Chapter 6 Manual Therapy 129(Landrum et al., 2008). Some research suggests
that a primary effect of joint mobilization is
enhancement of the sensorimotor system
(Maitland, 1977; Kaltenborn et al., 1999).
The following discussion of joint mobilization
principles and techniques is based on the teach
ings of Freddy Kaltenborn, a Norwegian physical
therapist who specialized in orthopedic manipu
lative therapy (OMT). He was certified in the
United States as an instructor of orthopaedic
medicine by James Cyriax, the British physician
and professor of osteopathy. Additionally,
Kaltenborn was an instructor of chiropractic in
Germany. He was the first clinician to integrate
the theory and practice of orthopedic medicine
with the practice of osteopathy, and he authored
several books related to manual techniques of
the peripheral joints and spine.
Assessing joint play
Joint play is evaluated with an assessment glide.
Kaltenborn defines a glide as the movement that
occurs when the same point on one surface of
the joint comes into contact with new points of
its opposing surface (Kaltenborn et al., 1999). The
purpose of the assessment glide is to evaluate
the quantity (amount of translation) and quality
of joint accessory motion. It is an advanced skill
requiring a thorough understanding of joint
anatomy and mechanics. Tightening or injury of
the capsule and/or its associated ligaments can
limit joint play (Figure 6.8).
Technique—assessment glide
The assessment glide is a single translatoric
glide in which one bony surface is stabilized
and the other is mobilized. It is performed close
to the joint line so that a pure translatory motion
occurs without compression. The glide is per
formed in the loose‐packed or resting position.
This is the position in which the joint capsule
and associated ligaments are most relaxed
and the most amount of joint play is possible
(Kaltenborn et al., 1999). If this position is unat
tainable due to pain or pathology, the position
of greatest comfort is used.
The angle of the glide is determined by the
position of the joint surfaces and is referred to as
the treatment plane. The 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 middle of the contacting
articular surface” (Kaltenborn et al., 1999)
(Figure 6.9). The treatment plane lies across the
concave articular surface and moves with the
concave joint partner (Kaltenborn et al., 1999).
The glide is performed by applying slow,
steady pressure along the treatment plane
(Figure 6.10). Movement is continued until aFigure 6.8 Motion involved in a joint glide. Source:
Adapted from Kaltenborn et al., 1999.
(A) (B)Figure 6.9 The glide is performed by applying slow, steady
pressure along the treatment plane. The treatment plane lies
across the concave articular surface. surface whether the
concave surface is on the mobile (A) or stationary
(B) segment. Source: Adapted from Kaltenborn et al., 1999.