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
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/

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 Two types of bone movements are important in OMT
system:

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 1: Extremity Joint Movement: p. 24

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• 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.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 1: Extremity Joint Movement: p. 29

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 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 FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 32

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 The Kaltenborn Treatment 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
Kaltenbom Treatment
Plane.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 32

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 Translatoric joint play movements

• The translatoric joint play movements used in the

OMT Kaltenbom-Evjenth System are
• Traction,
• Compression, and
• Gliding.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 33

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 Traction

Compression Gliding

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 33-34

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 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 .

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 34

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 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 FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 34

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 Kaltenborn Convex-Concave Rule

• the indirect method

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 35

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 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.
• 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

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 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.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 37-38

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Pathological grades of translatoric movement

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 39

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 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

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

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 Tests of function

• Tests of function are a key element within the OMT

evaluation;

• Assessing quantity of movement

• Assessing quality of movement

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 42-46

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 Quantity of Movement

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 42

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 Quality of Movement

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
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 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.

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

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 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

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 46

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 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

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 46-51

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

Passive joint play movements are normal Passive joint play movements produce or
and symptom free. increase symptoms and are restricted.

Resisted movements produce or increase Resisted movements are symptom free.

symptoms.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 50

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 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.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 51

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 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.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 51-52

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 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 greater tests should also be performed in various
comfort and reevaluate the patient's three-dimensional positions.
response to traction.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 52

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 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.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 52

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 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

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 52

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 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
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

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 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
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

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 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
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

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 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,
• 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

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 Indications

• Restricted joint play (hypomobility)

• An abnormal end-feel

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 59

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 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

http://www.physio-pedia.com/images/c/c0/Principles_of_Joint_Mobilization.pdf

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 Relative Contraindications

• Excessive pain or swelling

• Arthroplasty
• Pregnancy
• Hypermobility
• Spondylolisthesis
• Rheumatoid arthritis
• Vertebrobasilar insufficiency

http://www.physio-pedia.com/images/c/c0/Principles_of_Joint_Mobilization.pdf

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 THANK YOU

will be continued @ the Practical….

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