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Kaltenborn Manual Mobilization
Sreeraj S R
Kaltenborn – Evjenth
Orthopedic Manipulative Therapy (OMT)
• Kaltenborn Techniques
Kaltenborn’s techniques use a combination of traction and
mobilization to reduce pain and mobilize hypomobile joints
According to Kaltenborn, all joint mobilizations, when
performed correctly should be made parallel, or at right angles
Sreeraj S R
performed correctly should be made parallel, or at right angles
to this plane of motion
• Maitland's grades of joint mobilization differ from Kaltenborn's
because they are oscillations while Kaltenborn's are sustained.
http://quizlet.com/2850456/joint-mobs-maitland-vs-kaltenborn-flash-cards/
2
Two types of bone movements are important in OMT
system:
Sreeraj S R
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 1: Extremity Joint Movement: p. 24
3
• A common goal in OMT is to restore the gliding
component of roll-gliding to normalize movement
mechanics.
• Joint rolling movements in the absence of gliding can
produce a damaging concentration of forces in a
Sreeraj S R
produce a damaging concentration of forces in a
joint.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 1: Extremity Joint Movement: p. 29
4
The Kaltenborn Treatment Plane
• passes through the joint
and lies at a right angle
to a line running from
the axis of rotation in
the convex bony
Sreeraj S R
the convex bony
partner, to the deepest
aspect of the
articulating concave
surface.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 32
5
The Kaltenborn Treatment Plane
• remains with the concave
joint surface whether the
moving joint partner is
concave or convex.
Sreeraj S R
• Always test joint play or
mobilize a joint by moving
the bone parallel to, or at a
right angle to, the
Kaltenbom Treatment
Plane.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 32
6
Translatoric joint play movements
• The translatoric joint play movements used in the
OMT Kaltenbom-Evjenth System are
• Traction,
• Compression, and
Gliding.
Sreeraj S R
• Gliding.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 33
7
Traction
Compression Gliding
Sreeraj S R
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 33-34
8
Determining the direction of restricted gliding
• There are two methods of determining the direction
of restricted joint gliding:
1. The glide test, and
2. The Kaltenborn convex concave rule .
Sreeraj S R
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 34
9
Glide test
• It is the direct method
• Apply passive translatoric gliding movements in all
possible directions and determine in which directions
joint gliding is restricted.
• The glide test is the preferred method because it
Sreeraj S R
• The glide test is the preferred method because it
gives the most accurate information about the
degree and nature of a gliding restriction, including
its end-feel.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 34
10
Kaltenborn Convex-Concave Rule
• the indirect method
Sreeraj S R
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 35
11
Grades of translatoric movement
• The translatoric movements of traction and gliding
are divided into three grades.
• These grades are determined by the amount of joint
slack (looseness and resistance) in the joint
• The slack is taken up when testing and treating joints
with gliding or traction.
Sreeraj S R
with gliding or traction.
• When gliding is performed, the slack is taken up in
the direction of joint gliding;
• when traction is performed, the slack is taken up in
the direction of traction.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 36
12
Normal grades of translatoric movement
• In the Grade I and II SZ
range the therapist senses
little or no resistance.
• In the Grade II TZ range the
therapist senses gradually
increasing resistance.
Sreeraj S R
increasing resistance.
• At the First Stop, the
therapist senses marked
resistance as the slack is
taken up and all tissues
become taut.
• Stretching occurs beyond
this point.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 37-38
13
Pathological grades of translatoric movement
Sreeraj S R
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 39
14
Using translatoric grades
• Grade I (loosen): relief pain
• Grade II (tighten): initial treatment, maintain joint
play
• Grade III (stretch): stretch joint and increase joint
play
Sreeraj S R
play
1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 40
2. http://sunrise.hk.edu.tw/~stpt/languagetherapy/therapeutic/teacher/Introduction%20of%20manual%20therapy.pdf
15
Tests of function
• Tests of function are a key element within the OMT
evaluation;
• Assessing quantity of movement
Assessing quality of movement
Sreeraj S R
• Assessing quality of movement
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 42-46
16
Quantity of Movement
Sreeraj S R
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 42
17
Quality of Movement
Sreeraj S R
1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 45
2. Petersen CM, Hayes KW. Construct Validity of Cyriax's Selective Tension Examination: Association of End-feels With Pain at the Knee and
Shoulder. Journal of Orthopaedic & Sports Physical Therapy 2OOO;3O (9) :5 12-527
18
Quality of Movement
Normal End Feel
• Soft: characteristic of soft tissue approximation. Feels like
squeezing two balloons together. e.g., knee flexion.
