Principles Of Technique

1. Principles of Methods of
Mobilization Treatment
Readings Chapter 7 -Maitland Text

2. Factors that Govern Passive
Movement Techniques.
Relaxed Patient-avoid strain on pt.
Avoid a tight grip /patient comfort
Stabilization /hold around the joint so as to
feel movement.
Pt has confidence that the joint will not be
hurt
Good therapist position including the ability to
control movement. Ref : Maitland

3. Outline of the Method of
Mobilization Techniques
Selection of mobilization techniques are chosen after
examination and assessment have taken place.
Eight Principles
Direction of movements
Desired effect of technique
Patient’s starting position
Therapist starting position
Method of localization of forces
Method of application of forces
Expected response to treatment
Progression of techniques

4. Eight Principles
Direction
Techniques are aimed to return
movement - impaired direction
Example: limited shoulder flexion
Technique
 Passive Accessory - inferior glide
 Physiological movement in flexion

5. Eight Principles
Patient’s Starting Position
Position for desired effect
Supine- TX joint in neutral position- pain free position
Side Lying- when joint is very painful
Prone -Best way to treat some stiff joints
Sitting or standing -reproducing the functional or weight
bearing positions in which the techniques can be effective.

6. Eight Principles
Patient’s Starting Position
What is the desired treatment effect?
To relive pain
Stretch for stiffness

7. Therapist Staring Position
Guidelines
Therapist has to have complete control
It necessary to be in a position so that
forces are applied in direction of
restriction
Be sure to use all mechanical advantage

8. Localization of Force Principals
Avoid tight grip
Grip enough to perform the movement
safely
Have good control be able to assess
movement as it occurs
Remember comfort of grip and the
location of forces may be dictated by the
patient
Example: response to movement pain

9. Application of forces
general principles
Therapist arms and body should be the prime
movers which deliver the passive movement
to the patient’s body part (Maitland)
Hands act as sensing agent for movement.

10. Grades Of Movement
Grades of Passive movement can be used to denote the
position in the available range and the amplitude at
which the technique of passive movement is being
performed.

11. Movement Grades Using the diagram
AB=the passive movement
direction( Physiological /accessory
combined)
AC= quantity,quality,nature &
intensity(pain/resistance/spasm)
CD=line represents the max
resistance encountered
BD= end of average range
R1= onset of resistance
R2= Quality or quantity of
resistance which act to limit
ROM
Movement grades can be used to guide
your treatment

12. Rhythms of Movements
Joints can moved in many different ways
Stationary holding
Slow smooth movements
Staccato type rhythm
Manipulation (thrust speed)

13. Rhythms of Movements
Joints that are painful is best treated by
with grades that are slow even.
Joints that are stiff many do better with
sharp staccato rhythms

14. Direction Speed of Movement
When performing oscillatory movement in
treatment , the treating direction of that
movement is most commonly performed at a
speed that is faster than the retreating
movement.
 e.g. wrist extension- demonstrate.
Need to choose one of the least painful
directions for the treatment movement to
began with

15. Using Stationary Holding
Used when attempting to increase ROM of a
stiff and painful joint at it limit.
Movement should be applied slowly within the
available range up to the point when pain
becomes a limiting factor.
How long to hold?
Until the pain subsides after which a further
slow stretch is added to gain more range.

16. Oscillations
Back and forth movements
Timing or rhythm should be steady
avoid choppiness in technique.
The number of oscillations given during
treatment is the last consideration
When joint is irritable small movements
may be best. Less oscillation

17. Compression/ Distraction
Distraction best used when joint is
painful or irritable.
Compression can be used in chronic
problems like the hip.
E.g helps to improve lying on the effected
hip

18. When -Which -Why
In choosing grades and rhythms
Very irritable disorder-pain constant 7
sever (6 to 10)
Gentle techniques : G I,II,III (grades need to be
painless: can use large Amp. If permitted.)
Rhythm needs to be smooth in performing
oscillations
Accessory movements are better choice
than physiological. Ref Maitland

19. In choosing grades and rhythms
End of Range pain vs. through -range
pain - [chronic aching]
Small Grade IV is better
Use both accessory and Physiological
movements

20. In choosing grades and rhythms
Muscle spasm
Move the joint into the range where
spasm comes into play
Then use a sustained stretch w/o
oscillations
When pain lowers resume the stretch.
If spasm does not let go use small
oscillations

21. When to Use Grades
Through-range of
pain
Intra-articular
Pathology
End of range Pain
Grades I,II to III
Grades II to III
Grades II,III &IV

22. Where does MMT fit within
the Guide to PT Practice?
Section 4D-Impairment/Connective
Tissue Dysfunction
Section 4E,4F,4G,4H,4I,4J Impaired
Joint Mobility & Impaired Motor
Function
Procedural Intervention
Manual Therapy Techniques