Maitland concept.pptx.....................

Maitland concept

1. Maitland’s concept G D Maitland

2. Theoretical basis Basic concept deals with two entities: Pain response to movement (quality & behavior) Analytical assessment (change in pain/movement)

3. Guidelines to use this concept: Continuous analytical assessment throughout treatment Symptomatic responses during and after application are assessed and analyzed before progressing

4. Passive movement “ Any movement of any part of one person which is performed on that person by another person or equipment” Either physiologic movements or accessory movements. Includes- stimulation of joint healing, neuromuscular re-education and prevent immobilization complications.

5. Mobilization 2 kinds: Passive oscillatory movements/sustained stretching Performed at such a speed and manner that they can be controlled by the patient Purpose: Pain relief and restoring pain free movements To maintain joint ROM

6. Manipulation Technique performed at such a speed that it has taken place even before the person on whom it is performed is able to prevent it. High velocity low amplitude thrust performed within the anatomic limits of the joint Ideal to break adhesions in the joint.

7. CORE CONCEPT Patient centred approach- Patient at the focus of all the examination and treatment Patients problems and functional limitations derived in detail should guide further examination and treatment options.

8. Continuous analytical assessment Involves a continuous monitoring of the symptoms Before, during and after application of a technique at every session and throughout treatment Evaluate changes in patient’s signs and symptoms which may have occurred as a result of the treatment

9. Indicators of change Pain parameters Active/ Passive movement related ROM, pain/ resistance, quality of movement related changes Palpation related changes Improved function Tolerance to higher treatment intensity

10. Treatment technique Physiological, accessory and combinations of both To choose a technique knowledge of pain provoking/relieving movements is important Relate the rhythm, position in range, amplitude and strength of technique to examination findings

11. Examination

12. SUBJECTIVE EXAMINATION Subjective examination includes: ‘kind’ of disorder History Site of symptoms Behaviour of symptoms Special questions

13. Kind: pain, stiffness, instability, weakness History: Mechanism of onset, Progression since onset, Pre disposing factors Site of symptoms- PAIN ASSESSMENT Behaviour of symptoms: change in symptoms and its site related to activities, positions; diurnal variations, etc Special questions: to rule out contraindications like VBI, malignancies, osteoporosis

14. Irritability Type and duration activity that provokes the symptoms and how long symptoms take to subside? High irritability: limit examination to most important aspects Low irritability: allows detailed examination

15. What is a comparable sign?? Signs which are found on physical examination and which can be compared or related to the information acquired from subjective examination Eg : pain, stiffness, sensory or motor dysfunction

16. Planning Determines: What structures to examine based in the subjective information Limitations to the extent of examination imposed by the pathology

17. Any other remote structures to be examined to predict the source of pain Strength of the test movements that need to be performed

18. Objective examination Purpose is to: Interpret the patient’s experience of his disability in terms of joint, muscle and nerves causing pain Determine the physical factors causing pain and differentiate from contributing factors

19. Understand the functional limitations and willingness of the patient as a result of his dysfunction

20. Includes: Observation Active movements Passive movements Physiological Combined Patient demonstrated Physiological accessory

21. Resisted isometrics Palpation

22. Pain Changes Baseline pain experienced by the patient Present/absent Absent: ask patient to move until pain is felt Present: ask patient to move until pain aggravates If pain is tolerable then movement should be further into the range upto the limit of movement

23. Move to pain: ask patient to perform the movement until a point is reached where the pain commences Move to limit: ask patient to perform the movement until the available end range

24. Active movements Determine Range and Pain response Quality of movement – abnormal rhythm, deviations Combined movements: More than one movement is combined and performed in order to observe any pattern of pain response Determine aggravating and relieving movements

25. Functional demonstration movements Patient asked to perform the pain provoking movements which he experiences routinely Re-enacting the injuring movement when the disorder has been caused by some trauma Repetition or sustained movements or positions to check for change in behaviour of symptoms

26. Passive Physiological movements Performed with the patient relaxed completely Commonly performed with patient in lying position Pain, Spasm and Resistance parameters Should co relate with the comparable sign

27. Passive Accessory Movements Assessed in different joint positions In move to pain situations- test in loose packed, mid range positions, least painful positions In move to limit situations- assessed in a position slightly short of onset of symptoms in the limit of physiological range. Pain through the range- Assess around the lower limit of the affected range.

28. Principles of techniques Effective mobilization can be achieved by learning to sense or ‘feel’ the movement Optimal Grip Joint positioning: preferably in loose packed Emphasize on firm stabilization such that the rhythm of the movement is controlled

29. Force transmission through shoulder girdle and trunk muscles of the therapist, no contractions of thumb or wrist muscles Thumb Pad contact or heel of the hand or first web space Modify contact or grip

30. Grade Amplitude Range I Small Beginning II Large Well into range but within resistance III Large Moves into resistance IV Small Stretching into resistance V Small High velocity beyond physiological limit but within anatomical limit

31. Rhythms Stationary holding Slow and smooth Strong and rapid

32. The longer it takes to provoke a symptom on sustaining a test movement at the limit of the range, the longer the treatment technique should be sustained.

33. Duration and frequency of treatment Speed of oscillation: 1oscillation/2 secs Minimum set of oscillations for 30 seconds to several minutes Small/ Large amplitude + slow oscillation = relaxation/ pain relief Small amplitude+ rapid oscillations = stretch the joint/ relieve stiffness Sustained holding + gradual movement= muscle spasm

34. Selection of technique Direction of movement Position of joint Manner of technique Duration of technique