• Firm: indicates that the joint capsular or ligamentous
stretching limiting the ROM. Feels like stretching a leather
Sreeraj S R
stretching limiting the ROM. Feels like stretching a leather
belt. A normal ligamentous end-feel > capsular end-feel.
• Hard: indicates that bone touching bone is limiting the ROM.
Feels like pushing two wooden surfaces together. e.g., elbow
extension.
1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 45
2. http://www.scranton.edu/faculty/kosmahl/courses/gonio/intro/end-feel.shtml
19
Quality of Movement
Pathological end-feel
• Boggy: intra-articular swelling produces a soft
resistance
• Springy: For example, a displaced meniscus
Empty: Pain
Sreeraj S R
• Empty: Pain
• Firmer, less elastic: scar tissue, shortened connective
tissue
• More elastic and less soft end-feel: muscle spasm
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 46
20
Elements of function testing
• Standard (anatomical) movements
• Combined (functional) movements
• Painful arc
• Capsular pattern
Differentiating Contractile lesions from
Sreeraj S R
• Differentiating Contractile lesions from
Non contractile lesions
• Differentiating muscle shortening from
muscle spasm
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 46-51
21
Differentiating Contractile lesions from
Non contractile lesions
Contractile Non contractile
Muscle with its tendons and attachments Bones, joint capsules, ligaments, bursae,
Fasciae, nerve roots
Active and passive movements are
restricted in opposite directions.
Active and passive movements are
restricted in the same direction.
Sreeraj S R
restricted in opposite directions. restricted in the same direction.
Passive joint play movements are normal
and symptom free.
Passive joint play movements produce or
increase symptoms and are restricted.
Resisted movements produce or increase
symptoms.
Resisted movements are symptom free.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 50
22
Differentiating muscle shortening from
muscle spasm
• Based on end-feel testing.
• A shortened, tight muscle imparts a firmer, less
elastic end-feel
• Muscle spasm produces a more elastic and less soft
end-feel.
Sreeraj S R
end-feel.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 51
23
Translatoric joint play tests
• Testing the quantity and quality of joint play,
including end feel, using
• Traction,
• Compression, and
Gliding
Sreeraj S R
• Gliding
• In all of the translatoric directions in which a joint is
capable of moving.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 51-52
24
Traction and compression tests
Traction Compression
Relieves joint pain Aggravates joint pain
If traction tests is positive in the normal
resting position, find a position of greater
comfort and reevaluate the patient's
response to traction.
If compression tests are negative, the
tests should also be performed in various
three-dimensional positions.
Sreeraj S R
response to traction.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 52
25
Gliding tests
• Translatoric gliding primarily tests those structures
belonging to the anatomical joint.
• Also important for determining the specific
directions of joint movement restrictions.
Sreeraj S R
directions of joint movement restrictions.
• Evaluates gliding movement both in the joint's
resting and non resting positions.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 52
26
Resisted movements
• If compression tests provoke pain, resisted tests are of limited Value.
• Resisted tests evaluate
• neuromuscular integrity,
• contractile elements and
• status of associated joints, nerves, and vascular supplies.
• Cyriax interprets resisted tests in the following ways:
Sreeraj S R
Cyriax interprets resisted tests in the following ways:
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 52
Painful and strong : minor lesion of a muscle or tendon
Painful and weak : major lesion of a muscle or tendon
Painless and weak : neurological lesion or complete rupture of a
muscle or tendon
Painless and strong : normal
27
Differential diagnosis for pain in a
muscle synergy
• To identify a specific muscle responsible for a
patient's pain, the examiner selectively elicits or
prevents contraction of a specific muscle or group of
muscles. There are three methods described below.
1. Testing a muscle's secondary function in the
Sreeraj S R
1. Testing a muscle's secondary function in the
same joint.
2. Testing a muscle's secondary function at an
adjacent joint
3. Testing using reciprocal inhibition
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 53-54
28
Testing a muscle's secondary function in the
same joint
• If one muscle in a joint movement synergy has a
secondary function not shared by the other muscles
in the synergy, it can be selectively tested.
