1. Manual Mobilization Of The Extremity Joint Introduction

2. Manipulationvs. Mobilization 3. Manipulation

Orthopedic Sec. APTA

• Any manual procedure used for the purpose of examination , correction or modification of an articular or soft tissue dysfunction.

Paris

• The skilled passive movement to a joint, either within or beyond its active limited motion.

Maitland

• A sudden small amplitude thrust delivered at a speed which renders the patientpowerless to prevent it

4.

Defined APTA

• The act of imparting movement, either actively or passively, to joints or soft tissue structures.

Maitland

• Passive oscillatory movements or sustained stretch at the limit of range using graded amplitude movements.

Kaltenborn

• Component of MT referring to any procedure that increases the mobility of joints or ST structures

Mobilization 5. History & School Of Thought

James Cyriax

John Mennell

Freddie Kaltenborn

Geoffrey Maitalnd

Stanley Paris

6. James Cyraix

Concept of end feel

Examination by selective tissue tension

Friction Massage

7. John Mennell

Concept of joint dysfunction

• loss of accessory or joint play movement

Jt. dysfunction as pain- producing entity, causing loss of movement

Jt dysfunction is detected by passive movement. Normal passive movement is pain free.

8. Freddy Kaltenborn

Norwegian School- biomechanical model

Applied the works of MacConnell to joint mobilization

• Concave /Convex rule

• Open/ Closed Pack Position

Focus is on movement taking place within the joint capsule

9. Freddy Kaltenborn

Brought into play the arthrokinematic and osteokinematic relationship of joint movement.

The osteokinematic and arthrokinematicat a specific joint may be the same, opposite direction.

• eg. Shoulder abduction

10. Geoffrey Maitland

Deviated from biomechanical model

• Advocating treatment of painful joints by oscillating passive movement that provide

• • Neurophysiological therapeutic

• • Mechanical therapeutic

Implemented the grading system

11. Stanley Paris

Focus is on Hypomobility

Define joint dysfunction as a state of altered mechanics either increased or decreased from the expected normal motion.

Grade scale from 0-7

• 0 no mobility

• 3 is normal

• 6 &7 unstable

12. Terminology 13. Terminology

Kinematics:

• Study of movement

Osteokinematic:

• Overall movement of bone

Arthrokinematic

• Movement of one articular surface in relation to it partner- roll, glide, spin

14. Bone Rotation (roll-gliding )

All bone movements occur around an axis.

From a mechanical viewpoint are considered to be rotation or spin

In normal joints all active movements produce joint roll-gliding

• Exception planar joints

15. Roll,Slide , Spin

Roll:Movement in which points at interval on the moving JT, surface contacts points at the same intervals on the opposite surface.

Slide.Movement in which a single point on the moving surface contacts various points on the opposing surface.

Spin.Type of slide that accompanies spin of a bone . 1/2 of the jt surface slides in one direction while the other 1/2 slide the opposite direction.

16. Distraction / Compression

Distraction: Separation of joint surfaces

Compression: Approximation ofjoint surfaces- movingtoward close pack position.

17. Accessory Movements

Those movements which accompany thephysiologicalmovements and are necessary for normal function, but not undervoluntary neuromuscularcontrol

18. Categories Of Accessory Movements

Joint Play

Component

19. Joint Play Movement

Movement that can be produced passively at a joint but cannot be isolated actively.

Spin, roll, glide, compression, & distraction

Joint play movements are used when applying specific mobilization techniques to restore accessory movements sothat full & painless osteokinematic movement may return.( eg .Inferior distraction of the shoulder)

20. Component Motion

A type of accessory movement that is directly associated with the production of osteokinematic movement or motion that takes place in a joint complex or related joint to facilitate a specific active motion

• Example: at glenohumeral Jt.

• • Inferior and posterior glide of humeral head to produce flexion of the shoulder (humerus)

21. Closed & Open Pack Positions

Closed Pack Criteria:

• Jt. Maximally congruent

• Jt caps. & ligs. are twisted

• Jt becomes locked in position

Open Pack Criteria

• Lig & caps are slack

• Jt surfaces distracted

• Movements of roll slide are allowed

22. End Feel

Refers to the nature of movement limitation experienced by theexaminer

• Assessment of joint play

It is the sensation imparted to the examiners hands during passive movement of a joint at end range