Maximally Loose Packed Position (MLPP) & Close Packed Position (CPP) Explained

Summary

This video explains the concept of close-packed and maximum loose-packed positions in joint therapy. The close-packed position, where the joint surfaces are tightly compressed and the ligaments are under maximal tension, is the most stable position, but joint mobilizations cannot be performed here. In contrast, the maximum loose-packed position offers minimal stress on the joint, with relaxed ligaments and maximum space within the joint, making it ideal for joint mobilizations, manipulations, and assessing joint play. The video emphasizes the importance of these positions in physiotherapy treatments and their role in reducing pain and improving joint function.

Takeaways

• 😀 The close-packed position (CPP) is the joint position where the concave surface is in complete congruence with the convex surface, and the joint is under maximal tension.
• 😀 In the close-packed position, the joint surfaces are tightly compressed, and traction cannot be performed as the bones cannot be separated.
• 😀 The maximum loose-packed position (MLPP) is the opposite of the CPP, where the joint is under the least stress, and the capsule is most relaxed.
• 😀 The MLPP provides maximum space inside the joint, allowing for the greatest extent of traction across the joint.
• 😀 In the MLPP, articular surfaces have minimal congruence and contact areas between joint partners are reduced, offering optimal joint lubrication.
• 😀 Patients with serious joint inflammation tend to prefer keeping the joint in the MLPP for pain relief.
• 😀 The resting position refers to when all muscles crossing the joint are maximally relaxed, which is different from the MLPP.
• 😀 Knowledge of CPP and MLPP is crucial for physiotherapists to determine the correct joint mobilization techniques.
• 😀 In the CPP, joint mobilizations cannot be performed due to the joint's stability and tension.
• 😀 The MLPP is used for joint play assessments and for performing traction mobilizations and manipulations aimed at equally stressing the whole capsule.
• 😀 An overview table of CPP and MLPP for different joints is available for download, providing helpful reference for physiotherapists.

Q & A

What is the close-packed position of a joint?

The close-packed position occurs at one extreme of the most habitual movements of the joint. In this position, the concave surface is in complete congruence with the convex surface, the capsule and ligaments are under maximal tension, and the joint surfaces are tightly compressed.

What are the implications of the close-packed position for joint therapy?

In the close-packed position, joint mobilizations cannot be performed because the joint surfaces are tightly compressed, and the joint cannot be separated by traction. This position can be useful for stabilizing joints during certain therapeutic movements, such as fixing a toe joint to move an adjacent joint.

What is the maximum loose-packed position (MLPP) of a joint?

The maximum loose-packed position (MLPP) is the exact opposite of the close-packed position. In this position, the joint is under the least stress, the capsule is most relaxed, and there is maximum space within the joint, allowing for traction mobilizations and manipulations to reduce pain.

How does the MLPP relate to joint lubrication?

In the MLPP, the bones of the articular unit are spaced farther apart, which facilitates the greatest possible joint space for joint lubrication. This helps reduce friction and provides better movement across the joint.

Why do patients with serious inflammation prefer to keep their joints in the MLPP?

Patients with serious inflammation prefer to keep their joints in the MLPP because it is the position of least stress and the capsule is most relaxed. This reduces pain and discomfort by maximizing the space inside the joint.

What is the difference between MLPP and the resting position of a joint?

The MLPP refers to the position of the joint with minimal stress and maximum space, while the resting position is the posture in which all muscles crossing the joint are maximally relaxed. The resting position is not the same as the MLPP.

Why are joint mobilizations not performed in the close-packed position?

Joint mobilizations cannot be performed in the close-packed position because the joint surfaces are tightly compressed, and there is no room to separate the bones. Mobilizations require space within the joint to apply traction effectively.

How is the close-packed position used for therapeutic purposes?

The close-packed position can be used to fix a joint in place, such as the hip in extension, internal rotation, and adduction, to allow for the movement of adjacent joints or to stabilize a joint during specific therapeutic interventions.

What role does the MLPP play in reducing pain?

The MLPP is often used in therapy to perform traction mobilizations and manipulations that stress the entire joint capsule evenly. This is helpful in reducing pain and promoting healing by providing more space within the joint and reducing pressure on sensitive structures.

How can the CPP and MLPP knowledge benefit physiotherapists?

Knowledge of the CPP (close-packed position) and MLPP (maximum loose-packed position) is important for physiotherapists because it helps them understand the best positions for assessing joint play, performing joint mobilizations, and reducing pain through targeted therapy.