For example,
• if resisted knee flexion is painful, further examination
of resisted lateral and medial leg rotation may
Sreeraj S R
of resisted lateral and medial leg rotation may
identify the specific muscle causing the pain. If
lateral rotation is painful and medial rotation is not,
then it is likely that the biceps femoris is injured and
not the other knee flexors which medially rotate the
leg.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 54
29
Testing a muscle's secondary function at an
adjacent joint
• A muscle or tendon can be selectively stressed if it is
the only muscle in a synergy which functions at
another joint.
For example,
• pain with resisted shoulder flexion can be due to a
lesion in one of several muscles in a synergy
Sreeraj S R
lesion in one of several muscles in a synergy
producing this movement. If resisted elbow flexion
produces the same pain, then the biceps is
implicated as it is the only muscle which can produce
both shoulder and elbow flexion.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 54
30
Testing using reciprocal inhibition
• This technique uses to prevent a muscle from
contracting in synergy with other muscles during a
movement by resisting the antagonist of the muscle.
For example,
Sreeraj S R
• To eliminate the wrist extensors and test the finger
extensors, the examiner resists palmar flexion at the
wrist and finger extension simultaneously; the
resisted wrist palmar flexion will inhibit contraction
of the wrist extensors.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 54
31
Indications
• Restricted joint play (hypomobility)
• An abnormal end-feel
Sreeraj S R
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 59
32
Absolute Contraindications
• Malignancy in area of treatment
• Infectious Arthritis
• Metabolic Bone Disease
• Neoplastic Disease
• Fusion or Ankylosis
Sreeraj S R
• Fusion or Ankylosis
• Osteomyelitis
• Fracture or Ligament Rupture
• excessive joint play (hypermobility) for grade III
mobilization
http://www.physio-pedia.com/images/c/c0/Principles_of_Joint_Mobilization.pdf
33
Relative Contraindications
• Excessive pain or swelling
• Arthroplasty
• Pregnancy
• Hypermobility
Spondylolisthesis
Sreeraj S R
• Spondylolisthesis
• Rheumatoid arthritis
• Vertebrobasilar insufficiency
http://www.physio-pedia.com/images/c/c0/Principles_of_Joint_Mobilization.pdf
34
THANK YOU
Sreeraj S R
will be continued @ the Practical….
35

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Kaltenborn Manual Mobilization Techniques

  • 2. Kaltenborn – Evjenth Orthopedic Manipulative Therapy (OMT) • Kaltenborn Techniques Kaltenborn’s techniques use a combination of traction and mobilization to reduce pain and mobilize hypomobile joints According to Kaltenborn, all joint mobilizations, when performed correctly should be made parallel, or at right angles Sreeraj S R performed correctly should be made parallel, or at right angles to this plane of motion • Maitland's grades of joint mobilization differ from Kaltenborn's because they are oscillations while Kaltenborn's are sustained. http://quizlet.com/2850456/joint-mobs-maitland-vs-kaltenborn-flash-cards/ 2
  • 3. Two types of bone movements are important in OMT system: Sreeraj S R Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 1: Extremity Joint Movement: p. 24 3
  • 4. • A common goal in OMT is to restore the gliding component of roll-gliding to normalize movement mechanics. • Joint rolling movements in the absence of gliding can produce a damaging concentration of forces in a Sreeraj S R produce a damaging concentration of forces in a joint. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 1: Extremity Joint Movement: p. 29 4
  • 5. The Kaltenborn Treatment Plane • passes through the joint and lies at a right angle to a line running from the axis of rotation in the convex bony Sreeraj S R the convex bony partner, to the deepest aspect of the articulating concave surface. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 32 5
  • 6. The Kaltenborn Treatment Plane • remains with the concave joint surface whether the moving joint partner is concave or convex. Sreeraj S R • Always test joint play or mobilize a joint by moving the bone parallel to, or at a right angle to, the Kaltenbom Treatment Plane. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 32 6
  • 7. Translatoric joint play movements • The translatoric joint play movements used in the OMT Kaltenbom-Evjenth System are • Traction, • Compression, and Gliding. Sreeraj S R • Gliding. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 33 7
  • 8. Traction Compression Gliding Sreeraj S R Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 33-34 8
  • 9. Determining the direction of restricted gliding • There are two methods of determining the direction of restricted joint gliding: 1. The glide test, and 2. The Kaltenborn convex concave rule . Sreeraj S R Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 34 9
