Principles of Methods of Mobilization

Treatment

Principles of Methods of Mobilization

TreatmentReadings Chapter 7 -

Maitland TextReadings Chapter 7 -

Maitland Text

Factors that Govern Passive Movement

Techniques.

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

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

Outline of the Method of Mobilization

Techniques

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

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

Eight PrinciplesDirection

Eight PrinciplesDirection

Techniques are aimed to return movement - impaired direction Example: limited shoulder flexionTechnique

Passive Accessory - inferior glide Physiological movement in flexion

Techniques are aimed to return movement - impaired direction Example: limited shoulder flexionTechnique

Passive Accessory - inferior glide Physiological movement in flexion

Eight PrinciplesPatient’s Starting

Position

Eight PrinciplesPatient’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.

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.

Eight PrinciplesPatient’s Starting

Position

Eight PrinciplesPatient’s Starting

Position

What is the desired treatment effect?To relive pain

Stretch for stiffness

What is the desired treatment effect?To relive pain

Stretch for stiffness

Therapist Staring Position

Guidelines

Therapist Staring Position

Guidelines Therapist has to have complete

controlIt necessary to be in a

position so that forces are applied in direction of

restrictionBe sure to use all mechanical

advantage

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

Localization of Force Principals

Localization of Force Principals Avoid tight grip

Grip enough to perform the movement safely

Have good control be able to assess movement as it occursRemember comfort of grip and the location of forces may be

dictated by the patientExample: response to movement

pain

Avoid tight gripGrip enough to perform the

movement safely Have good control be able to assess movement as it occursRemember comfort of grip and the location of forces may be

dictated by the patientExample: response to movement

pain

Application of forces general principles

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.

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.

Grades Of MovementGrades 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.

Grades Of MovementGrades 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.

Movement Grades Using the diagramMovement 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

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

Movement grades can be used to guide your treatment

Rhythms of MovementsJoints can moved in many

different ways

Rhythms of MovementsJoints can moved in many

different ways Stationary holding Slow smooth movements Staccato type rhythm Manipulation (thrust speed)

Stationary holding Slow smooth movements Staccato type rhythm Manipulation (thrust speed)

Rhythms of MovementsRhythms 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

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

Direction Speed of Movement

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

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

Using Stationary Holding

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.

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.

OscillationsOscillations

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

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

Compression/ DistractionCompression/ 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

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

When -Which -WhyIn choosing grades and rhythms

When -Which -WhyIn 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

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

In choosing grades and rhythmsIn 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

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

In choosing grades and rhythmsIn choosing grades and rhythms

Muscle spasmMove 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

Muscle spasmMove 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

When to Use GradesWhen to Use Grades

Through-range of pain

Intra-articular Pathology

End of range Pain

Through-range of pain

Intra-articular Pathology

End of range Pain

Grades I,II to III

Grades II to III

Grades II,III &IV

Grades I,II to III

Grades II to III

Grades II,III &IV

Where does MMT fit within the Guide to PT

Practice?

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

Section 4D-Impairment/Connective Tissue Dysfunction

Section 4E,4F,4G,4H,4I,4J Impaired Joint Mobility & Impaired Motor Function

Procedural Intervention Manual Therapy Techniques