Kaltenborn manual mobilization srs

Kaltenborn Manual Mobilization

1. Kaltenborn Manual Mobilization

2. + 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
to this plane of motion

+ Maitland's grades of joint mobilization differ from Kaltenborn's
because they are oscillations while Kaltenborn's are sustained.

3. Two types of bone movements are important in OMT
system:

Bone movements Corresponding joint movements

Rotatoric (angular) movement Roll-gliding
- Standard (anatomical, uniaxial)
- Combined (functional, multiaxial)

Translatoric (linear) movement Translatoric joint play
- Longitudinal bone separation - Traction
away from the treatment plane
- Longitudinal bone approximation - Compression
towards the treatment plane
- Transverse bone movement - Gliding
parallel to the treatment plane

4. + Acommon 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

joint.

5. The Kaltenborn Treatment Plane

* passes through the joint
and lies at a right angle
to a line running from

the axis of rotation in LL
the convex bony

partner, to the deepest

aspect of the

articulating concave
surface.

6. The Kaltenborn Treatment Plane

* remains with the concave
ms ES
joint surface whether the zug
moving joint partner is
concave or convex.

Always test joint play or
mobilize a joint by moving
the bone parallel to, or ata

right angle to, the B
The treatment plane moves with The treatment plane remains

Kaltenbom Treatment the concave join pater essential statonary when the
convex jit partner moves
Plane.

E

7. ¢ The translatoric joint play movements used in the
OMT Kaltenbom-Evjenth System are

+ Traction,

+ Compression, and

+ Gliding.

8. Traction

Bone movement at a right angle to and away from the

treatment plane results in traction (separation) of joint surfaces.

Compression Gliding

HR A RY

Bone movement at a right angle to and towards the Translatoric bone movement parallel to the treatment plane
treatment plane results in compression of joint surfaces. resulting in translaloric gliding in the joint

9. ° There are two methods of determining the direction
of restricted joint gliding:

1. The glide test, and
2. The Kaltenborn convex concave rule .

10. ° Itis 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
gives the most accurate information about the
degree and nature of a gliding restriction, including
its end-feel.

11. Kaltenborn Convex-Concave Rule

* the indirect method RU D

CONVEX RULE + OPPOSITE
The right (moving) join partner's surface is conver.
Wen bone movement is restricted in an upward direction (curved
arrow), the treatment direction is downward (two bold arrows).

Fix.» ))| MOBIL.
D

CONCAVE RULE + SAME
The right (moving) joint partners surface is concave.

When bone movement is restricted in an upward direction (curved

arrow), the treatment direction is also upwards (two bold arrows).

12. 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.

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.

13. Normal grades of translatoric movement

In the Grade | and II SZ ==
range the therapist senses Grade | Grade Il Grade Ill
little or no resistance. Loosening Take up the slack | Tighten | Stretching
In the Grade Il TZ range the sz Tz
therapist senses gradually

increasing resistance. en

At the First Stop, the SZ = Slack Zone TZ = Transition Zone
therapist senses marked

resistance as the slack is

taken up and all tissues

become taut.

Stretching occurs beyond
this point.

14. First Stop

First Stop

15. Grade | (loosen): relief pain

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

Grade III (stretch): stretch joint and increase joint

play

16. « Tests of function are a key element within the OMT
evaluation;

¢ Assessing quantity of movement

« Assessing quality of movement

17. FD = No movement (ankylosis)

Hypomobility - | 1 = Considerable decreased movement
L_2 = Slight decreased movement
3 = Normal
4 = Slight increased movement
Hypermobility - | 5= Considerable increased movement

6 = Complete instability

A joint can be both hypomobile in one direction and hypermobile
in another.

18. Clan

Paris mare

Normal

Abnormal-Pathologic

1. Capsulart
2. Bone-to-bone*
3. Tissue approximation

1. Capsular* early in range
2. Bone-to-bone*

4. Spasm

5. Springy block

6. Empty

other place or is of another
quality than is characteristic
for the joint being tested.”

An end-feel “that occurs at an-

1
12.
13.
14,
15,

Soft tissue approximation
Muscular

Ligamentous
Carilaginous

Capsular

Capsular (chronic/acute)
Adhesions and scarring
Bony block

Bony grate

Springy rebound
Pannus

Loose

Empty

Painful

Muscle

* Capsular and bone-to-bone end-eels can be normal or abnormal-pathologic, depending on the motion and the point in the range at which they occur

Remember: Normal end-feels are pain free.

19. 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 ligamentous
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.

20. Pathological end-feel

Boggy: intra-articular swelling produces a soft
resistance

Springy: For example, a displaced meniscus

Empty: Pain

Firmer, less elastic: scar tissue, shortened connective
tissue

More elastic and less soft end-feel: muscle spasm

21. Standard (anatomical) movements
Combined (functional) movements
Painful arc

Capsular pattern

Differentiating Contractile lesions from
Non contractile lesions

Differentiating muscle shortening from
muscle spasm

22. 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.

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.

23. + Based on end-feel testing.

* Ashortened, tight muscle imparts a firmer, less
elastic end-feel

+ Muscle spasm produces a more elastic and less soft

end-feel.

24. + Testing the quantity and quality of joint play,
including end feel, using

+ Traction,
+ Compression, and
* Gliding

¢ Inallof the translatoric directions in which a joint is
capable of moving.

25. Tracti Compression

Relieves joint pain Aggravates joint pain

If traction tests is positive in the normal If compression tests are negative, the
resting position, find a position of greater | tests should also be performed in various
comfort and reevaluate the patient's three-dimensional positions.

response to traction.

lt is important fo test joint compression separately and before
resisted tests, since resisted movements also produce joint
compression.

26. e Translatoric gliding primarily tests those structures
belonging to the anatomical joint.

+ Also important for determining the specific
directions of joint movement restrictions.

+ Evaluates gliding movement both in the joint's
resting and non resting positions.

27. + 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:

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

28. + 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

same joint.

Testing a muscle's secondary function at an
adjacent joint

Testing using reciprocal inhibition

29. + 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
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.

30. + 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
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.

31. * 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,

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.

32. ° Restricted joint play (hypomobility)

+ An abnormal end-feel

33. Malignancy in area of treatment
Infectious Arthritis

Metabolic Bone Disease
Neoplastic Disease

Fusion or Ankylosis

Osteomyelitis

Fracture or Ligament Rupture

excessive joint play (hypermobility) for grade Ill
mobilization

34. Excessive pain or swelling
Arthroplasty
Pregnancy

Hypermobility

Spondylolisthesis

Rheumatoid arthritis

Vertebrobasilar insufficiency

35. THANK YOU