Therapeutic modalitiesTherapeutic modalities

Mobilizations of the lower Mobilizations of the lower extremityextremity

Kaltenborn’s scaleKaltenborn’s scale

Maitland scaleMaitland scale

Three Dimensional Joint Three Dimensional Joint positioningpositioning

• Zero position

• Resting position

• Actual resting position

• Non resting position

• Closed –packed position

Zero position Zero position

• Starting position- use of goniometer

• ie. Flexion/extension 30-0-10

Resting positionResting position

• Periarticular structures are most lax

• Used in joint play- evaluate end feel

• Treating symptoms Grade 1-2

• Treating hypomobility

• Minimize secondary joint damage

Actual resting positionActual resting position

• Presence of intra or extra articular pathology or pain

• Position where patient feels least discomfort

• May initially be used in evaluation and treatment

Non resting positionNon resting position

• Maybe area where subtle joint dysfunction becomes apparent

Closed –packed positionClosed –packed position

• Joint capsule and ligaments are tight or maximally tensed

• Maximal contact between articular surfaces

• Articular surfaces gliding reduced with slight traction

Bone and Joint movementBone and Joint movement

• Rotations

• Curved(angular)movement around an axis

• Translations

• Linear(straight-lined) movements parallel to an axis in one plane

Direction of restricted glidingDirection of restricted gliding

• Glide test (direct method)

preferred method because it is the most accurate

• Kaltenborn’s convex concave rule ( indirect method)

Using Kaltenborn’s scaleUsing Kaltenborn’s scale

• Grade 1 relieve pain, use of traction with glide to reduce joint compression

• Grade 2 (treatment in slack zone) can be used to relieve pain, spasm, to maintain or increase ROM

• Grade 3 Increase mobility and joint play by stretching shortened tissue

Joint mobilizationJoint mobilization

• Pain relief mobilization

• Relaxation mobilization

• Stretch mobilization

• Manipulation ( will not be done as part of this course)

Pain relief mobilizationPain relief mobilization

• Working Grade 1- 2 Slack Zone

in the ( actual ) resting position

Relaxation mobilizationRelaxation mobilization

• Working Grade 1- 2

in the (actual) resting position

Stretch mobilizationStretch mobilization

• Grade 3 in the (actual) resting position

• Grade 3 at the point of restriction

Kaltenborn’s treatment planeKaltenborn’s treatment plane

Kaltenborn scaleKaltenborn scale

Scale and addressing painScale and addressing pain

Scale and addressing painScale and addressing pain

Positioning of jointPositioning of joint

Concave convex ruleConcave convex rule

Joint compressionJoint compression

Rolling glideRolling glide

Translatoric glidingTranslatoric gliding