Front Matter

Chapter 6 Manual Therapy 131

move in the same cranial direction on the
stabilized convex distal femur. Conversely, if
a convex surface moves on a stable concave sur­
face, the arthrokinematic glide will occur in the
opposite direction of the osteokinematic move­
ment of the bony segment. For example, during
osteokinematic shoulder extension, the shaft of
the humerus moves cranially while arthrokine­
matically, the convex surface of the humerus
moves in the opposite direction (caudally) on the
stabilized concave glenoid fossa.
In summary, the therapist moves a bone with
a convex joint surface opposite to the direction of
the restricted bone movement, and a concave
joint surface in the same direction as the direction
of the restricted bone movement (Kaltenborn
et al., 1999).
Treatment variables include: (1) position of
joint, (2) type of mobilization, (3) direction of
mobilization, and (4) grade of mobilization.
As with the assessment glide, treatment is initi­
ated with the joint in the loose‐pack or resting
position. There are two types of mobilizations—
a glide or oscillation and a sustained traction.
A glide is performed parallel to the treatment
plane and uses graded oscillations, while trac­
tion is performed perpendicular to the treat­
ment plane and involves a graded sustained
pull (Figure 6.12). The direction of the glide will
depend on the specific restriction of the joint.
The grade of mobilization will depend on the
goal of your treatment (pain vs mobility).

Treatment glide

A treatment glide is essentially a graded assess­

ment glide that is performed in the treatment

plane (parallel to the joint line). Grade I and II

glides are used to treat pain. Grade III–IV glides

are used to increase or maintain motion. All

grades are used to stimulate mechanoreceptors

and stimulate proprioceptive fibers. Grading is

outlined in Table 6.4.

Geoffrey Maitland proposed that different

grades of mobilization produce selective activa­

tion of different mechanoreceptors in the joint

(Maitland, 1977).

Grade I activates type I mechanoreceptors

with  a low threshold that respond to very

small increments of tension. This grade

will  activate cutaneous mechanorecep­

tors. Oscillatory motion will selectively

activate  the dynamic, rapidly adapting

receptors (i.e., Meissner’s and Pacinian

corpuscles).

Grade II activates some type I mechano­

receptors. By virtue of the large amplitude

of movement it will affect type II mechanore­

ceptors to a greater extent.

Grade III is similar to grade II but selectively

activates more of the muscle and joint

mechanoreceptors as it goes into resistance,

and fewer of the cutaneous ones as the slack

of the subcutaneous tissues is taken up.

Grade IV has a more sustained movement

at the end of range and thus activates the

static, slow‐adapting type I mechanore­

ceptors whose resting discharge rises in

proportion to the degree of change in joint

capsule tension.

Traction

Glide

Treatment plate

90°

Figure 6.12 Glides are performed parallel to the treatment
plane. Traction is performed at a right angle to the treatment
plane. Source: Adapted from Kaltenborn et al., 1999.

Table 6.4 Grading of treatment glides

Grade Characteristics

I Small‐amplitude fast oscillations performed

at the beginning of the available range

II Large‐amplitude slow oscillations performed

throughout the first half of the available range

III Large‐amplitude slow oscillations performed

throughout the second half of the available

range

IV Small‐amplitude fast oscillations performed

at the end of the available range