Maitland mobiisation

assessment of maitland mobilisaion

1. MAITLAND MOBIISATION

2. ESSENTIAL COMPONENTS Central theme or core Particular mode of thinking Examination Techniques recording

3. THE CENTRAL THEME OR CORE Making sense of the information the patient provides Listening and believing the patient without any prejudging using the patient own terminology Having skill in understanding and using verbal and non verbal communication Encouraging a feeling of confidence and trust in us the clinicians

4. PARTICULAR MODE OF THINKING THE THINKING MODE IS THE STRENTH OF THE CONCEPT AND THE SECURITY AND THE THERAPIST THEORETICAL CLINICAL PATHOLOGY NEUROPHYSIOLOGY ANATOMY DIAGNOSIS HISTORY SYMPTOMS SIGNS

5. BRICK WALL THEORY It’s a symbolic permeable brick wall which guides therapists in their mode of thinking By this mode of thinking therapist can keep their thoughts reflections, impressions, hypothesis and knowledge in two separate compartments One compartment contains all theoretical information,known and speculative including the precautions and contraindications. The other compartment should contain all the clinical evidence The main core of this mode of thinking states that we must not get diverted by the theoretical aspects of the patient disorder because there are enormous events which we do not know

6. ASSESSMENT 1. EXAMINATION SUBJECTIVE OBJECTIVE

7. OBJECTIVE EXAMINATION ACCESSORY MOVEMENTS COMBINED MOVEMENTS COMPRESSION TESTS FUNCTIONAL REDUCING MOVEMENTS INJURING MOVEMENT DIFFERENTIATION RANGE AND PAIN RESPONSE EFFECT OF OVER PRESSURE

8. ACCESSORYMOVEMENTS Examined in loose pack position At the end of limited ranges or In painful positions of a free range of movement It is closely related to patient symptoms

9. COMBINED MOVEMENTS Combining accessory test movement to the physiological movement is special

10. COMPRESSION TESTS TO know the origin of patient symptoms from joint surface abnormality compression performed in following circumstances when usual test movements do not show patient symptoms ,compression applied through range assessing the smoothness and matching pain response If pain response much greater than when surfaces compressed,the indication is that the disorder associated wih [joint surface abnormality] NOTE Common joints require examination by compression are Tarsometatarsal joint of big toe Patellofemral jint Carpometacarpal joint of the thumb The hip and The glenohumeral joint

11. FUNCTIONAL REPRODUCING MOVEMENTS Specially when pain rather than stiffness is the disability . Subject demonstrates the particular movement.

12. DIFFERENTIATION Used when a passive test movement causing simultaneous movement of at least two joints, reproduces a patient symptoms

13. RANGE AND PAIN RESPONSE To note whether it is [ through range pain or end range pain ] Does the behavior of the pain with the movement match the behavior of the resistance with that same movement within its available range? NEVER THINK OF RANGE WITHOUT THINKING OF PAIN NEVER THINK OF PAIN WITHOUT THINKING OF RANGE

14. EFFECT OF OVERPRESSURE Normal if a very firm pressure can be applied without provoking anything more than the expected normal stretch response. When the stretch response is normal and the overpressure is with adequate firmness the movement recorded with two ticks. 1 TICK over pressure is applied and the range is normal 2 TICK stretch response to over pressure has been normal.

15. MOVEMENT DIAGRAMS To draw a diagram representing the findings on examining a particular movement forces he clinician to analyse the relationship of pain \stiffness \muscle spasm which may be present

16. 2 ASSESSING THE TECHNIQUE Proving or assessing the value of a technique in the treatment

17. 3 ANALYTICAL ASSESSMENT Analytical assessment used during a treatment programme and at the completion of programme . The mental process involves . Vertical thinking. Lateral thinking. Inductive thinking. Deductive thinking.

18. TECHNIQUES The basic treatment techniques must include every movement of which the joint is capable[ Both Physiological movements and accessory movements ] and possible combination of them. The techniques are never ending and NEVER should have ending. The clinicians mind must always be open ; the teacher must never be dogmatic.

19. TECHNIQUES The techniques are never ending and NEVER should have an ending The clinicians mind must always be open

20. TECHNIQUE DEPENDS ON Physiological movements\accessory movements\combinations Small amplitude\large amplitude\sustained Early in range \late in range\within range Smoothly\staccato\sustained Without compression \with compression Short of discomfort\into discomfort \into pain Short of resistance\into resistance respecting pain\into resistanceup to bite

21. The primary joint signs are Pain [at rest or with movement ] Stiffness [due to contracted structure or adhesion Muscle spasm the above may occur in combinations Eg painless spasm \painful and stiff joint

22. TREATMENT MOVEMENTS Treatment for pain treatment for stiff treatment for pain and stiff group 1 group 2 group 3 pain and stiff stiff and pain

23. PAIN TREATMENT The joint is placed in pain free position . The accessory movements started of large amplitude without discomfort If discomfort persists then mild distraction applied while performing the technique If improvement occurs the amplitude of movements is increased and move to range that is painful Continue to grade 3 At stage where grade 3+without discomfort occurs grade 2 will start.this results in improvement of about 60percent. Gradually amplitude increase till grade 3+physiological movement performed without pain .

24. TREATMENT FOR STIFFNESS Joint is taken to physiological limit of range Grade 4 is given for nearly2 minutes. Started from 4 increase to 4+ and even 4++strength Holding at limit therapist performs accessory movements at grade 4 Physiotherapist repeats the above movements 3 or 4 times If technique produce soreness then relieve it by performing physiological movements

25. RECORDING Patient opinion of effect of treatment [ a comparison statement ] Execute treatment plans by planning and reasoning process which has to be recorded. The treatment and effect record next .it involves treatment technique ,its grade ,its rhythm and its symptomatic response. Commit thoughts about how the treatment techniques need to be modified next .

26. BY N. SAI PRIYANKA

27. THANK YOU