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Kalten Born

This document discusses the Kaltenborn joint mobilization technique. It begins by describing Kaltenborn's use of traction and mobilization to reduce pain and increase joint mobility. It then discusses the difference between Kaltenborn and Maitland grades of mobilization. The document goes on to describe the Kaltenborn treatment plane, types of joint movements, and grades of mobilization. It concludes by covering indications, contraindications, and provides a reference.

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273 views34 pages

Kalten Born

This document discusses the Kaltenborn joint mobilization technique. It begins by describing Kaltenborn's use of traction and mobilization to reduce pain and increase joint mobility. It then discusses the difference between Kaltenborn and Maitland grades of mobilization. The document goes on to describe the Kaltenborn treatment plane, types of joint movements, and grades of mobilization. It concludes by covering indications, contraindications, and provides a reference.

Uploaded by

jayadevan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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KALTENBORN JOINT

MOBILIZATION

BY
VIGNESH KUMAR B
MPT 1ST YEAR
Kaltenborn – Evjenth Orthopedic Manual
Therapy
• 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 to this plane of
motion

• Maitland's grades of joint mobilization differ from Kaltenborn's


because they are oscillations while Kaltenborn's are sustained.
Two types of bone movements are important in OMT system:
• 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 joint.
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
partner, to the
deepest aspect of the
articulating concave
surface.
• Kaltenborn plane remains
with the concave joint
surface whether the
moving joint partner is
concave or convex.

• Always test joint play or


mobilize a joint by moving
the bone parallel to, or at a
right angle to, the
Kaltenborn Treatment
Plane.
Translatoric joint play movements
• The translatoric joint play movements used in the
OMT Kaltenborn-Evjenth System are
• Traction,
• Compression, and
• Gliding.
TRACTION

COMPRESSION
GLIDING
Determining the direction of restricted
gliding
• There are two methods of determining the
direction of restricted joint gliding:
1. The glide test
2. The Kaltenborn convex concave rule
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
gives the most accurate information about the degree
and nature of a gliding restriction, including its end-
feel.
Kaltenborn Convex-Concave Rule
• Indirect method
Grades of translatory 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.
• 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.
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.

• 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.
Pathological grades of translatoric
movement
Kaltenborn joint play techniques
• Grade I (loosen): Small-amplitude distraction is applied,
where no stress is placed on the capsule. It equalizes cohesive
forces, muscle tension, and atmospheric pressure acting on the
joint.
• Grade II (tighten): Enough distraction or glide is applied to
tighten the tissues around the joint. Kaltenborn called this
“taking up the slack.”
• Grade III (stretch): A distraction or glide is applied with an
amplitude large enough to place stretch on the joint capsule
and surrounding periarticular structures.
Tests of function
• Tests of function are a key element within the OMT
evaluation;

• Assessing quantity of movement


• Assessing quality of movement
Quantity of Movement
Quality of movement
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
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.
Quality of movement
•Pathological end-feel
• Boggy: intra-articular swelling produces a
soft resistance
• Springy: For example, a displaced meniscus
• Empty: Pain
• Firmer, less elastic: scar tissue, shortened
connective tissue
• More elastic and less soft end-feel: muscle spasm
Elements of function testing
• Standard (anatomical) movements
• Combined (functional) movements
• Painful arc
• Capsular pattern
• Differentiating Contractile lesions from Non
contractile lesions
• Differentiating muscle shortening from muscle spasm
Differentiating Contractile lesions from
Non contractile lesions
Contractile Non contractile

Muscle with its tendons and Bones, joint capsules, ligaments,


attachments bursae, Fasciae, nerve roots

Active and passive movements are Active and passive movements are
restricted in opposite directions. restricted in the same direction.

Passive joint play movements are Passive joint play movements


normal and symptom free. produce or increase symptoms and
are restricted.

Resisted movements produce or Resisted movements are symptom


increase symptoms. free.
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.
Translatoric Joint Play Tests
• Testing the quantity and quality of joint play,
including end feel, using
• Traction,
• Compression, and
• Gliding
• In all of the translatoric directions in which a joint is
capable of moving.
Traction and compression tests
Traction Compression

Relieves joint pain Aggravates joint pain

If traction tests is positive in the normal If compression tests are negative, the
resting position, find a position of tests should also be performed in
greater comfort and reevaluate the various three-dimensional positions.
patient's response to traction.
Gliding tests
• Translatoric gliding primarily tests those structures
belonging to the anatomical joint.
• Also important for determining the specific
directions of joint movement restrictions.
• Evaluates gliding movement both in the joint's
resting and non resting positions
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:
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
Indications
• Restricted joint play(hypomobility)
• An abnormal end feel
Absolute contraindications
• Malignancy in area of treatment
• Infectious Arthritis
• Metabolic Bone Disease
• Neoplastic Disease
• Fusion or Ankylosis
• Osteomyelitis
• Fracture or Ligament Rupture
• excessive joint play (hypermobility) for grade
III mobilization
Relative contraindications
• Excessive pain or swelling
• Arthroplasty
• Pregnancy
• Hypermobility
• Spondylolisthesis
• Rheumatoid arthritis
• Vertebrobasilar insufficiency
• Reference
Manual mobilization of the joints
volume 1,6th edition.

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