Mobilization (non-thrust manipulation) principles

Purposes of examination? (3)

assess motion

assess end-feel

assess change in symptoms

what side should you check first?

uninvolved

purposes of treatment?

decrease pain

increase muscle relaxation

decrease muscle spasm

preconditioning of articular structures for further movement

increase joint motion

outcomes: improve function

When to use joint mobilizations- examination?

if pt has decreased motion:

• is it from soft tissue?

• is it from joint?

when to use joint mobilizations- treatment?

decrease pain- low grade mobs

increase motion- high grade mobs

which joints do not follow convex- concave rules?

shoulder and MCP joints

what is assessed during accessory joint motion testing?

pain during testing: same pain, increased or decreased

amount of motion: hyper mobile, normal, hypomobile

end feel of motion: soft, firm, hard

when doing accessory joint motion testing how do you assess?

assess in all directions st that joint, indicated by the history and other prior tests and measures

assess in open packed positions (typically mid-range)

classification of end feels

soft: a gradual increases in resistance to passive motion at end range

firm: an abrupt increase in resistance to passive motion at end range

hard: an immediate stoppage to passive motion at end range

what should you assess prior to starting?

pain

joint active and passive ROM

function (activities)/ liability (participation measures

review for contraindications/ precautions

what are the nonthrust manipulations (mobilizations) system types?

Maitland

• graded oscillation techniques

kaltenborn

• sustained translator joint play techniques

mobilizations with movement (Mulligan techniques)

• sustained accessory mob while the pt is performing an active physiological movements to end ROM

self- mobilization

• self-stretching techniques that specifically use traction or glides

Grade Maitlands oscillations

grade 1: small amplitude at the beginning of rang

grade 2: large amplitude near the beginning of range

grade 3: large amplitude near end of range

grade 4: small amplitude at end of range

Grade Kaltennborn (sustained stretch) method

grade 1: “loosen”, no appreciable joint separation, only enough traction applied so as to nullify the compression forces on the joint. used with all gliding tests and mobilizations

grade 2: “tighten"‘; the slack is taken up on the tissue surrounding the joint are tightened

grade 3: “stretch’; after the slack has been taken up, more traction force is applied, and tissues are stretched

how is the reliability of the Maitland and Kaltenborn systems for examination and treatment?

poor

What grading will we use?

low grade: grade 1 and 2 Maitland, Kaltenborn 1-2

High-grade: grade 3 and 4 Maitland, Kaltenborn 2-3

utilize with or without oscillations during the mobilization

what are the contraindications?

hypermobile joint, high grade

• if painful joint, can do low grade with precaution

joint effusion, hi-grade: joint capsule is already stretched

• if painful joint, can do low- grade with precautions

inflammation: as per joint effusion

what are precautions?

• excessive pain

• hyper mobility in associated joints

• disease joint

• patient either hemiplegia or hemiparesis

• recent fracture pr unhealed fracture

• total joint replacements

• recent surgery, therefore weakened tissue

• systemic disease

• elderly

what are characteristics of documentation? (6)

rate of application of movement

location of range in the available motions

direction of force applied by the therapist

target of force

relative structural movement

patient position

if your goal is to decrease pain, what should you remember?

put joint in an open packed or least provocative joint position for mobs

if your goal is to increase ROM, what should you remember?

position the joint at end ROM

what is key for comfort and force?

PT positioning