Kaltenborn manual mobilization srs

Kaltenborn Manual Mobilization

Sreeraj S R

Kaltenborn – Evjenth

Orthopedic Manipulative Therapy (OMT)

• Kaltenborn Techniques

� Kaltenborn’s techniques use a combination of traction and

mobilization to reduce pain and mobilize hypomobile joints

� According to Kaltenborn, all joint mobilizations, when

performed correctly should be made parallel, or at right angles

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performed correctly should be made parallel, or at right angles

to this plane of motion

• Maitland's grades of joint mobilization differ from Kaltenborn's

because they are oscillations while Kaltenborn's are sustained.

http://quizlet.com/2850456/joint-mobs-maitland-vs-kaltenborn-flash-cards/

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Two types of bone movements are important in OMT

system:

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Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 1: Extremity Joint Movement: p. 24

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• A common goal in OMT is to restore the gliding

component of roll-gliding to normalize movement

mechanics.

• Joint rolling movements in the absence of gliding can

produce a damaging concentration of forces in a

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produce a damaging concentration of forces in a

joint.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 1: Extremity Joint Movement: p. 29

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The Kaltenborn Treatment Plane

• passes through the joint

and lies at a right angle

to a line running from

the axis of rotation in

the convex bony

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the convex bony

partner, to the deepest

aspect of the

articulating concave

surface.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 32

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The Kaltenborn Treatment Plane

• remains with the concave

joint surface whether the

moving joint partner is

concave or convex.

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• Always test joint play or

mobilize a joint by moving

the bone parallel to, or at a

right angle to, the

Kaltenbom Treatment

Plane.Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 32

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Translatoric joint play movements

• The translatoric joint play movements used in the

OMT Kaltenbom-Evjenth System are

• Traction,

• Compression, and

Gliding.

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• Gliding.


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Traction

Compression Gliding

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Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 33-34

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Determining the direction of restricted gliding

• There are two methods of determining the direction

of restricted joint gliding:

1. The glide test, and

2. The Kaltenborn convex concave rule .

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Glide test

• It is the direct method

• Apply passive translatoric gliding movements in all

possible directions and determine in which directions

joint gliding is restricted.

• The glide test is the preferred method because it

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• The glide test is the preferred method because it

gives the most accurate information about the

degree and nature of a gliding restriction, including

its end-feel.


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Kaltenborn Convex-Concave Rule

• the indirect method

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Grades of translatoric movement

• The translatoric movements of traction and gliding are divided into three grades.

• These grades are determined by the amount of joint slack (looseness and resistance) in the joint

• The slack is taken up when testing and treating joints with gliding or traction.

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with gliding or traction.

• When gliding is performed, the slack is taken up in the direction of joint gliding;

• when traction is performed, the slack is taken up in the direction of traction.


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Normal grades of translatoric movement

• In the Grade I and II SZ range the therapist senses little or no resistance.

• In the Grade II TZ range the therapist senses gradually increasing resistance.

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increasing resistance.

• At the First Stop, the therapist senses marked resistance as the slack is taken up and all tissues become taut.

• Stretching occurs beyond this point.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 37-38

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Pathological grades of translatoric movement

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Using translatoric grades

• Grade I (loosen): relief pain

• Grade II (tighten): initial treatment, maintain joint

play

• Grade III (stretch): stretch joint and increase joint

play

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play

1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 40

2. http://sunrise.hk.edu.tw/~stpt/languagetherapy/therapeutic/teacher/Introduction%20of%20manual%20therapy.pdf

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Tests of function

• Tests of function are a key element within the OMT

evaluation;

• Assessing quantity of movement

Assessing quality of movement

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• Assessing quality of movement

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 42-46

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Quantity of Movement

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Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 42

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Quality of Movement

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1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 45

2. Petersen CM, Hayes KW. Construct Validity of Cyriax's Selective Tension Examination: Association of End-feels With Pain at the Knee and

Shoulder. Journal of Orthopaedic & Sports Physical Therapy 2OOO;3O (9) :5 12-527

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Quality of Movement

Normal End Feel

• Soft: characteristic of soft tissue approximation. Feels like squeezing two balloons together. e.g., knee flexion.

• Firm: indicates that the joint capsular or ligamentousstretching limiting the ROM. Feels like stretching a leather

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stretching limiting the ROM. Feels like stretching a leather belt. A normal ligamentous end-feel > capsular end-feel.

• Hard: indicates that bone touching bone is limiting the ROM. Feels like pushing two wooden surfaces together. e.g., elbow extension.

1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 45

2. http://www.scranton.edu/faculty/kosmahl/courses/gonio/intro/end-feel.shtml

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Quality of Movement

Pathological end-feel

• Boggy: intra-articular swelling produces a soft

resistance

• Springy: For example, a displaced meniscus

Empty: Pain

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• Empty: Pain

• Firmer, less elastic: scar tissue, shortened connective

tissue

• More elastic and less soft end-feel: muscle spasm


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Elements of function testing

• Standard (anatomical) movements

• Combined (functional) movements

• Painful arc

• Capsular pattern

Differentiating Contractile lesions from

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• Differentiating Contractile lesions from

Non contractile lesions

• Differentiating muscle shortening from

muscle spasm


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Differentiating Contractile lesions from

Non contractile lesions

Contractile Non contractile

Muscle with its tendons and attachments Bones, joint capsules, ligaments, bursae,

Fasciae, nerve roots

Active and passive movements are

restricted in opposite directions.

