I often hear the terminology
open-packed and close-packed joint positions used in the clinic. In general,
clinicians know to mobilize in the open-packed position and avoid manipulation
in a close-packed position, but what else should we know about these terms? Is
there any other clinical significance to the open vs close-packed positions?
|
Open-packed Position
•Position with the least amount joint surface congruency •Capsule and support ligaments are lax •Accessory motion or joint play is maximized |
Close-packed Position
•Position with the most amount of joint congruency •Capsule and supporting ligaments maximally tight •Accessory motion is minimized |
How
Should PT's Interpret Open vs Close-Packed Clinically?
As I mentioned above, it is
important to start your joint assessment and treatment in the open-packed
position. Since the joint has the most available room for movement,
mobilizations are best tolerated in this position. For example, the open-packed
position of the knee is 25 degrees of flexion. The close-packed position is
full extension. At 25 degrees of flexion the knee is loose- one can assess
varus and valgus ligament stress testing or check tibial IR/ER mobility in this
position. Biomechanically, the knee is 'unlocked.' Following an injury, the
body favours this position because there is space for swelling and other fluid
to accumulate within the joint. As the patient's ROM improves, pain decreases,
and the swelling subsides, the clinician can start to mobilize the joint in
other positions of flexion and extension as needed.
Additionally, understanding the
open and closed packed positions is essential when performing manipulations. We
want to manipulate a joint in the open-packed position, but often times we
cannot target a specific joint unless we lock out or close-pack the surrounding
joints. For example, when performing a prone SIJ distraction manipulation, the
hip needs to be placed in extension, abduction, and internal rotation. These
three movements are the close-packed position of the hip joint. You must lock
out the hip so you do not manipulate it when you are targeting the SIJ.
Each joint has a different open and close packed position and being able to quickly recall that position will make you a more efficient clinician. If you do not understand the open and close-packed positions of regional joints, the specificity of your techniques will decrease.
Each joint has a different open and close packed position and being able to quickly recall that position will make you a more efficient clinician. If you do not understand the open and close-packed positions of regional joints, the specificity of your techniques will decrease.
Thanks to Jim
Source: https://www.thestudentphysicaltherapist.com/featured-articles/importance-of-open-closed-packed-positions