DPT 754 Joint mobilizations part 1 (Maitland)

Describe the fundamental task of Maitland joint mobilizations

Examiner feels for abnormal resistance to motion and monitors for any symptoms

Assess and reassess

What type of principles influenced Maitland's philosophy?

Neurophysiologic principles relating to pain

Describe the fundamental task of Kaltenborn joint mobilizations

Examiner feels for abnormal resistance to motion with emphasis on end-feel testing

What type of principles influenced Kaltenborn's philosophies?

Joint based, mechanical approaches

MAIN goals of joint mobilizations (2)

Restore joint play by normalizing roll and glide of movements

Modulate pain to restore normal, painless joint function

Relate the treatment plane for joint mobs with the convex/ concave surface of joints

Treatment plane always relates to concave surface, regardless whether moving joint partner is concave or convex

What numerical system is used to identify Maitland joint mob grades?

Roman numerals

How are Maitland joint mobs applied?

Uses oscillatory movements of different amplitudes applied at different parts of the ROM

Describe the amount of motion delivered in a grade I Maitland joint mob. Do we encounter resistance?

Small amplitude at the beginning of range

No tissue resistance encountered

How do grade I Maitland joint mobs reduce pain and enhance relaxation?

Via neurophysiological effects

Describe the amount of motion applied in a grade II Maitland joint mob. Do we encounter resistance?

Large amplitude oscillation from near beginning to midrange.

If you reach resistance, you have gone too far.

How do grade II Maitland joint mobs reduce pain?

Via neurophysiological effects (same as grade I)

Reasons to use grades I and II Maitland joint mobs (3)

Maintain (not increase) joint mobility

Promote tissue healing

Provide pain relief

How do small oscillatory movements (grades I and II) modify pain signals?

Stimulate mechanoreceptors that modify pain via descending inhibition of nociceptive transmission in SC

Do grades I and II joint mobs excite the system centrally or distally?

Hypothesized to be mediated centrally via brainstem

Should grades I and II joint mobs place a stretch on the reactive tissues?

No

Examples of times when grades I and II would be useful joint mobs (3)

Active inflammation of joint

Post-operatively

When you can't add stretch to an area

What grade is the most common Maitland joint mob to perform?

Grade III

Describe the movements of the grade III Maitland joint mob. Do we encounter resistance?

Large amplitude oscillation from mid -> end range

Hits end range abruptly

Taken into tissue resistance

Describe the movements of the grade IV Maitland joint mob. Do we encounter resistance?

Small amplitude oscillations at end range into tissue resistance

Grades III and IV Maitland joint mobs have this sort of effect on joints

Mechanical effect

What symptoms are grades III and IV joint mobs meant to treat?

Stiffness (III and IV)

Stretching of capsular lesions (III) (disruption of adhesions)

What type of joints receive grades III and IV Maitland joint mobs?

Joints with hypomobility and/or periarticular capsular restrictions

Main goal of grades III and IV Maitland joint mobs

Increase joint mobility

Describe the movement of a grade V Maitland joint mob. What do we feel?

Small amplitude thrust beyond end range

Do grade V Maitland joint mobs use a neurophysiologic or mechanical effect?

Mechanical effect

Primary purpose of grade V Maitland joint mob

Used for stiffness and pain control

Nickname for grade V Maitland joint mobs

Manipulations