  • 10. Glide test • It is the direct method • Apply passive translatoric gliding movements in all possible directions and determine in which directions joint gliding is restricted. • The glide test is the preferred method because it Sreeraj S R • The glide test is the preferred method because it gives the most accurate information about the degree and nature of a gliding restriction, including its end-feel. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 34 10
  • 11. Kaltenborn Convex-Concave Rule • the indirect method Sreeraj S R Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 35 11
  • 12. Grades of translatoric movement • The translatoric movements of traction and gliding are divided into three grades. • These grades are determined by the amount of joint slack (looseness and resistance) in the joint • The slack is taken up when testing and treating joints with gliding or traction. Sreeraj S R with gliding or traction. • When gliding is performed, the slack is taken up in the direction of joint gliding; • when traction is performed, the slack is taken up in the direction of traction. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 36 12
  • 13. Normal grades of translatoric movement • In the Grade I and II SZ range the therapist senses little or no resistance. • In the Grade II TZ range the therapist senses gradually increasing resistance. Sreeraj S R increasing resistance. • At the First Stop, the therapist senses marked resistance as the slack is taken up and all tissues become taut. • Stretching occurs beyond this point. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 37-38 13
  • 14. Pathological grades of translatoric movement Sreeraj S R Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 39 14
  • 15. Using translatoric grades • Grade I (loosen): relief pain • Grade II (tighten): initial treatment, maintain joint play • Grade III (stretch): stretch joint and increase joint play Sreeraj S R play 1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 40 2. http://sunrise.hk.edu.tw/~stpt/languagetherapy/therapeutic/teacher/Introduction%20of%20manual%20therapy.pdf 15
  • 16. Tests of function • Tests of function are a key element within the OMT evaluation; • Assessing quantity of movement Assessing quality of movement Sreeraj S R • Assessing quality of movement Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 42-46 16
  • 17. Quantity of Movement Sreeraj S R Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 42 17
  • 18. Quality of Movement Sreeraj S R 1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 45 2. Petersen CM, Hayes KW. Construct Validity of Cyriax's Selective Tension Examination: Association of End-feels With Pain at the Knee and Shoulder. Journal of Orthopaedic & Sports Physical Therapy 2OOO;3O (9) :5 12-527 18
  • 19. Quality of Movement Normal End Feel • Soft: characteristic of soft tissue approximation. Feels like squeezing two balloons together. e.g., knee flexion. • Firm: indicates that the joint capsular or ligamentous stretching limiting the ROM. Feels like stretching a leather Sreeraj S R stretching limiting the ROM. Feels like stretching a leather belt. A normal ligamentous end-feel > capsular end-feel. • Hard: indicates that bone touching bone is limiting the ROM. Feels like pushing two wooden surfaces together. e.g., elbow extension. 1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 45 2. http://www.scranton.edu/faculty/kosmahl/courses/gonio/intro/end-feel.shtml 19
  • 20. Quality of Movement Pathological end-feel • Boggy: intra-articular swelling produces a soft resistance • Springy: For example, a displaced meniscus Empty: Pain Sreeraj S R • Empty: Pain • Firmer, less elastic: scar tissue, shortened connective tissue • More elastic and less soft end-feel: muscle spasm Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 46 20
  • 21. Elements of function testing • Standard (anatomical) movements • Combined (functional) movements • Painful arc • Capsular pattern Differentiating Contractile lesions from Sreeraj S R • Differentiating Contractile lesions from Non contractile lesions • Differentiating muscle shortening from muscle spasm Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 46-51 21
  • 22. Differentiating Contractile lesions from Non contractile lesions Contractile Non contractile Muscle with its tendons and attachments Bones, joint capsules, ligaments, bursae, Fasciae, nerve roots Active and passive movements are restricted in opposite directions. Active and passive movements are restricted in the same direction. Sreeraj S R restricted in opposite directions. restricted in the same direction. Passive joint play movements are normal and symptom free. Passive joint play movements produce or increase symptoms and are restricted. Resisted movements produce or increase symptoms. Resisted movements are symptom free. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 50 22
  • 23. Differentiating muscle shortening from muscle spasm • Based on end-feel testing. • A shortened, tight muscle imparts a firmer, less elastic end-feel • Muscle spasm produces a more elastic and less soft end-feel. Sreeraj S R end-feel. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 51 23