Active and passive movements are

restricted in the same direction.

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restricted in opposite directions. restricted in the same direction.

Passive joint play movements are normal

and symptom free.

Passive joint play movements produce or

increase symptoms and are restricted.

Resisted movements produce or increase

symptoms.

Resisted movements are symptom free.


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Differentiating muscle shortening from

muscle spasm

• Based on end-feel testing.

• A shortened, tight muscle imparts a firmer, less

elastic end-feel

• Muscle spasm produces a more elastic and less soft

end-feel.

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end-feel.


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Translatoric joint play tests

• Testing the quantity and quality of joint play,

including end feel, using

• Traction,

• Compression, and

Gliding

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• Gliding

• In all of the translatoric directions in which a joint is

capable of moving.


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Traction and compression tests

Traction Compression

Relieves joint pain Aggravates joint pain

If traction tests is positive in the normal

resting position, find a position of greater

comfort and reevaluate the patient's

response to traction.

If compression tests are negative, the

tests should also be performed in various

three-dimensional positions.

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response to traction.


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Gliding tests

• Translatoric gliding primarily tests those structures

belonging to the anatomical joint.

• Also important for determining the specific

directions of joint movement restrictions.

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directions of joint movement restrictions.

• Evaluates gliding movement both in the joint's

resting and non resting positions.


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Resisted movements

• If compression tests provoke pain, resisted tests are of limited Value.

• Resisted tests evaluate

• neuromuscular integrity,

• contractile elements and

• status of associated joints, nerves, and vascular supplies.

• Cyriax interprets resisted tests in the following ways:

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Cyriax interprets resisted tests in the following ways:


Painful and strong : minor lesion of a muscle or tendon

Painful and weak : major lesion of a muscle or tendon

Painless and weak : neurological lesion or complete rupture of a

muscle or tendon

Painless and strong : normal

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Differential diagnosis for pain in a

muscle synergy

• To identify a specific muscle responsible for a

patient's pain, the examiner selectively elicits or

prevents contraction of a specific muscle or group of

muscles. There are three methods described below.

1. Testing a muscle's secondary function in the

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1. Testing a muscle's secondary function in the

same joint.

2. Testing a muscle's secondary function at an

adjacent joint

3. Testing using reciprocal inhibition


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Testing a muscle's secondary function in the

same joint

• If one muscle in a joint movement synergy has a secondary function not shared by the other muscles in the synergy, it can be selectively tested.

For example,

• if resisted knee flexion is painful, further examination of resisted lateral and medial leg rotation may

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of resisted lateral and medial leg rotation may identify the specific muscle causing the pain. If lateral rotation is painful and medial rotation is not, then it is likely that the biceps femoris is injured and not the other knee flexors which medially rotate the leg.


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Testing a muscle's secondary function at an

adjacent joint

• A muscle or tendon can be selectively stressed if it is the only muscle in a synergy which functions at another joint.

For example,

• pain with resisted shoulder flexion can be due to a lesion in one of several muscles in a synergy

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lesion in one of several muscles in a synergy producing this movement. If resisted elbow flexion produces the same pain, then the biceps is implicated as it is the only muscle which can produce both shoulder and elbow flexion.


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Testing using reciprocal inhibition

• This technique uses to prevent a muscle from contracting in synergy with other muscles during a movement by resisting the antagonist of the muscle.

For example,

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• To eliminate the wrist extensors and test the finger extensors, the examiner resists palmar flexion at the wrist and finger extension simultaneously; the resisted wrist palmar flexion will inhibit contraction of the wrist extensors.


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Indications

• Restricted joint play (hypomobility)

• An abnormal end-feel

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Absolute Contraindications

• Malignancy in area of treatment

• Infectious Arthritis

• Metabolic Bone Disease

• Neoplastic Disease

• Fusion or Ankylosis

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• Fusion or Ankylosis

• Osteomyelitis

• Fracture or Ligament Rupture

• excessive joint play (hypermobility) for grade III mobilization

http://www.physio-pedia.com/images/c/c0/Principles_of_Joint_Mobilization.pdf

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Relative Contraindications

• Excessive pain or swelling

• Arthroplasty

• Pregnancy

• Hypermobility

Spondylolisthesis

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• Spondylolisthesis

• Rheumatoid arthritis

• Vertebrobasilar insufficiency

http://www.physio-pedia.com/images/c/c0/Principles_of_Joint_Mobilization.pdf

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THANK YOU

Sreeraj S R

will be continued @ the Practical….

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Kaltenborn manual mobilization srs

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