Kaltenborn: Foundation of treatment technique

-

The treatment goal: To restore joint play & normalize roll-gliding that occurs in normal active physiological movements

1. Resting & actual resting positions: resting positions is otherwise called maximum loose pack position. In this position the capsule is lax maximally hence can accommodate maximum most fluid.

a. The term actual resting position is used for special circumstances where it is impossible, impractical or difficult to use maximum loose pack position.
b. Positional fault: Traction to decrease pain is usually performed form resting position. If it is difficult to perform traction from the resting position then the actual resting position is chosen. If traction to reduce pain performed from actual resting position produces pain then a positional fault is said to exist.
c. Once this is found first aim is to perform glide-mobilizations to correct the positional fault & it is obvious that one must find the direction of glide that is restricted & responsible for positional fault.
d. Once the positional fault is corrected traction & other mobilization techniques may then be performed.

2. Every hypo-mobile joint is initially treated with traction-mobilization for pain possibly with other electro-therapeutic adjunct. After there is improvement of pain glide-mobilization in the restricted direction can be carried out.

3. Traction-mobilization & Glide-mobilization should occur without pain.

4. In severely restricted joints usually the Glide-mobilization is painful in the restricted direction. In this case traction-mobilization &/or glide-mobilization in pain-free directions is performed until the joint is more mobile or gliding in the restricted direction is no longer painful.

Excerpts from my manual therapy class

Comments

Post a Comment

Popular posts from this blog

Entrapment of medial calcaneal nerve (MCN)

-
Image
Peripheral nerve entrapment is a rare, but important, cause of foot and ankle pain that often is underdiagnosed and mistreated. A peripheral nerve may become entrapped anywhere along its course, but certain anatomic locations are characteristic (2). The medial calcaneal nerve (MCN) The Tibial nerve is called the planter nerve in the sole. The tibial nerve passes to the sole of the foot takes a turn on the medial side of the calcaneum is called MCN. The medial calcaneal nerve arises from tibial nerve of the inner side of the ankle, perforates the laciniate ligament, travels downwards passing below the bony projection on the inner side of the ankle, and supplies the skin over the medial aspect of the heel. Hence it is the most important nerve for heel sensations. MCN have 2 branches. The anterior branch dominate the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominate the sensation of the posterior an
Read more

Review of Labral Tears of shoulder

-
Image
The glenoid labrum of the shoulder has extensive anatomic variation but appears to be important for contributing to shoulder stability and for increasing the depth of contact between the glenoid labrum and the humeral head. Tears of the labrum are commonly seen in association with other pathologic entities, such as instability and rotator cuff tears, and treatment of the labral pathology may be incidental to treatment of the other more significant pathology. However, conditions isolated to the labrum do occur and can be a significant source of shoulder problems. Effective treatment of these lesions may result in significant improvement in the patient's symptoms (4). Labral lesions are difficult to diagnose, and special diagnostic studies and, frequently, arthroscopy are required. How much we can rely on clinical tests is a question. Shoulder complaints are frequently recurrent. Instability might cause some of these complaints (3). History taking and clinical tests are commonly used
Read more

Differential diagnosis of Anatomic (Radial) snuffbox pain: It is not always DeQuervain’s tenosynovitis.

-
Image
Tendon, Bone & Ligament causes: 1. DeQuervain’s tenosynovitis: Swelling of tendon of APL (Abductor pollicis longus) & extensor pollicis brevis at lateral wrist near anatomic snuff box.  The primary complaint is radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb. The pain has been described as a “constant aching, burning, pulling sensation." Pain is often aggravated by repetitive lifting, gripping, or twisting motions of the hand. Swelling in the anatomical snuff box, tenderness at the radial styloid process, decreased CMC abduction ROM of the 1st digit, palpable thickening of the extensor sheaths of the 1st dorsal compartment and crepitus of the tendons moving from the extensor sheath may be found upon examination. Other possible findings include weakness and paresthesia in the hand. Finkelstein’s diagnostic test will present positive provoking the patient’s symptoms. If left untreated, the inflammation and progressive narro
Read more