  • 24. Translatoric joint play tests • Testing the quantity and quality of joint play, including end feel, using • Traction, • Compression, and Gliding Sreeraj S R • Gliding • In all of the translatoric directions in which a joint is capable of moving. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 51-52 24
  • 25. Traction and compression tests Traction Compression Relieves joint pain Aggravates joint pain If traction tests is positive in the normal resting position, find a position of greater comfort and reevaluate the patient's response to traction. If compression tests are negative, the tests should also be performed in various three-dimensional positions. Sreeraj S R response to traction. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 52 25
  • 26. Gliding tests • Translatoric gliding primarily tests those structures belonging to the anatomical joint. • Also important for determining the specific directions of joint movement restrictions. Sreeraj S R directions of joint movement restrictions. • Evaluates gliding movement both in the joint's resting and non resting positions. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 52 26
  • 27. Resisted movements • If compression tests provoke pain, resisted tests are of limited Value. • Resisted tests evaluate • neuromuscular integrity, • contractile elements and • status of associated joints, nerves, and vascular supplies. • Cyriax interprets resisted tests in the following ways: Sreeraj S R Cyriax interprets resisted tests in the following ways: Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 52 Painful and strong : minor lesion of a muscle or tendon Painful and weak : major lesion of a muscle or tendon Painless and weak : neurological lesion or complete rupture of a muscle or tendon Painless and strong : normal 27
  • 28. Differential diagnosis for pain in a muscle synergy • To identify a specific muscle responsible for a patient's pain, the examiner selectively elicits or prevents contraction of a specific muscle or group of muscles. There are three methods described below. 1. Testing a muscle's secondary function in the Sreeraj S R 1. Testing a muscle's secondary function in the same joint. 2. Testing a muscle's secondary function at an adjacent joint 3. Testing using reciprocal inhibition Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 53-54 28
  • 29. Testing a muscle's secondary function in the same joint • If one muscle in a joint movement synergy has a secondary function not shared by the other muscles in the synergy, it can be selectively tested. For example, • if resisted knee flexion is painful, further examination of resisted lateral and medial leg rotation may Sreeraj S R of resisted lateral and medial leg rotation may identify the specific muscle causing the pain. If lateral rotation is painful and medial rotation is not, then it is likely that the biceps femoris is injured and not the other knee flexors which medially rotate the leg. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 54 29
  • 30. Testing a muscle's secondary function at an adjacent joint • A muscle or tendon can be selectively stressed if it is the only muscle in a synergy which functions at another joint. For example, • pain with resisted shoulder flexion can be due to a lesion in one of several muscles in a synergy Sreeraj S R lesion in one of several muscles in a synergy producing this movement. If resisted elbow flexion produces the same pain, then the biceps is implicated as it is the only muscle which can produce both shoulder and elbow flexion. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 54 30
  • 31. Testing using reciprocal inhibition • This technique uses to prevent a muscle from contracting in synergy with other muscles during a movement by resisting the antagonist of the muscle. For example, Sreeraj S R • To eliminate the wrist extensors and test the finger extensors, the examiner resists palmar flexion at the wrist and finger extension simultaneously; the resisted wrist palmar flexion will inhibit contraction of the wrist extensors. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 54 31
  • 32. Indications • Restricted joint play (hypomobility) • An abnormal end-feel Sreeraj S R Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 59 32
  • 33. Absolute Contraindications • Malignancy in area of treatment • Infectious Arthritis • Metabolic Bone Disease • Neoplastic Disease • Fusion or Ankylosis Sreeraj S R • Fusion or Ankylosis • Osteomyelitis • Fracture or Ligament Rupture • excessive joint play (hypermobility) for grade III mobilization http://www.physio-pedia.com/images/c/c0/Principles_of_Joint_Mobilization.pdf 33
  • 34. Relative Contraindications • Excessive pain or swelling • Arthroplasty • Pregnancy • Hypermobility Spondylolisthesis Sreeraj S R • Spondylolisthesis • Rheumatoid arthritis • Vertebrobasilar insufficiency http://www.physio-pedia.com/images/c/c0/Principles_of_Joint_Mobilization.pdf 34
  • 35. THANK YOU Sreeraj S R will be continued @ the Practical…. 35