, Translational & Rotational)
F.A.P.
• NZ continued – Starting from the neutral position, there is
large deformation due to application of a small load. After this
“easy” deformation, again called “free-play” or “joint play”,
there is increasing resistance offered by the tissue. Thus, the
motion that takes place between the neutral position (mid-line)
and the beginning of significant resistance is the NZ.
F.A.P.
• Pathological neutral – The NZ has been shown to increase with:
• Degeneration (joint & disc)
• Surgical injury
• Repetitive cyclic loads
• High-speed trauma
• Elastic Zone is at the end of the neutral zone to the end of
active and passive joint motion.
• This passive sub-system provides restraint to control end of
range motion.
• Plastic Zone starts at the yield point and leads to plastic
deformation.
• Destructive zone. Encompasses both the plastic deformation to
complete failure (fracture).
BARRIERS TO MOTION

• 1st barrier is called physiologic and represents the end of A-


ROM.
• 2nd barrier is called elastic and represents the end of P-ROM.
• 3rd barrier is called anatomic or anatomical and represents the
end of joint motion that causes no permanent damage to the
structures that limit or “check” motion and are important to
joint stability.
FULL (RESTRICTION FREE) JOINT
MOTION
• Is that motion attained through complete and un-encumbered
motion with assistance (passive) up to that joints anatomical
barrier.
• To get from the elastic barrier to the anatomic barrier requires
a force that exceeds the strength of those things (capsular, fluid
& surface tension etc.) that normally restrict joint motion
creating that elastic barrier.
THE SPACES BETWEEN THE
BARRIERS.
• The space created between the physiologic barrier and the
elastic barrier or the space created between the different
distances attained with A-ROM & P-ROM is where we perform
mobilization.
• This is an aspect of joint motion that one can not do to them self
or by them self. It requires outside assistance and therefore is
passive in nature.
• We use this area (work with in this space) to increase ROM
when we can not, for some reason, perform the preferred HV-
LA.
ANATOMICAL BARRIER
• We can breech this barrier in degrees (plastic zone). These are
usually graded. There are plastic changes of tissues about the
joint that occur initially before total separation &/or permanent
damage. Changes to this barrier effect future joint stability.
• Limits of Motion (Barriers)