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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