history of manual therapy

who were the two principal pioneers of joint play manual therapy

•Geoffrey Maitland of Australia, and Freddy Kaltenborn of Norway.

•Geoffrey Maitland of Australia was influenced by

neurophysiologic prinicples relating to pain

Freddy Kaltenborn was inflenced by

joint based mechanical approaches advocated by Cyriax, Mennel, and Stodard.

peripheral joint mobilization is the

use of skilled graded forces to mobilize joints, to improve joint motion, and to normalize joint function

indication for joint mobs

•Improve joint nutrition.

•Improve m. spasm & tension

•Reduce pain.

•Reverse joint hypomobility.

•Improve or restore motion.

•Treat joint dysfunction as stiffness.

classificantion of joint mobility

•0 No Movement - joint ankylosed

•No attempts should be made to mobilize

•1 Extremely hypomobile Mobilization

•2 Slightly hypomobile Mobilization-Manipulation

•3 Normal No dysfunction; no treatment needed

•4 Slightly hypermobile Look for hypomobility in adjacent joints.

•Exercise, taping, bracing, etc

•5 Extremely hypermobile Look for hypomobility in adjacent joints.

•Exercise, taping, bracing, etc

•6 Unstable Bracing, splinting, casting,

•surgical stabiliztion

Precautions

•Malignancy -» spread & growth.

•Excessive pain -» muscle guarding, prevent movement.

•Total joint replacement -» dislocation or loosen internal fixation.

•Bone disease (Osteoporosis, TB, Rickets).

•Unhealed # (site & stabilization) -» re-fracture.

•Hypomobility (in associated joints & muscle weak) -»↑ capsule laxity, ligament. Weakness & joint dislocation.

Maitland Approach

•Maitland's joint play testing uses both rotational and translational movement within a joint.

• These movements are performed in an oscillatory manner (1 and 2-3 oscillation per second)

•The examiner feels for abnormal resistance to motion and carefully monitors any symptoms reported by the patient

grade I

•Small amplitude rhythmic oscillations at the beginning of ROM.

grade II

Large amplitude rhythmic oscillations within the ROM, but not reaching the limitation.

Grade III

•Large amplitude rhythmic oscillations up to the limit of available motion & stressed into tissue resistance.

Grade IV

•Small amplitude rhythmic oscillations, up to the limit of the available motion & stressed into tissue resistance.

Grade V

Small amplitude, high velocity, thrust technique.. Performed to break adhesions at the level of available motion (manipulation or chiropractic)

Kaltenborn's approach

•In contrast to Maitland, Kaltenborn developed his joint play testing with an emphasis on straight line, translatoric, movement within a joint.

•This testing is not truly oscillatory although it is often repeated several times using different speeds of movement.

•The examiner feels for abnormal resistance to motion with a particular emphasis on end-feel testing.

Kaltenborn 3 point scale grade I

•"loosening" movement is an extremely small traction force which produces no appreciable increase in joint separation. Grade I traction nullifies the normal compressive forces acting on the joint.

• Small amplitude distraction, applied where no stress is placed on the capsule.

•1. Equalizes cohesive force,

• 2. M. tension

• 3. Atmospheric pressure acting on the jt

Kaltenborn 3 point scale grade II

tightening •movement first takes up the slack in the tissue surrounding the joint and then tightens the tissues.

distraction or glide applied to tightened tissue around the joint

Kaltenborn 3 point scale grade III

"stretching" movement is applied after the slack has been taken up and all tissues become taut.

Maitland advocated treating

•patients with pain by directing oscillations towards the direction of movement causing pain (but not into pain).

Kaltenborn

on the other hand emphasized treating to improve function using directions that cause the least amount of pain

soft end feel

•- Characteristic of soft tissue approximation (e.g., knee flexion) or soft tissue stretching (e.g., ankle dorsiflexion with the knee extended)

•Firm

•- Characteristic of capsular or ligamentous stretching.

•• A firm endfeel is variable among individuals depending on factors such as size, age, and the extent of degenerative changes.

•• Hard

- Occurs when bone or cartilage meet (e.g., elbow extension and flexion

If the surface of moving bone is convex

•opposite direction glide

If the surface of moving bone is concave

glide in the same direction.

Traction

•the process of pulling one bony surface away from the other (joint separation)

Capsular Pattern

•The proportional loss or limitation of passive range of motion that suggests inflammation in a joint.